Surgical principles in posterior transpedicular screw fixation and fusion for treatment of spondylolisthesis: Retrospective evaluation of 77 cases

Abstract

Aim: This study aimed to report our surgical principles and outcomes in patients who had posterior transpedicular screw fixation and fusion operation with a diagnosis of spondylolisthesis at our department between 2014 and 2017. Method: Seventy-seven patients who had internal fixation and posterolateral fusion operation using lumbar posterior transpedicular screw systems were retrospectively evaluated. All patients were assessed by dynamic lumbar graphics, computerized tomography and magnetic resonance imaging prior to surgery. Posterior decompression, internal fixation with posterior interpeduncular screw, and posterolateral fusion were applied to all patients. Stabilization systems were evaluated by lumbar graphics and computerized tomography at the postoperative first day. Results: All patients who had clinical and radiological evidences of lumbar spinal instability also had lumbar and/or leg pain and varying levels of neurological deficits. Mean age of the patients was 52.6 (19-74) years, of whom 10 were male and 67 were females. Sixty-nine patients had grade I, and 8 patients had grade II spondylolisthesis according to the Meyerding classification. Nine patients were operated for L3-4, 36 were operated for L4-5, 30 were operated for L5-S1 spondylolisthesis, and 2 patients had 2 levels of spondylolisthesis. Complaints were decreased postoperatively in all patients. One patient was reoperated due to a screw on L5, which was out of the pedicle and caused symptoms. Another 3 patients were reoperated due to breaking of a unilateral S1 screw. Conclusion: Internal fixation with posterior transpedicular screw and posterolateral fusion applications should be preferred for surgical treatment of patients who have symptomatic and neurologic-deficit causing lumbar spondylolisthesis.