Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopedic Surgery

Background: Lytic spondylolisthesis represent a common disabling condition with a significant impact on the social, working and economic lives of patients. The role of surgical correction of sagittal imbalance in cases of lytic spondylolisthesis is essential. Evidence of the possible short- and long-term benefits of restoring sagittal balance is upgrading.Purpose: To evaluate the sagittal balance improvement in surgically treated patients with Lytic Spondylolisthesis and its relation to clinical improvement. Patient sample: Prospective case study of 25 patients with LyticSpondylolisthesis with followup 12 months at least. Outcome measures: Patients were evaluated by the Visual Analogical Scale (VAS) for low back pain (LBP) and leg pain (LP) and Oswestry Disability Index (ODI) preoperatively and postoperatively 1, 3, 6, 12 months. The radiological evaluation of pelvic incidence, pelvic tilt, sacral slope and lumbar lordosis, were preoperatively, postoperatively and at 12th month. The evaluation of fusion followed the Brantigan methodology depending on X-ray and CT on 6&12 months when indicated. Methods: It consisted of a prospectively collected consecutive series of 25 patients with Lytic Spondylolisthesis who met inclusion criteria treated between January 2018 and February 2019. Fourteen cases were managed by posterolateral fusion (PLF), 6 cases by posterior interbody fusion (PLIF) and 5 cases (20%) by mixing PLF and PLI. Fusion supplemented by posterior instrumentation for all cases by polyaxialpedicular screws and rods aiming for maintaining correction of the sagittal imbalance in Cairo University hospital, Egypt. The study included 4 males and 21 females with the youngest patient was 35 years old and the eldest patient was 59 years old. Pre-operative assessment: History taking, clinical examination and radiological assessment (Plain X-Ray, MRI). Results: All patients achieved satisfactory results as regards the back pain, radicular pain and neurologic deficits. ODI significantly improved from 69.32±6.91 preoperatively to 32.16±4.91 at 1m, 16.92±4.74 at 6m and 10.76±2.59 at 12m (P <0.001). Mean Back pain VAS decreased significantly from 8.84±0.85 preoperatively to 4.00±0.82 at 1m, 1.76 ± 0.66 at 6m and 0.92 ±0.76 at 12m (P <0.001). Mean Leg pain VAS decreased significantly from 8.16±1.07 preoperatively to 2.80± 0.91 at 1m, 1.04± 0.73 at 6m and 0.72±0.74 at 12m (P <0.001)

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