성인의 협부형 척추전방전위증에서 전방추체유합술과 척추경 나사못을 이용한 후측방 유합술의 결과 비교

Abstract

The results of surgical treatment for isthmic spondylolisthesis in children and adolescent have been well documented. Successful clinical results with fusion can be expected in children and adolescent. But in adults, instability was not the only problem. In addition to their instability, adults were more likely to have degenerative disc changes and nerve compression not solved by fusion only. The role of decompression in the surgical treatment of adult isthmic spondylolisthesis remains controversial. Anterior interbody fusion could obtain indirect decompression of nerve root through widening of intervertebral space. Posterolateral fusion with transpedicular fixation could get direct decompression. So, the purpose of this study is to compare the clinical results of the anterior interbody fusion and the posterolateral fusion with transpedicular fixation for the treatment of isthmic spondylolisthesis in adults. We reviewed the clinical data of 40 adult patients who had been taken operation due to isthmic spondylolisthesis from June, 1977 to June, 1994. The anterior interbody fusion was performed in 20 patients (Group I) and the posterolateral fusion with transpedicular fixation was performed in 20 patients (Group II). The mean age of group I was 44.1 years old (21-62), and that of group II was 41.3 years old (21-57). The gender of patients was 8 males and 12 females in group I, and 5 males and 15 females in group II. The symptoms and signs of group I and II were similar. The duration of follow-up was average 3.6 years (1.1-16 years) in group I and average 2.3 years (1.1-6 years) in group II. The anterior slippage of group I by Taillard method was 16.1% and was corrected into 10.4% after opera-up was average 3.6 years (1.1-16 years) in group I and average 2.3 years (1.1-6 years) in group II. The anterior slippage of group I by Taillard method was 16.1% and was corrected into 10.4% after operation. That of group II was 15.2% and corrected into 9.8% after operation. The fusion rate at 12 months after operation was 90% in group I and 95% in group II. The clinical results were analysed by Kim's criteria that was focused on the improvement of clinical symptoms. The satisfactory results were obtainted in 85 % of group I and 90 % of group II. So there was no significant difference of clinical results between the anterior interbody fusion and the posterolateral fusion with transpedicular fixation for the treatment of isthmic spondylolisthesis in adults (p<0.05).