Copy-KARTHIK MOS LISTHESIS FINAL copy.pptx

Spondylolisthesis of lumbar spine

1. “Evaluation of the Predictors for Unfavorable Clinical Outcomes of Lumbar Spondylolisthesis After Fusion” Dr. Karthik devaraj , 2ND year orthopaedic resident, Prof. Dr.RAJA RAJAN unit , Department of othopaedic , ESIC KK NAGAR CHENNAI.

2. Concepts To prevent the negative feedback from the patients. Our study was performed aiming to determine the predictors that contributed to unfavourable clinical efficacy among patients with LS after fusion 1 2

3. AIM To evaluate the risk of unfavourable clinical outcomes in short-term postoperative period in LS after fusion

4. MATERIALS &METHODS THIS STUDY IS DONE IN DEPARTMENT OF ORTHOPAEDIC SURGERY ESIC MC ,KK NAGAR, CHENNAI. SAMPLE SIZE - 30 STUDY DESIGN – ANALYTICAL PROSPECTIVE STUDY

5. criteria (1)American Society of Anesthesiologists (ASA) rating of III or higher (2) M ulti -level decompression and LIF (3) P revious lumbar surgical intervention (4) R evision surgery (5) S pinal tumor, deformity, fracture, infection or other spine diseases (6) R ejection of implants. (1) Patients diagnosed with symptomatic LS (2) Age ranged from 45 to 75 years old (3) S ingle-level spondylolisthesis (4) With all DATA of C linical parameters, radiological variables, and surgical records INCLUSION CRITERIA: EXCLUSION CRITERIA:

6. CLINICAL EVALUATION Preoperative and Postoperative functional evaluation, including ODI (Oswestry Disability Index) and VAS (Visual Analogue Scale) will be performed, endpoint events will be defined as significant relief of symptom in the short term (2 weeks postoperatively)

7. OSWESTRY DISABILITY INDEX (ODI)

8. RADIOLOGICAL EVALUATION X-ray anteroposterior and lateral views flexion & extension view CT MRI both pre op & post op 2nd week CT preoperative MRI

9. Preoperative and post operative CT SCAN is taken Facet angle , disc height and lateral listhesis is noted both preoperative and postoperative RADIOLOGICAL EVALUATION

10. PROCEDURE Surgery is done under all standard protocol Surgery is done by the same surgeon Prone position Standard midline incision used Screw method Pedical screw size of 6.5mm and 5.5mm is used Posterolateral fusion or PLIF Water tight closure done

11. DVT prophylaxis Regular dressing Suture removal at POD - 12

12. POST OP REHABILITATION Postoperative bedside mobilization started at POD- 1 patient made to sit in POD-2 Made to stand using walker support in POD -3 Made to Walk using walker support in POD -4

13. 48/F C/O PAIN LOWER BACK RADIATING PAIN BOTH LOWER LIMB POWER 5/5 L3- L4 GRADE - I LISTHESIS ODI - 30/50 VAS – 7 CASE 1

14. PRE OP DH -7MM FA –R 44 L 51.7 NO LLS

15. POST OP POWER 5/5 ODI - 16/50 VAS – 3 DH-8 MM FA – R 40 L 37

16. CASE - 2 63/F POWER 4/5 EHL LEFT GRADE 2 LISTHESIS VAS -8 ODI 34/50 DH 10.6 FA- R 33.5 L 51 LLS 2 .5 MM

17. VAS -6 POWER SAME AS PRE OP ODI 28/50 DH 10 FA- R 31.8 L 50.4 LLS 2 .5 MM

18. CASE - 3 45/F POWER 5/5 GRADE 2 LISTHESIS VAS - 6 ODI - 26/50 DH -6 FA R 72 L 69.3 NO LLS

19. POWER - 5/5 ODI - 24 VAS - 5 DH - 6MM FA - R 76 L 66 NO LLS

20. CASE - 4 51/M POWER 5/5 GRADE 1 LISTHESIS VAS 7 ODI 24/50 DH 7 FA R 36.8 L 40.7 LLS -2 .5 MM

21. POWER 5/5 ODI 12/50 VAS 3 DH 6 MM FA R 34.2 L-38.6 NO LISTHESIS

22. POSTERIOLATERAL FUSION 12 PATIENTS BONE GRAFT- AUTOGRAFT NO CEMENT AUGMENTATION DONE NILL SURGICAL COMPLICATION PLIF 18 PATIENTS TOTAL NO. PATIENTS - 30

23. Pr E op vs post op PRE OP VAS PRE OP ODI POST OP VAS POST OP ODI WITH COMPARISON OF OUR CLINICAL EVAULATION SCALE PT COMPLAINTS HAS IMPROVED POST SURGERY AVERAGE VAS - 7 AVERAGE ODI - 34/50 AVERAGE POST OP VAS - 4 AVERAGE POST OP ODI – 20/50

24. Disc height 5.5 mm 6.8mm AVERAGE DISC HEIGHT – 5.5mm MINIMUM DH – 2.5 MAXUMIUM DH -10.6 PRE - OP DISC HEIGHT AVERAGE POST-OP DISC HEIGHT – 6.8mm MINIMUM DH – 4.5 MAXUMIUM DH -12.2 POST- OP DISC HEIGHT

25. FACET ANGLE L-38.2 DEGREES L-47.1 DEGREES R-34.6 DEGREES R-40 DEGREES AVERAGE PRE OP FACET ANGLE R-34.6 L- 38.2 MIN R-17.8 L-14.8 MAX R-70.8 L-78.7 PER OP FACET ANGLE AVERAGE POST-OP FACET ANGLE R-40.8 L- 47.1 MIN R-30 L-32 MAX R-66.7 L-77.2 POST OP FACET ANGLE

26. LATERAL LISTHESIS LATERAL LISTHESIS WAS NOTED IN – 5 PATIENTS WITH AVERAGE OF 2 .5 MM DISPLACEM E NT

27. Discussion & Conclusion In o ur study AVG POST OP DISC HEIGHT OF 6.8 Restoration of disc height to normal physiological level or less than normal have more better functional outcome than supra-physiological fixation patients have > 60% improvement in functional evaluation at 2 weeks postoperatively

28. In our study, outcomes in patients suggested that increased FA limits functional recovery

29. IN OUR STUDY A limited surgical benefit was observed in LS with LLS, including an elevated and persistent back pain due to the coronal displacement of the slipped segment successful surgery is largely dependent on acquiring a solid fusion and re-establishing normal local sagittal and coronal balance

30. PURPOSEFUL SURGICAL STRATEGIES AND INSTRUMENTS ARE RECOMMENDED TO CORRECT VERTEBRAL SLIPPAGE IN PATIENTS WITH LATERAL SLIPPAGE Include s PRESERVING LUMBAR LORDOSIS IMPLANTING A APPROPRIATE SIZE CAGE LATERALLY DISTRACTING THE DISPLACED VERTEBRAL BODY

31. OUR RESULTS POSTOPERATIVE DISC HEIGHT POSTOPERATIVE FACET ANGLE RISK FACTORS IN UNFAVORABLE CLINICAL OUTCOMES AT SHORT-TERM FOLLOW-UP PREOPERATIVE LLS

32. PLIF VS PLF HAD SIMILAR OUT COME WITH EQUAL COMPLICATION RATE ,REVISON RATE AND OPERATION TIME AND BLOOD LOSS WITH 1 YEAR FOLLOW UP PLIF HAD HIGH FUSION RATE THAN PLF

33. decompression alone or decompression with interbody fusion study indicated that the patients that attained a <6-mm DH intraoperatively were more likely to derive a sustained benefit from the decompression with a fusion procedure than the patients reporting poor clinical outcomes with higher disc height

34. Thank You