الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Degenerative Lumbar and lumbosacral spondylolisthesis is one of the most common causes of LBP and Leg pain, when the Conservative modalilities for treatment fail to give satisfactory results. The surgical treatment in the form of LSS fixation and fusion become the most effective modality for relief both leg pain and back pain.
The traditional open surgery technique which involves Midline Lower back incision with wide subperiosteal muscle separation was used for decades for lumbar and Lambosacral spine fixation and fusion, although it gives good results in pain reduction and spinal fusion, but it has the disadvantage of severe Post operative pain, high amount of blood Loss, Long duration of hospital stay.
With development of new techniques for minimal invasive spine fixation, the introduction of percutaneous spine fixation system gives a new chance to minimize tissue distraction speed up postoperative recovery, and improves patient satisfaction.
Many comparative studies were done to compare between the two modalities of spine fixation eighther in traumatic or degenerative cases.
In our study, we compare between the 2 modalities as regarding operative technique, intra operative complications and difficulties, postoperative care and post operative outcome and patient satisfaction.
Percutaneous lumbar spine fixation has the advantage of being less invasive with minimal blood loss, and shorter duration of the operation, with shorter duration of post operative hospital stay, however, because of the degenerative nature of the disease, which leads to neural canal compromise secondary to ligamental hypertrophy, facet joint hypertrophy and anterior slipping of one of the lumbar spine over the other causing canal and foramenal stenosis, percutaneous fixation has to be accompanied by lumbar canal decompression, foramenotomy and insertion of interbody fusion by using plif or tlif which requires well trained hand skills with higher learning curve and adds additional intra operative time for neural tissue decompression and spine fusion in addition to more tissue destruction to the original minimal invasive percutaneous fixation surgery alone.
On follow up, both groups recorded good response to surgical intervention in the form of improvement of lbp, leg pain and regain of normal daily activity, with no statistically significant difference between the 2 groups according to ODI, and VAS for leg and back pain after 6, 12 and 18 months of follow up.
According to this study, both surgical approaches are effective in management of degenerative spondylolisthesis, however the percutaneous lumbosacral fixation technique is more expensive and requires higher curve of learning with the need for additional minimal invasive intervention for decompression of neural tissue and insertion of lumbar cage for further fusion of spine, which makes the conventional open surgery technique a good and effective technique for management of degenerative spondylolisthesis.
Conclusion
Percutaneous fixation of lumbosacral spine in case, of degenerative lumbosacral spondylolisthesis has the advantage of being less invasive, with less intra operate bleeding, less operation time and post-operative hospital stay than the conventional open surgery lumbar fixation technique. However, both techniques have the same results of improving patients’ leg and back symptoms on the Long term. However, the percutaneous fixation system is much more expensive, and requires a high learning curve as it requires minimal invasive discectomy and insertion of inter body fusion in some cases.