Keywords: Spondylolisthesis, Lumbar Spine, Treatment, Risk factors

"LIFT it! Novel steps in research on lumbar spondylolisthesis"

The aim of this thesis was to describe three aspects of lumbar spine (lower back) and slippage of the lumbar vertebrae due to degeneration or surgery, called spondylolisthesis. The first part is about the normal motion of the lumbar spine, of which a firm definition has not yet been discovered. Inter- and intra-individual differences should be taken into account to determine a method for defining normality in motion of the lumbar spine.

In the second part, the risk of developing spondylolisthesis after decompression surgery has been discussed in which part of the vertebral arc has to be resected to decompress the nerves. Female sex, spondylolisthesis before decompression surgery and level of surgery are associated with symptomatic spondylolisthesis after decompression surgery. High BMI and larger facet angles (the two joints in the lumbar spine at the back) have a lower probability to develop spondylolisthesis.

In the third part, different aspects regarding the treatment of spondylolisthesis were reviewed. The most common surgical techniques - TLIF versus PLIF – were compared. No differences in effect, blood loss, duration of surgery or hospitalization, and complications were demonstrated. The cost-effectiveness review illustrates the knowledge gap of cost-effectiveness in spine surgery, with high heterogeneity among studies. Finally, image-guided techniques used during screw insertion during fusion surgeries were compared. Fluoroscopy led to the highest radiation exposure for surgeon and patients, but still has advantages of short learning curve and wide availability. Furthermore, it resulted in novel postoperative neurological complaints in only 3.25% of the study population.

Language: Dutch

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