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 lưng không vững có liệt tuỷ khung Hartshill bệnh viện Saint Paul Hà Nội, Luận án tiến sỹ Y khoa, Đại học Y Hà Nội Bùi Huy Phụng (2000), Điều trị phẫu thuật hẹp ống sống thắt lưng trượt đốt sống khuyết eo cung sau, Luận văn chuyên khoa cấp II, Trường đại học y dược thành phố Hồ Chí Minh Đồn Việt Qn, Đồn Lê Dân (2000), Nhận xét điều trị phẫu thuật chấn thương cột sống lưng-thắt lưng với cố định nẹp vít qua cuống theo Roy-Camille", Y học Việt Nam, 253 (11), 7-13 Nguyễn Quang Quyền (1997), Atlas giải phẫu người, Nhà xuất Y học 10 Vũ Tam Tỉnh (1996), Điều trị gãy trật cột sống lưng thắt lưng với dụng cụ kết hợp xương gắn bám vào cuống cung sống, Luận án phó tiến sỹ khoa học Y Dược, Trường đại học y dược thành phố HCM 11 Nguyễn Vũ (2008), Đặc điểm lâm sàng, cận lâm sàng kết điều trị trượt đốt sống khuyết eo, Luận văn tốt nghiệp Bác sỹ nội trú, trường Đại Học Y Hà Nội 12 S Terry Canale, Jame H Beaty (2015), Campbelt's Operative Orthopaedics, Elsevier Health Sciences 543-563 13 Aruna G (2002), Isthmic Spondylolysthesis, Neurosurgical Focus, 13(1), 24-26 14 Baksi D.P (1998), Sacrospinalis muscle-pedicle bone graft in posterolateral fusion for spondylolisthesis, International Orthopaedisc, 22, 234-40 15 Bell G.R., Ross J.S (1997), Imaging Study of the Spine, Orthopaedic Knowledge Update Spine, American Academy of Othopaedic surgeons, 41-54 16 Bennett G.J (2004), Spondylolysis and Spondylolisthesis, Youmans neurological surgery, 16-31 17 Bernauer T.A., Mathews V.P (2003), Magnetic Resonance Imaging of the Spine”, Textbook of Neurosurgicla Surgery: Principles and Practice, Lippincott Williams & Wilkins, Vol 1, 166-73 18 Bradford D.S., Boachie A.O (1990), “Treatment of Severe Spondylolisthesis by Anterior and Posterior Reduction and Stabilization”, J.B.J.S., 72 A (7), 160-179 19 Bradford D.S., Gotfried Y (1987), “Staged Salvage Reconstruction of Grade IV and V Spodylolisthesis”, J.B.J.S., 69 A (2), 191-202 20 Brian B., Alexander R.V (2002), “Advances in Posterior Lumbar Interbody Fusion”, The Orthopedic Clinics of North America, 33(2), 367-74 21 Cheng C.L., Fang D., Lee P.C (1989), “Anterior Spinal Fusion for Spondylolysis and Isthmic Spondylolisthesis”, J.B.J.S., 71 B (2): 264-7 22 Dietemann J.L., Zollner G (1999), Radiologic Investigations - Lumbar Segmental Instability, Lippincott Williams & Willkins, 115-`121 23 Edelson J.G., Nathan H (1986), “Nevre Root Compression in Spondylolysis and Spondylolisthesis”, J.B.J.S., 68 B (4), 596-599 24 Fagan A.B., Cain C.M., Hall D.H (1999), “Carbon Fiber Cages for Anterior Lumbar Intrebody Fusion”, Lumbar Segmental Instability, Lippincott Williams & Willkins, 203-208 25 Fairbank J.C., Pynsent P.B (2000), Oswestry Disability Index Spine Health 2000; 25 (22), 40-52 26 Floman Y (2000), Progression of Lumbosacral Isthmic Spondy lolysthesis in Adults, Spine, 25 (3), 342-370 27 Finn B.C., Malene L., John G., Ebbe S.H., Cody E.B (2001), Posterolateral spinal fusion at unintended levels due to bone-graft migration, Acta Orthop Scand, 72 (4), 54-85 28 Giovanni La Rosa, Antonino G, Alfredo C, Fabio C, Gerardo C, Francesco T (1999), Posterior fusion and implantation of the SOCONSRI system in the treatment of adult spondylolisthesis, Neurosurg Focus 7(6), 34 - 54 29 Harms J., Tabasso G (1999), Instrumented spinal surgery, principle and technique, Theme Stuttgart New York, 6, 02-18 30 Harris I.E., Weinstein S.L (1987) Long-Term Follow up of Patiens with Grade III and IV Spondylolisthesis Treatment with or without Posterior Fusion, J.B.J.S., 69 A (7), 960-9 31 Hensinger R.N (1989) Spondylolysis and Spondylolisthesis in Children and Adolescents J.B.J.S., 71 A (7), 1098-107 32 Herkowitz H.N., Kurz L.T (1991), Degenerative Lumbar Spondylolisthesis with Spinal Stenosis A prospective decompression with Decompression and Intertransverse Process Arthrodesis, J.B.J.S 73 A (6), 802-834 33 Jacques Benezech, Anca Mitulescu (2007), Retrospective patient outcome evaluation after semi-rigid stabilization without fusion for degenerative lumbar instability, Eur J Orthop Surg Traumatol 17, 227234 34 Jeffrey A.S., Joel S.S (1997), Physical Rehabiliration of Low Back Pain, Othopaedic Knowledge Update: Spine, American Academy of Othopaedic surgeons, 113 - 120 35 Jinkins J.R., Rauch A (1994), Magnetic Resonance Imaging of Entrapment of Lumbar Nevre Roots in spondylolytic spondylolisthesis J.B.J.S 76 A (11): 643-688 36 John D.S., Hansen A.Y., Bruce E.F (1997), "Anterior Interbody Fixation Device", The Adult Spine: Principles and practice, Raven press Ltd New York, 220-239 37 John D.M., Robert W.G (2001), Spondylolisthesis - Chapmans Othopaedic Surgery, Lippincott Williams & Wilkins, Vol 4, 43-58 38 Jone A.A., McAfee P.C., Robinson R.A (1988), Failed Arthrodesis of the Spine for Severe Spondylolisthesis Salvage by Interbody Arthrodesis J.B.J.S., 70 A (1), 25-30 39 Keith H.B, Ronald L.D (1997), Spondylolisthesis - The textbook of Spinal Surgery, Philadelphia Second Edition, Lippincott-Raven Publishers, 40 Knight M., Goswami A (2002), “Management of Isthmic Spondylolysthesis with posterolateral endoscopic Foraminal Decompres- sion”, Spine, 28 (6): 573-581 41 Lars Hackenberg, Henry Halm, Viola Bullmanm, et al (2005), “Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results” Eur Spine J 14, 551-8 42 Le A.X., Dellamarter R.B., (2003), Posterior Fibular Strut Graft for Spondylolisthesis, Spine Surgery periodical 67, 181-219 43 Leonid Kalichman, David J Hunter (2007) Disgnosis and conservation management of degenerative lumbar spondylolisthesis Eur Spine J, 17, 345 - 356 44 Lin P.M., Cautilli R.A., Joyce M.F (1983) Posterior Lumbar Interbody Fusion, Clinical Orthopeadics 180, 154-267 45 Lindh M (1989) Biomechanics of The Lumbar Spine, Basic Biomechanics of the Musculoskeletal System MC Milan, 183-207 46 Lowe J., Libson E., Ziv I (1987) Spondylolysis in Lumbar Spine A Study of 32 Patients, J.B.J.S., 69 B (4), 582-634 47 Mamoru Kawakami and Tetsuya Tamaki (2004) Relationships Between Lumbar Sagittal Alignment and Clinical Outcomes After Decompression and Posterolateral Spinal Fusion for Degenerative Spondylolisthesis Advances in spinal fusion, 116, 398-406 48 Mark Arts, Willem Pondaag, Wilco Peul, Raph Thomeer (2006) Nerve root decompression without fusion in spondylolytic spondylolisthesis: long-term result of Gill‟s procedure Eur spine J., 15, 455-63 49 McAfee P.C (1999) Interbody Fusion Cages in Reconstructive Operation on the Spine J.B.J.S 81 A (6), 859-78 50 McQueen M.M., Court B.C., Scott J.H (1986), Stabilization of Spondylolisthesis Using Dwyer Instrumentation, J.B.J.S., 68 B (2): 185-8 51 Mooney V (1987), Where Is the Pain Coming from, Spine journal, 12(8): 754-790 52 Parizel P.M., Van Goethem J.W.M (1999) The Use of Magnetic Resonance Imaging in Lumbar Instability and Lumbar Segmental Instability, Lippincott Williams & Willkins, 123 - 138 53 Peek R.D., Wiltse L.L., Reynolds J.B (1989) In Situ Arthrodesis without Decompression for Grade III or IV Isthmic Spondylolisthesis in Adults Who Have Severe Sciatica J.B.J.S., 71 A (1): 62-89 54 Ray C.D (1999), Lumbar Interbody Fusion with Ray Threaded Cages, Lumbar Segmental Instability, Lippincott Williams & Willkins, 191-201 55 Peter F Ullrich (2004), Lumbar spinal fusion surgery, http://www.spine_health.com/topics/surg/overview/lumbar/lumb08_antpost.html 56 Richard Balderston, Russell Blummett (2003), Degenerative and isthmic spondylolisthesis: Evaluation and management Principles and pratice of Spine surgery, Mosby Company, 527 - 538 57 Robert W.G (2000), “The Use of Pedicle Screw Internal Fixation for the Operative Treatment of Spinal Disorders”, J.B.J.S., 82 A (10), 458 - 476 58 Robert F.H (2002), “Spondylolisthesis: Introduction and Illustra- tive Cases”, Neurosurgy Focus, 13(1), 45 - 67 59 Roy-Camille R., Gérard S., Christian M (1986), Intenal Fixation of the Lumbar Spine with Pedicle Screw Plating, Clinical Orthopedidics, 203 217 60 Saifuddin A., White J., Tucker S (1998), Orientation of Lumbar Defects Implications for Radiological Management J.B.J.S 80 B (2): 208-11 Detection and Surgical 61 Scaglietti O., Frontino G., Bartolozzi P., (1976), Technique of Anatomical Reduction of Lumbar Spondylolisthesis and its Surgical Stabilization, Clinical Orthopedidics, 117, 164-75 62 Schnee C.L et al (1997), Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation J Neurosurgeons 86, 56-63 63 Seitsalo S., Osterman K., Hyvarinen H (1990), Severe Spondylolisthesis in Children and Adolescents A Long- Term Review of Fusion in situ, J.B.J.S., 72 B (2), 259-265 64 Serena S.Hu, Clifford B.T, Mohammad D, Alexander J.G (2008) Spondylolisthesis and Spondylolysis J Bone Joint Surg Am, 90, 656-671 65 Sijbrandij S (1981), A New Technique for the Reduction and Stabilisation of severe spondylolisthesis, J.B.J.S 63 B (2): 266-71 66 Smith M.D., Bohlman H.H (1990), Spondylolisthesis Treated by a Single-Stage Operation Combining Decompression with in Situ Posteriolateral and Anterior Fusion, J.B.J.S 72 A (3): 415-21 67 Spangler W.J., Adams M., Dikman C.A., (2003), “Bone Graft Harvest techniques, Supplementation, and Alternatives”, Textbook of Neurosurgical Surgery: Principles and Practice, Lippincott Williams & Wilkins, Vol 3, 2171-76 68 Stephen I.E., Nazar N., Phelps K (1995), Posterior Interbody Arthrodesis with A Fibular Strut Graft in Spondylolisthesis J.B.J.S 77 A (2): 172-190 69 Steven M.T (2001) Isthmic Spondylolisthesis and Spondylolysis Journal of the Southern Orthopaedic Association, 10(3) , 164-172 70 West J.L., Bradford D.S., Ogilvie J.W (Sept 1991) Results of Spinal Arthrodesis with Pedicle Screw-Plate Fixation J.B.J.S., 73 A (8), 179-184 71 Wiltse L.L., Leon J.G (1991), Classification, Non-Operative, and Operative Treatment of Spondylolisthesis, The Adult Spine: Principles and practice, Raven press Ltd New York 655 - 703 72 Wiltse L.L., Winter R.B (1983), Terminology and Measurement of Spondylolisthesis, J.B.J.S., 65 A (6): 768-792 73 Zdeblick T.A (1997), Spinal Instrumentation and Othopaedic Knowledge Update: Spine, American Academy of Othopaedic surgeons, 55-61 74 Zoher Ghogawala, Edward Benzel (2004), Prospective outcome evaluation after decompression with or without intrumented fusion for lumbar stenosis and degenerative grade I spondylolisthesis J.Neurosurgery and Spine 3, 267-272 75 Vitor Ka-Siong Kho, Wen-Chih Chen (2006) Posterolateral fusion using laminectomy bone chips in the treatment of lumbar spondylolisthesis International Orthopaedics septembre, 116, 100-103 76 Guigui P, Rillardon L, Lenoir T (2006), Traitement chirurgical des sténoses du canal lombaire, Elsevier Masson SAS, Paris, Techniques chirurgicales-Orthopédie-Traumatologie, 19(1), 44-181 77 Laredo J.D., Ziza J.M., Mazel C., Roy-Camille R (1992), Rachis”, TDM et IRM Cliniques, Editions Frison-Roche, 471-515 78 Nordin J.Y (1991) Spondylolisthésis par lyse isthmique Spondylolisthésis dégénératif, Encycl Méd-Chir (Paris), Appareil locomoteur 15835 A10 474 - 488 79 Pedram M., Dupuy R., Vital J.M (2003) Spondylolisthésis lombaire dégénératif, Encycl Méd-Chir (Paris), Appareil locomoteur 15835 B10, 123-165 80 René Louis (1997), Chirurgie du spondylolisthésis, Elsevier Masson SAS Techniques chirurgicales-Orthopédie-Traumatologie, Toulouse éditeur, 144179 81 Roger J.M., Bord E., Hamel A (1995), Anatomie et Instrumentation rachidiennes, Instrumentation rachidienne, Cahier d'enseignement 53, Expansion Scientifique Francaise, Paris médicament, 10-12 82 Roy-Camille R (1986), Spondylolisthésis” Cahiers d’enseignement de la SOFCOT Confèrences d‟enseignement, 89-101 83 Roy-Camille R (1995), Instrumentation rachidienne, Cahier d'enseignement 53, Expansion Scientifique Francaise, Paris médicament, 42-43 84 Vital J.M, Pedram M (2005) Spondylolisthésis par lyse isthmique Elsevier Masson SAS, Paris, Appareil locomoteur 15-83 85 Vital J.M, Pointillart V, Sénégas J (1998) Stabilisation rachidienne chirurgicale dans la pathologie dégénérative lombaire Elsevier Masson SAS, Paris, Techniques chirurgicales-Orthopédie-Traumatologie, 44-182 86 Nguyễn Vũ (2016) Đặc điểm lâm sàng, cận lâm sàng kết phẫu thuật trượt đốt sống thắt lưng khuyết eo, Luận án tiến sĩ y học, Trường Đại học Y Hà Nội 87 Vừ Văn Thanh (2014) Kết điều trị trượt đốt sống thắt lưng L4-L5 phẫu thuật lấy đĩa đệm, cố định cột sống ghép xương liên thân đốt Luận văn tốt nghiệp Bác sỹ nội trú, Trường Đại học Y Hà Nội 88 Yohei Ishihara, Masutaro Morishita et al (2018) Comparison of Transforaminal Lumbar Interbody Fusion Using the Boomerang-Shaped Cage with Traditional Posterior Lumbar Interbody Fusion for Lumbar Spondylolisthesis, Spine Surgery and Related Research 19(1), 470 – 474 89 Uribe JS, Myhre SL, Youssef JA Preservation or restoration of segmental and regional spinal lordosis using minimally invasive interbody fusion techniques in degenerative lumbar conditions Spine 2016; 41(1), 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 ... of transforaminal lumbar interbody fusion for isthmic lumbosacral spondylolisthesis" with two goals: Description of clinical features, imaging diagnosis of patients with 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 Speciality... 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