KẾT QUẢ PHẪU THUẬT CỐ ĐỊNH CỘT SỐNG THẮT LƯNG - GHÉP XƯƠNG LIÊN THÂN ĐỐT QUA LỖ LIÊN HỢP ĐIỀU TRỊ TRƯỢT ĐỐT SỐNG THẮT LƯNG CÙNG Ở BỆNH NHÂN LOÃNG XƯƠNG

Abstract

Objective: To evaluate the outcomes of transforaminal lumbar interbody fusion (TLIF) surgery in the treatment of lumbosacral spondylolisthesis in osteoporotic patients. Methods: A retrospective descriptive study of 48 osteoporotic patients with lumbar spondylolisthesis who underwent transforaminal lumbar interbody fusion (TLIF) at Hanoi Medical University Hospital from January 2023 to December 2023. Results: In our study, the average age was 64.6 ± 5.2 years (ranging from 55 to 81). The female-to-male ratio was 7:1. Only 14.6% of patients received osteoporosis treatment prior to surgery. All patients presented with low back pain accompanied by neurological claudication. The average preoperative VAS score for back pain was 6.96 ± 0.98, and for radicular leg pain, it was 6.63 ± 1.19. Step-off sign was observed in 29.2% of patients. Sphincter dysfunction was noted in 6.2%. The average preoperative ODI score was 60.1 ± 8.1. Isthmic  spondylolisthesis was found in 11 patients (22.9%). Coexisting spinal canal stenosis was present in 34% of patients (70.1%). The average preoperative bone mineral density (BMD) was -2.9 ± 0.4. Mean operative time was 109.1 ± 22.4 minutes. Intraoperative complication of dural tear occurred in 2 patients (4.3%). Postoperative clinical symptoms improved significantly. The average hospital stay was 8.6 ± 2.6 days. VAS scores for back and leg pain showed statistically significant improvement at 1 and 6 months  postoperatively (p < 0.01). ODI scores also improved significantly at the 6-month follow-up. The rates of good and fair fusion at 6 months were 72.9% and 20.8%, respectively. At 12 months, 3 patients (6.3%) experienced cage subsidence and 4 patients (8.3%) had screw loosening. Conclusion: Transforaminal lumbar interbody fusion is clinically effective in treating lumbar spondylolisthesis in osteoporotic patients, with significant improvements in VAS and ODI scores, high fusion rates, and low complication rates. Adherence to osteoporosis treatment plays an important role.