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KMID : 0378019830260020058
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New Medical Journal
1983 Volume.26 No. 2 p.58 ~ p.66
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Degenerative lumbar spondylolisthesis with an intact neural arch
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Abstract
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15 patients were operated for degenerative spondylolisthesis with an intact neural arch between 1976 and 1982.
Most of the patients were women of 40s-50s of age. Female to male ratio was 4 to 1.
Neurogenic intermittent claudication (NIC) was most common (86%). Limited backward bending of the low back (87%) and absent ankle reflexes (73%) were common. The majority had unrestricted straight-leg raising and no signs of acute neural entrapment were seen as in patients with a herniated disc.
The most common level of slipping was L4-5(73%) and the next 13-4(20%). The usual degree of dislocation of the vertebral body was 6-8mm with a maximum of 1cm in addition to the slipping the plain lumbar spine X-rays show degenerative hypertrophic facets, open and wide angle between inferior articular facet and pedicle, widening of the interarticular space and unsymmetry of the facets (facet trophism).
Myelography showed usually complete block of dye column at the lesion (80%). Spinal computed tomography (CT) revealed acurate size and shape of the narrow spinal canal, facets, surrounding soft tissues as well as intervertebral discs.
Treatment consisted of wide total laminectomy, foramenotomy and medial facetectomy.
Epidural fat transplantation was routinely carried out to prevent laminectomy epidural fibrosis. Also intraoperative facet denervation was performed to reduce low back pain. Posterior lumbar interbody fusion was performed using with bone chips of lamina and spinous process at the time of laminectomy in a patient.
Good to excellent results were obtained in 13 cases (87%).
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KEYWORD
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