Double-level lumbar spondylolysis and spondylolisthesis: A retrospective study

Lumbar spondylolysis and isthmic spondylolisthesis are common conditions. However, double-level lumbar spondylolysis and spondylolisthesis are rare. We report 24 cases of it along with a review of literature and a briefly description of the clinical and radiological features and integrated management of patients with this condition.

Of 1700 inpatients diagnosed with lumbar spondylolisthesis at our hospital between January 2008 and September 2015, we selected those with a diagnosis of double-level spondylolisthesis who underwent surgery. We analyzed the data regarding age, sex, and heavy physical labour. Japanese Orthopaedic Association (JOA) and Visual Analog Scale (VAS) scores were used to evaluate preoperative and postoperative neurological function and back pain. All patients underwent decompression, reduction, and posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with a cage. After the operation, we were followed up for more than 2 years to observe the effect of the operation. In the meantime, the height of the intervertebral discs was measured at follow-up, and all data are analyzed in SPSS stastic.

Double-level spondylolisthesis occurred at the L2/L3 and L3/L4 levels in one patient, L3/4 and L4/L5 levels in 11 patients, and L4/L5 and L5/S1 levels in 12 patients. Nine patients also had spondylolysis. Twenty patients underwent posterior lumbar interbody fusion and internal fixation with autologous bone chip, and 4 of them underwent cage and autogenous bone graft fixation. Postoperatively, the major symptoms (neurological dysfunction and low-back pain) improved significantly. Comparison of JOA and VAS scores indicated effective recovery of neurological function (p < 0.05). Postoperative follow-up demonstrated satisfactory interbody fusion and pars interarticularis healing.

Double-level lumbar spondylolysis and spondylolisthesis occurred more often in women. Most common site of double lumbar spondylolisthesis was L3-L5. The treatment principle was the same as that for single-level spondylolisthesis, but the reset order is questionable. Both, posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with cage can relieve discomfort in most patients. In our follow-up, we found that there was a high degree of loss in disk height when autogenous bone was used. Therefore, we suggest the use of a cage.