Spondylolisthesis refers to the forward displacement of one vertebra relative to another. Objective: to compare functional outcome of lumbar decompression versus lumbar decompression with bilateral instrumental posterolateral bony fusion in elderly patients with lumbar degenerative spondylolisthesis (DS) Methods: 50 patients were included (age more than 55 years) with lumbar DS (first or second degree) with failed conservative measures for at least three months before surgery. Plain X. ray obtained during functional postures and vertebral stability was studied, also MRI and/or CT scan of lumbosacral spine were done. Cases operated upon from March 2013 to September 2013 in neurosurgery department of Benha university hospital and Mabarra hospital and followed up 12 months at least. Patients classified into 2 groups according to vertebral stability: group A (25 cases) and group B (25 cases). Cases chosen without privilege to sex , or weight, but suffering from midline low back pain and/ or claudication and/ or sciatica that were proven to be attributed to spondylolisthesis. Results: adequate lumbar decompression in cases of group A (with vertebral stability) showed good functional outcome with less complications when compared to cases of group B (showing vertebral instability) treated with decompression with bilateral pedicle screw fixation and posterolateral fusion. Conclusion: Lumbar DS is a degenerative disease results in neural compression but does not result necessarily in vertebral instability, some cases of lumbar DS may need only neural decompression as restabilization process may have taken place but for cases showing vertebral instability decompression with instrumental fusion is recommended.
Key words : lumbar degenerative spondylolisthesis, pedicle screw fixation. |
