Objective To compare the radiographic and clinical results of transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative spondylolisthesis (DS) with or without kyphotic angulation.Methods This study retrospectively reviewed a consecutive cohort of 137 patients with L4 DS (Meyerding grade Ⅰ or Ⅱ) who received TLIF between January 2009 and December 2012 and had a minimum follow-up of 2 years,including 24 males and 113 females,with the average age of 59.1±11.6 years(45-72 years).The enrolled patients were divided into two groups based on the angulation of intervertebral space:the kyphotic group and the non-kyphotic group.Slip angle (SA),anterior disc height (ADH),posterior disc height (PDH),slip percentage (SP) and segmental kyphosis (SK) was measured to evaluate the radiographic outcomes.Oswestry disability index (ODI) and visual analogue scale (VAS) was collected to evaluate the clinical results.The radiographic measurements and clinical indexes were recorded before and after surgery and at latest follow-up.The independent samples t test was performed to analyze the differences between the two groups in terms of radiographic and clinical outcomes.Results Kyphotic slip was observed in 21 (15.3％) patients,while non-kyphotic slip in 116 (84.7％) patients.No significant difference was observed in terms of age,gender,operation time and blood loss between the two groups.The preoperative SA in kyphotic and non-kyphotic group was 3.1°±2.3° and-8.2°±4.7°,respectively.The kyphotic group had significantly lower ADH and higher PDH than the non-kyphotic group,while there was no significant difference in SP between the two groups.After surgery,the postoperative and latest follow up radiographic results showed that patients of both groups had significant improvement,without significant differences between groups in terms of ADH,PDH,SA and SK,but the reduction of slip was significantly higher in the kyphotic group.Postoperative and follow-up ODI and VAS scores demonstrated remarkable improvement after surgery,without difference between groups,despite being higher in the kyphotic group than the non-kyphotic group preoperatively.Conclusion The kyphotic angulation of intervertebral space benefits to and facilitates slip reduction for L4 DS via TLIF procedure,and achieves improvements in life quality which is similar to the nonkyphotic group.%目的 探讨经椎间孔椎体间融合术治疗后凸型L4退变性滑脱症的疗效.方法 回顾性分析2009年1月至2012年12月行经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗且有2年以上随访的137例Ⅰ～Ⅱ度L4退变性滑脱症患者的病历资料,男24例,女113例;年龄45～72岁,平均(59.1±11.6)岁.根据脊柱全长侧位X线片滑脱椎间隙的开放方向分为后凸型滑脱组和非后凸型滑脱组.术前、术后和随访时测量滑脱率、滑脱角、前方椎间隙高度、后方椎间隙高度和局部后凸角;采用Oswestry功能障碍指数(Oswestry disability index,ODI)和腰痛疼痛视觉模拟评分(vi-sual analogue scale,VAS)对患者的生活质量进行评价.两组间影像学和生活质量评估指标的比较采用t检验.结果 后凸型滑脱组21例(15.3％)、非后凸型滑脱组116例(84.7％).两组患者的年龄、性别、手术时间、出血量等的差异均无统计学意义.后凸型滑脱组和非后凸型滑脱组术前滑脱角分别为3.1°±2.3°和-8.2°±4.7°;后凸型滑脱组椎间隙前方相对高度明显低于非后凸型滑脱组、椎间隙后方相对高度明显高于非后凸型滑脱组;而两组患者滑脱率的差异无统计学意义.两组患者TLIF手术后及末次随访时各影像学指标较术前均明显改善;两组患者术后和末次随访时滑脱角、局部后凸角、椎间隙高度的差异均无统计学意义,但后凸型滑脱组滑脱复位率明显高于非后凸型组.术前后凸型滑脱组ODI和VAS评分明显高于非后凸型滑脱组,术后ODI和VAS评分均较术前明显改善,但两组间术后和末次随访时的差异无统计学意义.两组患者术后及随访期间并发症的差异无统计学意义.结论 后凸型L4退变性滑脱组椎间隙向后开放,有利于应用TLIF手术进行滑脱复位,术后生活质量改善与非后凸型滑脱组相当.
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