GSS spinal fixation system on the treatment of lumbar spondylolisthesis（GSS脊柱内固定系统治疗腰椎滑脱）

GSS spinal fixation system on the treatment of lumbar spondylolisthesis（GSS脊柱内固定系统治疗腰椎滑脱） GSS spinal fixation system on the treatment of lumbar spondylolisthesis [Abstract] Objective To observe the GSS combined posterolateral fusion (PLF efficacy of treatment of lumbar spondylolisthesis. Methods 56 cases of spondylolisthesis underwent combined PLF of GSS data analyzed retrospectively the clinical results follow-up 0.5-6 years, Clinical excellent rate of 92.8%, 0.5-1.5 years after the film, except one case of elderly patients with severe osteoporosis due to loosening of internal fixation, bone grafting is not fusion, the rest are fusion, the fusion rate was 98.2%. Conclusion GSS joint PLF Treatment of lumbar spondylolisthesis is a simple, satisfactory reduction, nerve damage and low complication treatment. [Keywords] GSS fixation system posterolateral fusion of lumbar spondylolisthesis [Abstract] purpose: to observe the effect of the treatment of lumbar olisthe disease that GSS used in joint of the posterolateral interbody bones (PLF). Method: the clinical data of 56 cases with lumbar olisthe done GSS and PLF in patients 1 were retrospectively analyzed . The results of the follow-up 0.5-6 years, the rate of the good examples on clinical is high up to 92.8%, the examination shows that, postoperative 0.5-1.5 years later, except one example that an elderly patient due to serious osteoporosis occur bone graft fixation failed, interbody bones were loose, the others allfused, the rate is up to 98.2%. Conclusion: using GSS and PLF method to treat the lumbar olisthe disease is a kind of treatments which is simple operation, reset satisfaction, nerve damage complications low. [Keywords:] GSS show fixation system, the fusion of posterolateral interbody bones, lumbar olisthe disease Degenerative spondylolisthesis is a common disease of bone, the incidence in the population is about 5%, the most common symptoms are low back pain, 80% of patients pain location limitations, need for surgical treatment only 30% [1]. Treatment aims to relieve symptoms and make long-term stability of the spine, the basic principles of treatment is decompression and fusion, the majority of claims in full decompression is currently the basis of the upstream reduction and internal fixation, 2 in order to facilitate early activity, while increasing bone fusion rate. our department from January 2004 -2009 October 56 spondylolisthesis treated patients, are used pedicle screw fixation of posterior decompression (GSS supplemented with posterolateral fusion (PLF treatment, after satisfactory results are reported below. Clinical data 1.1 General Information 56 patients, male 32 cases, 24 females, aged 36 to 75 years, mean age 58.6 years old in this group of patients underwent preoperative lumbar lateral, two oblique and flexion film had held out to find a no spondylolysis, spondylolisthesis distinguish between true and false, where true spondylolisthesis, 38 cases of pseudo-spondylolisthesis 18 cases by Meyerding classification: ? ? degrees 26 degrees 23 cases of patients with stage ? degree in 7 cases. The main clinical manifestations of low back pain associated with lower limb neurological symptoms and intermittent claudication, associated with unilateral lower limb pain in 34 cases of radiation, radiation with bilateral lower extremity pain, 22 cases of intermittent claudication in 13 cases, enough toe 3 hallux dorsiflexion weakened in 18 cases. 1.2 Procedures The patients underwent a strict conservative treatment, no significant effect, carry out GSS + PLF surgery, surgery with tracheal intubation, the patient prone on the operating table to do after slipping phase center median longitudinal incision, blunt sharp separation combined with bilateral sacral spinal muscular, exposed spinous process, lamina, facet joint and transverse roots, to determine the pedicle into the needle site, and do positioning, C-arm X-ray fluoroscopy positioning the needle position is correct, screwed into the pedicle screw, laminectomy decompression, nerve root canal expansion, loosen up and down bit nerve root, if necessary, removal of herniated disc. Install the appropriate length of conformal pre-bent titanium rod vertical, distraction distraction device, pulling reset vertebral slippage. Then stripped both sides of the transverse process bone knife bone bed, autologous bone or artificial bone graft, installation and connection bar. Again the C-arm X-ray fluoroscopy, to 4 understand the situation slipping vertebra reduction. close the wound, surgery is completed. 1.3 after treatment Routine use of antibiotics 7-10 days, the general use of hormones and mannitol 3 days, to reduce inflammation and tissue edema, and can promote the recovery of neurological function. Generally 24-48 hours after the removal of drainage, 2 weeks after suture removal, bed back muscle exercise in 4-6 weeks under the protection of appropriate brace ambulation, 3 months after the removal of bracing exercise. 1.4 The evaluation criteria This group of patients for postoperative follow-up, combined with understanding of the disease after examination and related examination, observation fusion and fixation conditions. The use of Suk et al [2] to determine the fusion of the standard, ? if there is bone and intertransverse continuous trabecular bone, vertebral lateral flexion activity is less than 4 degrees, that the bone has been integrated, ? If the bone graft with a continuous trabecular bone between the transverse observation is 5 unclear, and lateral vertebral flexion and extension activities less than 4 degrees, the bone that may be integrated, ? If there is no continuous trabecular bone fusion area observed a gap or trabecular bone is unclear, lateral vertebral flexion and extension activities of greater than 4 degrees, then that is not fusion for patients with suspicious CT scan fusion to understand the integration situation under spondylolisthesis after evaluation standard [3] assessed the efficacy: Excellent fusion sound, no signs of low back pain and nerve root injury, waist near normal restoration of the original work. Good good fusion and no signs of nerve root injury, mild back pain or leg pain, waist slightly limited, can be engaged in original work. Fusion can be a good, mild low back pain or leg pain, lower back limited mobility, can adhere to the general light work. Poor bone fusion is not the original low back pain and leg pain and symptoms of nerve root injury did not reduce the waist activity was limited, can not engage in light work. Links to free download 6 2 results All this group of patients followed up for 0.5-6 years after surgery, an average of 3.8 years after the wound healed, without complicated infections, 3 cases of dural injury, given repair. 48 cases of postoperative low back pain completely disappeared , low back pain is still mild discomfort in 5 cases, waist soreness feeling discomfort in 1 case, 1 case associated with osteoporosis, after pedicle screw loosening, bone fusion is not feeling the same symptoms before surgery, according to the evaluation standard excellent in 47 cases, good in 5 cases, 3 cases and poor in 1 case, good rate of 92.8%. 3 Discussion 3.1 spondylolisthesis have strict indications for surgery [4]. Generally believed that: ? ? degrees below the spondylolisthesis, non-surgical treatment, low back pain without relief, ? ? degrees, with or without neurological symptoms, ? spondylolisthesis was progressively increased, ? there symptoms or cauda equina compression associated with lower limb intermittent claudication or radicular leg radiating pain. inappropriate choice of surgical indications, 7 is not satisfied after a major reason for this group of patients after conservative treatment, the effect is not ideal, but imaging studies have indeed confirmed that nerve as a result of the reasons for the existence of clinical signs. 3.2 to complete nerve decompression, internal fixation to be strong. Laminectomy spinal decompression can completely remove the pressure to reduce the reset time of traction on the nerve root damage, conducive to the reduction of vertebral slippage, while the line nerves root canal decompression, nerve root completely release, combined with disc herniation, can be removed. rigid internal fixation is conducive to further strengthen the stability of the vertebral body, the structure of the spine to restore and maintain the balance of the spine, the spinal cord to protect from to an important role for elderly patients, patients with severe osteoporosis, pedicle screws may be loose, resulting in bone fusion, slip recurrence. 3.3 spondylolisthesis reduction is the goal, interbody fusion is fundamental. Authors believe that: as 8 far as possible the reduction of vertebral slip, but do not insist on anatomic clinical practice, a considerable number of patients with anatomic reduction difficult to achieve 100% [5]. Long-term degenerative spondylolisthesis is the result of accumulation, and its surrounding structure of the corresponding change has been relatively adaptable, if a substantial reduction will lead to postoperative nerve root tension, traction nerve damage and other complications occur, we use after posterolateral fusion (PLF, is a common treatment of degenerative lumbar spondylolisthesis fusion method, and points to the small joints between the intertransverse bone graft, its simple, simultaneous decompression surgery around the rich blood supply, is conducive to fusion the disadvantage of small intensity compared with interbody fusion [6], but avoid interbody fusion graft prolapse occurs, reduce the risk of neurovascular injury. References [1] Zhong Fang, Li Feng. Degenerative spondylolisthesis progress of treatment. Biological materials and clinical orthopedic research, 2010,7 (4:25-26 9 [2] Suk SI, Lee CK, Kim WJ, et al.Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after de2 compression in spond2ylolytic spondylolisthesis [J]. Spine, 1997,22 (2) :210-220. [3] Yang double stone, Jing-hair, WU Zeng-hui, et al. Spondylolisthesis different analysis of the efficacy of surgical treatment [J]. Chinese Journal of Orthopedic Surgery, 2000,7 (4:404-405. [4] Shu-Xun Hou, Shi Yamin, Wu Wen Wen, et al. Spondylolisthesis surgical indications and surgical treatment [J]. Spine, 1998,18 (12:707-710. [5] Jiang joyous, Wang Jixing. The treatment of degenerative lumbar spondylolisthesis status and controversies [J]. Chinese Journal of Orthopedic Surgery, 2010,18 (15:1285-1287. [6] Lu Shenglin. Degenerative spondylolisthesis progress in surgical treatment [J]. China Modern Drug 10 Application, 2010,4 (17:223-224. Links to free download 11