The results of transforaminal lumbar interbody fusion for isthmic lumbosacral spondylolisthesis

MINISTRY OF EDUCATION AND MINISTRY OF HEALTH TRAINING HANOI MEDICAL UNIVERSITY VU MINH HAI THE RESULTS OF TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR ISTHMIC LUMBOSACRAL SPONDYLOLISTHESIS MASTER’S THESIS HANOI-2019 MINISTRY OF EDUCATION AND MINISTRY OF HEALTH TRAINING HANOI MEDICAL UNIVERSITY VU MINH HAI THE RESULTS OF TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR ISTHMIC LUMBOSACRAL SPONDYLOLISTHESIS Speciality : Surgery Code : 60720123 MASTER’S THESIS Supervisor: MD NGUYEN HOANG LONG HANOI- 2019 ACKNOWLWDGEMENTS I would like to express my deep gratitude to the teachers and colleagues working at the Faculties, Departments in Universities and Hospitals, for their efforts in training and creating the best conditions for me in the process of learning, working as well as completing this thesis: Department of Surgery, Hanoi Medical University Department of Spine Surgery, Viet Duc University Hospital Office of Postgraduate Management, Hanoi Medical University Department of General Planning, Viet Duc University Hospital I would like to sincerely thank MD Nguyen Hoang Long for directly supervising me throughout the process of completing this thesis Spiecial thanks to MD Duong Dai Ha for encouraging and motivating me to continue with this English thesis Special thanks to teachers in the Council for their valuable suggestions, advice and dedicated help to me in completing this dissertation Thanks to the staff of the Department of Spine Surgery, Viet Duc University Hosptital for their companion, monitoring, sharing, help to me in the period of studying in the department Finally, I would like to express my deep gratitude to my parents, uncle and aunt, friends and colleagues for encouraging and supporting me in study, research and life Hanoi, August 8, 2019 Vu Minh Hai AFFIDAVIT I am Vu Minh Hai, a graduate student at Hanoi Medical University, majoring in Surgery,26th session This is my own thesis directly under the guidance and supervision of MD Nguyen Hoang Long This research does not coincide with any other studies published in Vietnam The data and information in the research are completely accurate, truthworthy and objective which have been verified and approved by the research institution I assume overall responsibility with the law for these commitments Hanoi, September 9, 2019 Vu Minh Hai ABBREVIATIONS MRI : Magnetic resonance imaging CT : Computed tomography TLIF : Transforaminal lumbar interbody fusion PLIF : Posterior lumbar interbody fusion ODI : Oswestry Disability Index TABLE OF CONTENTS INTRODUCTION Chapter 1: OVERVIEW 1.1 History 1.1.1 Global 1.1.2 Vietnam 1.2 Lumbar spine anatomy 1.2.1 Lumbar Intervertebral Segment 1.2.2 Connective components of the spine 1.3 Pathogenesis of lumbar spondylolisthesis 12 1.4 Clinical and paraclinical manifestations 15 1.4.1 Clinical 15 1.4.2 Paraclinical 20 1.4.3 Diagnosis 29 1.5 Treatment 29 1.5.1 Non-Surgical 29 1.5.2 Surgery 30 Chapter 2: SUBJECTS AND RESEARCH METHODS 41 2.1 Subjects 41 2.1.1 Criteria for patient selection 41 2.1.2 Criteria for patient exclusion 41 2.1.3 Research process 42 2.2 Research Methods 42 2.2.1 Research design 42 2.2.2 Methods to collect research data 42 2.2.3 Research information 43 2.2.4 Standards of diagnosis 43 2.2.5 Post-operative assessment and follow-up 47 2.3 Data analysis 50 2.4 Ethics in research 50 Chapter 3: RESULTS 51 3.1 General characteristics of the patients 51 3.1.1 Distribution of patients by age 51 3.1.2 Gender distribution 52 3.1.3 Distribution by occupation 52 3.1.4 Medical history 53 3.2 General characteristics of etiopathogenesis 53 3.2.1 Onset and pathogenesis 53 3.2.2 Incubation period 54 3.2.3 Medication treatment before hospital admission 54 3.2.4 Spondylolisthesis locations 55 3.3 Clinical and paraclinical manifestations 56 3.3.1 Clinical 56 3.3.2 Paraclinical 59 3.4 Postoperative results 61 3.4.1 Improvement of symptoms 61 3.4.2 Degree of slippage before and after surgery 61 3.4.3 Re-examination results 62 Chapter 4: DISCUSSION 63 4.1 General features 63 4.1.1 Gender 63 4.1.2 Age 63 4.1.3 Occupation 64 4.1.4 Medical history and medication treatment 64 4.2 Etiopathogenesis 65 4.2.1 Onset and development 65 4.2.2 Incubation period 65 4.2.3 Locations of spondylolisthesis 65 4.3 Clincal and radiographic manifestations 66 4.3.1 Clinical symptoms 66 4.3.2 Radiographs 71 4.4 Treatment results 74 4.4.1 Surgical indications 74 4.4.2 Results immediately after surgery 75 4.4.3 Evaluation months post-operatively 76 4.5 intra- and post- operative complications 77 4.6 Medical record illustration 78 CONCLUSION 85 REFERENCES MEDICAL RECORD SAMPLE LIST OF TABLES Table 3.1: Distribution by occupation 52 Table 3.2: Distribution by medical history 53 Table 3.3: Incubation period 54 Table 3.4: Medication treatment 54 Table 3.5: Locations of spondylolisthesis 55 Table 3.6: Onset symptoms 56 Table 3.7: Functional symptoms 56 Table 3.8: Preoperative physcal symptoms 56 Table 3.9: Preoperative sensation disorders 57 Table 3.10: Movement disorders according to ASIA 58 Table 3.11: Spondylolisthesis locations affected clinical symptoms 58 Table 3.12: Spondylolisthesis grades affected clinical symptoms 59 Table 3.13: Sorts of radiography were used 59 Table 3.14: MRI images 60 Table 3.15: Pre- and post-operative result comparison 61 Table 3.16: Pre-and post-oprative grade of spondylolisthesis 61 Table 3.17: Recovery according to ODI 62 Table 3.18: Recovery according to VAS 62 Table 3.19: Bone fusion after months 62 LIST OF CHARTS Chart 3.1 : Distribution by age 51 Chart 3.2 : Distribution of patients by gender 52 Chart 3.3 : Disease onset 53 Chart 3.4: Spondylolisthesis locations 55 Chart 3.5: Conventional X-ray 60 86 TLIF surgery Re-examination months post-operatively, grade I bone fusion accounts for 66.7%, grade II makes up 20%, grade III constitutes 13.3%, there are no cases having poor results (grade IV) No recurrence of spondylolisthesis, broken screws, broken rods, no displacement of cages The cage combined with the lamina‟s bone chips is suitable for interbody fusion TLIF facilitates spondylolisthesis correction REFERENCES Nguyễn Văn Công, Lưu Hồng Sơn, Đinh Đức Huy, Phan Thanh Hải (1999), Khuyết eo cung đốt sống, vài nhận xét dịch tễ học Hội nghị chuyên đề tập huấn cột sống TP Hồ Chí Minh lần thứ 4-12/1999 Nguyễn Danh Đô, Phạm Thanh Hải, Lê Ngọc Quang (2002), Nhận xét kết phẫu thuật cố định trượt thân đốt sống thắt lưng nẹp vít phía sau, Y học thực hành, 436, 99-102 Phan Minh Đức, Võ Phạm Trọng Nhân (2007), Điều trị phẫu thuật trượt đốt sống thắt lưng nẹp vít chân cung ghép xương liên mỏm ngang, Báo cáo hội nghị PTTK toàn quốc Phan Trọng Hậu (2002), Nghiên cứu chẩn đoán điều trị bệnh trượt đốt sống thắt lưng hở eo người trưởng thành, Luận án tiến sỹ Y khoa, Học viện Quân y Nguyễn Ngọc Khang (2002), Điều trị trượt đốt sống thắt lưng – thắt lưng cùng, phân tích 30 trường hợp phẫu thuật, Y học thực hành, 436, 106-10 Nguyễn Đắc Nghĩa (2004), Nghiên cứu điều trị phẫu thuật gẫy cột sống ngực – thắt 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S50–S58 90 Rothenfluh DA, Muller DA, Rothenfluh E, Min K (2015) ăPelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion Eur Spine J 24(6) 1251–1258 91 Khajavi K, Shen A, Lagina M, Hutchison A (2015) Comparison of clinical outcomes following minimally invasive lateral interbody fusion stratified by preoperative diagnosis Eur Spine J 24(3):322–330 92 FINLAND, J.V.M.T (1994) The development of isthmic lumbar spondylolisthesis in an adult Journal of Orthopaedic Surgery, 76 (A), 1179-1184 MEDICAL RECORD SAMPLE Code: _ I/ Patient Demographics Name: Age Gender Occupation: Address: Date: Admission: Operation: Discharge: II/ Chief complaint: III/ History of present illness Onset and duration of symptoms: Onset: gradually  Situation: Naturally  suddenly  Micro injury  Injury  gradually  suddenly  Initial symptoms: yes  * Back pain: * Radicular pain: yes  no  * Spread: calf hamstrings no  toe * Movement affection: No  pain avoidance posture  paralysis  * Sensation affection: yes  numbness  * Incontinence: tingling  yes prickling   no  no  time duration from initial radicular pain: neurogenic claudication : yes  distance no  7.other symptoms: _ medication treatment: yes  prescribed  self-medication no  before operation: * Segmetal spinal instability‟s symptoms yes  * Nerve root decompression syndrome Back VAS : no  yes  no  Leg VAS : ODI: JOA: IV/ Past medical history: injury _low back pain Surgery others V/ Examination Spine: yes  no  * Lumbar muscle spasm yes  no  * Trigger points yes  no  * “Stair step” yes  no  * spine curvature loss nerve root compression: Lasègue L  R Valleix yes  no  movement examination: L  * Total paralysis * Contraction when pinching R L  R * Active movement, full range of motion, gravity eliminate: L * Active movement, full range of motion, against gravity L  * Against gravity and provides some resistance L L * Normal Heel walking: normal  weak  Toe walking normal  weak  Muscle tone normal  weak  R R  R  R Sensation examination: L R Both Paresthesia    Impaired sensation    Both    Normal  Tendon reflex: * Pellar normal    * Achilles normal    Muscle atrophy : calf Y thigh Y N Both Y N N Incontinence: urinary – faecal retention Y Involuntary urinate on – defecation Y  N N VI/ Paraclinical conventional radiography: Y Slippage degree N narrow intervertebral space Degeneration  pars defect  congenital :  Functional radiography: CTS scan: MRI: Index-level degenerative disc stenosis foraminal stenosis pars defect other lesions: Preoperative diagnosis: Postoperative diagnosis:  VII/Operation starting time : Finishing time: Surgeons: Method: Images: Intraoperative complications: Blood: Transfusion: VIII/ Result immediately after surgery Back VAS Leg VAS Complications: Recheck by radiography: Recovery of symptoms: IX/ results months postoperatively Back VAS ODI JOA X- ray CT: Bridwell Leg VAS ... noticeable in the fifth lumbar disc In the upper segment of the lumbar spine, the lordosis is due almost entirely to the shape of the disc, but in the lower lumbar regions, the shape of the vertebral... results of transforaminal lumbar interbody fusion for isthmic lumbosacral spondylolisthesis" with two goals: Description of clinical features, imaging diagnosis of patients with isthmic lumbosacral. .. directions  There are nerves that branch off from the spinal column at each level of the spine They pass through small holes in the back of the lower spine They then connect together to form the sciatic