الفهرس 
IntrouductionOnly 14 pages are availabe for public view
 |  | from | 110 |  |  |
| | | from | 110 | | |
Abstract
The end result of this study is:
Lumbar transpedicular screw fixation with interbody fusion ( PLIF or TLIF ) is more beneficial to the patient than lumbar transpedicular screw fixation with lateral intertransverse process bone grafting posterolateral fusion (PLF)
Increased surgery time and increases in some complications (although they might be neglectable ) are against the early clinical benefits of the combined method used in the present study.
Future studies including more patients are highly needed to confirm our results.
SUMMARY
The term spondylolisthesis was derived from the Greek roots spondylos, meaning a vertebra and olisthy, meaning to slip. It is defined as the forward displacement of one vertebral body on another, that frequently occurs in the lumbosacral region.
The most widely recognized classification system subdivides splndylolisthesis into isthmic, degenerative, dysplastic, traumatic and pathologic type in addition to the postsurgical type.
Most cases with spondylolisthesis are asymptomatic. Although, the various types of spondylolisthesis differ as regard to cause, age, sex and pathology. Several clinical presentations are common to all types including back pain, radicular pain, deformity in the form of scoliosis and gait disturbances.
Plain radiographs anteroposterior, lateral, dynamic and oblique views lumbosacral spine are excellent initial step in the evaluation of displacements. In addition to magnetic resonance ( MRI).
Conservative treatment is the first line of treatment. Indications of surgery after failure of conservative treatment includes incapacitating pain, neurological deficits and slip progression.
Operative intervention for spondylolisthesis employs variable combinations of neural decompression, fusion and internal fixation.
Posterior lateral fusion is achieved by putting bone graft on the transverse process while posterior lumbar interbody fusion is achieved by putting bone graft or cage in the disc space between two bodies after discectomy
Postrolateral fusion:
For predominant symptoms of radiculopathy in a patient with spondylolisthesis, decompression should accompany posterolateral fusion. Pedicle screw instrumenta¬tion to improve the fusion rate. Fusion alone may relieve symptoms in adults with low-grade spondylolisthesis without instrumentation (Wenger et al., 2005).
Instrumentation should be considered for high-risk groups (e.g., smokers). Instrumentation is especially important if a redaction has been done, even if unintentional (Deguchi et al., 1998).
The pedicles usually are identified after the primary exposure is complete. They can be identified at the point formed by the intersection of an imaginary line bisecting the transverse process and another line bisecting the superior facet. This area is denuded, and the pedicle is probed with special instruments or guide wires. The pedicles can be tapped to receive the screws after the position of the probes or guide wires has been confirmed by roentgenograms, fluoroscopy, or computer-assisted navi-gation (Pizzutillo et al., 1986).
Direct EMG stimulation of pedicle screws also is helpful if pedicle cortical bone has been violated, especially medial and inferiorly. The placement of the screws and plates or rods varies with the type of instrumentation used (Schnee et al., 1997).
Posterior Lumbar Interbody Fusion
A technique for PLIF described by Cloward in 1943 has been used extensively by him and others for the treatment of spondylolistbesis. It is best for grade I or II displacement. Retraction of nerve roots and the dural sac is necessary to insert the grafts, and cauda equina deficits have been reported (Madan et al., 2002).
Cloward reported a 4% incidence of footDROP in his series, all of which improved. This technique frequently requires internal fixation to prevent displacement of the graft and further slip. Cloward used spinous process wring. Steffee and Sitkowski and others suggested the use of pedicle screws and plates for this type of fixation. Cloward-achieved fusion in 97%, complete resolution of pain in 83% of patients, the results of PLIF combined with pedicle screw instrumentation for patients with combinations of back pain, radiculopathy, and neurogenic claudication. In their retrospective review .of 76 patients, claudication symptoms resolved in 96%, motor symptoms improved in 71%, and sensory changes were better in 55% (Ricciardi et al., 1995).
A variation of PLIF is unilateral” PLIF or transforaminal lumbar interbody fusion (TLIF). Originally described by Blume, PLIF produced successful results in 80% of patients treated for lumbar disc pathology. Unique to this procedure is the preservation of the ligamentum flavum by approaching the disc in the foraminal region after unilateral facetectomy. This theoretically avoids epidural scarring and excessive postoperative instability because the spinal canal is not opened and the interspinous-supraspinous ligament complex, lamina, and contralateral facet are left intact successful arthrodesis with TLIF in 97% of patients. Complications have been few and in carefully selected patients this procedure has definite advantages over traditional PLIF (Verlooy et al., 1993).