Does the Use of Monoaxial Pedicle Screws in Caudal Vertebra Make a Difference in Management of Lumbar Spondylolisthesis? A Propensity-Matched Study
Background: This propensity-matched case-control study aimed to enunciate the relative advantages of monoaxial screws in the management of spondylolisthesis. Materials and Methods: A prospectively collected database of two patient groups was analyzed. Patients with a single-segment fixation for lumb...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Indian Spine Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.4103/isj.isj_49_24 |
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| Summary: | Background: This propensity-matched case-control study aimed to enunciate the relative advantages of monoaxial screws in the management of spondylolisthesis. Materials and Methods: A prospectively collected database of two patient groups was analyzed. Patients with a single-segment fixation for lumbar spondylolisthesis with a minimum follow-up of two years were included. The study group involved patients with the use of monoaxial pedicle screws into the caudal vertebra and polyaxial screws in the cranial listhesis vertebra. The control group consisted of patients with the use of only polyaxial screws in the entire construct. One-to-two nearest neighbor propensity score matching was performed for age, sex, percentage slippage, BMI, presence of osteoporosis, smoking, disc height reduction >50% at the involved level, and type of spondylolisthesis (degenerative or lytic). Statistical analysis was conducted for immediate postoperative translation-correction and angulation-correction at the involved level; loss of translation-correction and angulation-correction at the last follow-up as compared to immediate postoperative status; improvement in VAS scores for leg and back pains; and improvement in ODI and Odom’s criteria. Results: In the immediate postoperative period, better translation-correction (P = 0.012) was noted in the study group (n = 15) without any advantage in lordosis-improvement as compared to the control group (n = 30). However, study group had better maintenance of translation-correction(P = 0.007) and lordosis-correction(P = 0.003) over an identical follow-up period (mean: 25.26 months). This also reflected in better improvements in ODI scores (P = 0.02), VAS-back pain (P = 0.02), VAS-radicular pain (P = 0.02), and Odom’s criteria (P = 0.046) at the last follow-up. Conclusions: In addition to better intraoperative correction of translation, the study group demonstrated better maintenance of correction of translation and lordosis in the postoperative period. This is likely to lead to better functional outcomes. |
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| ISSN: | 2589-5079 2589-5087 |