董小雄(Dong Xiaoxiong，Dept Orthop，86th Hosp PLA，Dangtu，Anhui 243100)…∥Chin J Clin Basic Orthop Res.－2010，2(2).－140～143

Surgical strategy for high-grade isthmic spondylolisthesis of 5th lumbar vertebrae

董小雄(Dong Xiaoxiong，Dept Orthop，86th Hosp PLA，Dangtu，Anhui 243100)…∥Chin J Clin Basic Orthop Res.－2010，2(2).－140～143

ObjectiveTo investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡdegree)of 5th lumbar vertebrae.MethodsFrom August 2003 to October 2008，26 patients with high-grade isthmic spondylolisthesis(L5)were treated by the application of TLIF(transforaminal lumbar interbody fusion)techniques，using posterior spinal nerve canal decompression centered by lumbar zygoapophsis，intervertebral space release，distraction and reduction，supplemental reduction and fixation with pedicle screw-rod system，and intervertebral impacted bone graft combined with lumbar interbody fusion cage.ResultsAfter 18 to 36 months(average 30 months)follow-up，no loss of slipped vertebrae reduction and intervertebral height maintenance occurred，physical curvature of lumbar spine returned to normal level，and there were no patients with neither a breaking/loosening pedicle screw nor fusion cage displacement orsedimentation.Twenty-five patientsachieved solid fusion.According to NaKai rating criteria，excellent rate was 84.6%.ConclusionTo treat highgrade isthrnic spondylolisthesis(L5)，nerve root canal decompression is the key.Slipped vertebrae reduction is conducive to nerve root decompression and intervertebral body fusion rate improvement，while this fusion is the foundation to maintain long-term efficacy.11 refs，1 fig.

(Authors)