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| WANG Yongqian,YUAN Lei,LI Weishi.Risk factors and management of distal junctional isthmic spondylolisthesis after posterior lumbar decompression with instrumented fusion[J].Chinese Journal of Spine and Spinal Cord,2025,(3):243-252. |
| Risk factors and management of distal junctional isthmic spondylolisthesis after posterior lumbar decompression with instrumented fusion |
| Received:January 19, 2025 Revised:February 12, 2025 |
| English Keywords:Lumbar decompression and fusion Mechanical complications Distal junctional failure Spondylolysis spondylolisthesis Revision operation |
| Fund:北京市面上项目（编号：7232204）；北京市自然科学基金-海淀原始创新联合基金项目（编号：L232127） |
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| 【Abstract】 Objectives: To investigate the risk factors and treatment methods for distal junctional isthmic spondylolisthesis(DJIS) following posterior lumbar decompression and fixation surgery. Methods: The 10 patients who were treated at our hospital for DJIS following posterior decompression and fixation between January 2015 and January 2022 were retrospectively analyzed. The patients were included in the DJIS group, including 7 males and 3 females, aged 63.4±10.3(45-75) years old. And according to age, gender, preoperative diagnosis, operative stage, and operative method, the patients were matched in a ratio of 1∶2 with some other patients who didn′t develop DJIS after underwent posterior decompression and fixation at our hospital due to lumbar degenerative diseases during the same period as control(20 cases). The general data[body mass index(BMI), L1 CT value, proportion of patients with osteoporosis)], laminectomy range of the lower vertebra(transverse decompression percentage of lamina, spinous process resection percentage), pelvic incidence(PI), and postoperative lumbar lordosis(LL), pelvic tilt(PT), sacral slope(SS), etc. of the two groups were compared to explore the risk factors for DJIS after posterior lumbar decompression and fixation. The treatment methods for DJIS were also summarized. Results: The BMI of patients in the DJIS group was significantly higher than that of the control group(27.4±4.1kg/m2 vs. 23.7±3.4kg/m2, P<0.001). The L1 vertebral CT value of the DJIS group was significantly lower than that of the control group(105.2±43.9HU vs. 133.5±23.5HU, P=0.028), and the proportion of patients with osteoporosis of the DJIS group was higher(70% vs. 10%, P=0.003). The DJIS group was greater in PI(52.5°±8.8° vs. 45.8°±7.4°, P<0.05) and postoperative LL(47.4°±14.3° vs. 36.5°±10.6°, P<0.05) significantly than the control group, PT and SS were not significantly different between the two groups(P>0.05). Additionally, the transverse decompression percentage of lamina of the lower vertebra[(89.3±9.0)% vs. (78.0±3.2)%, P<0.05] and the spinous process resection percentage of the distal vertebra[(51.1±16.1)% vs. (39.3±9.1)%, P<0.05] in the DJIS group were also significantly higher than those in the control group. Eight DJIS patients underwent distal decompression, reduction, fixation, and fusion surgery, and their quality of life scores significantly improved after revision surgery. Two DJIS cases with mild clinical manifestations were treated conservatively, no symptom exacerbation was reported during follow-up. Conclusions: High BMI, osteoporosis, high PI, and excessive distal vertebral lamina resection during surgery are potential risk factors for DJIS after posterior lumbar decompression and fixation. |
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