Transcript Diapositiva 1

Neurological Surgery Department
Translaminar facet screw fixation in ithsmic
lumbar spondylolisthesis.
Angel J. Lacerda MD PhD, Daisy Abreu MD, Julio A. Díaz MD,
Sandro Perez MD, Julio C Martin MD, Daiyan Martin MD.
Introduction:
Herbineaux described first spondylolisthesis (1667)
in a pregnant woman who had a “tumor” in minor
pelvis which was causing obstruction to the
delivery. Kilian, Robert, and Lambl described
spondylolysis accompanied by spondylolisthesis in
the literature in the mid 1800s but development of
spondylolisthesis was appreciated only after
Naugebauer's anatomic studies in the late 1800s.
Wiltse, Macnab, and Newman developed a
classification to help outline causes of vertebral
translation in an anterior direction.Their categories
include the following:
Type I: Congenital spondylolisthesis.
Type II: Isthmic spondylolisthesis.
Type III: Degenerative spondylolisthesis.
Type IV: Traumatic spondylolisthesis.
Type V: Pathologic spondylolisthesis.
Isthmic lumbar spondylolisthesis is a defect in the
pars interarticularis and occurred when forward
translation of lumbosacral vertebra relative to
another is of 25%.
Translaminar facet screw fixation is an easy form of
lumbar internal fixation but it is less invasive than
other techniques.
Indications for this procedure are:
• Disabling mechanical lower back pain because of
degenerative disk disease or facet joint syndrome.
• Symptomatic grade I spondylolisthesis.
The aim of this study was to report the surgical
results in our hospital in patients with lumbar
ithsmic spondylolisthesis operated on by
translaminar facet screw fixation.
Methods:
We have conducted a descriptive study about 12
patients operated on neurosurgery department of
“Roberto Rodríguez” general hospital, Moron, Ciego
de Avila, Cuba, between january 2001 and december
2006, with ithsmic lumbar spondylolisthesis using
the translaminar facet screw fixation.
Although this technique was described by King in
1948 and Boucher in 1954, the current method of
performing the procedure was described by
Montesano and colleagues.
Spondylolisthesis was evaluated by Meyerding
grading system.
Results were evaluated by Ebelin scale.
Meyerding grading system classification:
Grade 1: 1- 25% slippage
Grade 2: 26-50% slippage
Grade 3: 51-75% slippage
Grade 4: 76-100% slippage
Grade 5: Greater than 100% slippage.
Grade I lumbar ithsmic spondylolistesis
Surgical procedure:
A “meca” position and lumbar midline approach is
generally used. Neural microsurgical
decompression is performed as indicated.
The articular surfaces of the involved facet should
not be decorticated to avoid screw purchase
weaken. Only the articular cartilaginous end plate is
removed.
Only the articular cartilaginous end plate is
removed. After that a drill bit is inserted
percutaneously and directed toward the base of the
spinous process and toward the base of the
contralateral transverse process, through a plane
across the base of spinous process and lamina and
into the facet joint before ending in the transverse
process. A small laminotomy allows palpation of the
undersurfase of the lamina to avoid drilling into the
spinal canal. After that a 4.5 mm standard cortical
screw is inserted. The screw length is 50-54mm. The
entry point of the second screw is slightly cephalad
to avoid crossing the first screw. After screw
placement if fusion techcnique will be used the
grafts are placed over the graft sites.
Screw inserted
Screw inserted
Characteristic
Number of patients
12
Sex(Male/Fem)
10/2
Mean age(years)
54,65
Approached levels and disk herniation associated
66,67%
L5-S1
33,33%
L4-L5
8
4
83,33%
Disk herniation associated
0
2
4
6
10
8
10
12
Luque system
Transpedicular screw
fixation
Translaminar facet
screw fixation
Ebelin results scale
Technique failure
Worse
Regular
2
Good
6
Excellent
4
0
1
2
3
4
5
6
7
Conclusions:
•There were no complications with this technique.
•It is relatively simple and brief technique compared
with other stabilization techniques.
•Surgical tima is low.
•It is biomechanically similar to Luque rectangles.
•The facet joint fixating achieves a degree of
stabilization that increased the chance for
successful fusion in some cases without grafting.
•The instrumentation is inexpensive compared with
other techniques.