title: The effects of anterior vacuum disc on surgical outcomes of degenerative versus spondylolytic spondylolisthesis: at a minimum two-year follow-up.
abstract: BACKGROUND
  The vacuum phenomenon within the intervertebral disc usually represents disc degeneration. There are no reports in the English literature that focus on the effect of an anterior vacuum disc on surgical outcome of same-segment spondylolisthesis.
  
  
  METHODS
  Patients with degenerative spondylolisthesis (DS) or isthmic spondylolisthesis (IS) who underwent a spinal surgery between January 2005 and December 2006 were reviewed. Patients who met certain criteria, including (1) only mono-segment spondylolisthesis, (2) gas air within the disc space of the spondylolisthesis segment on preoperative radiographs, (3) having received posterior decompression, posterior pedicle screw fixation, and posterolateral fusion, and (4) at least 12 months of follow-up radiographs available to define the posterolateral fusion rate, were enrolled into the study. Four radiographic parameters (disc height, translation, intradiscal angle, segmental angle) were assessed. Two-year postoperative radiographs were used to determine whether the posterolateral segment was fused or not. Clinical outcome and complications during the follow-up period were documented.
  
  
  RESULTS
  Incidence of the disc vacuum phenomenon was significantly higher in the IS group than in the DS group (p < 0.001). The IS group had more listhesis and a narrower disc height on preoperative static radiographs; however, the DS group had a more prominent angle and listhesis change in preoperative dynamic variables. The posterolateral fusion rate was significantly higher in the IS group (p = 0.019). The preoperative Oswestry Disability Index (ODI) score, the final ODI, and the ODI difference were similar between groups. More excellent and good results were seen in the IS group. Besides, better final ODI and results were seen in the bilateral fusion group than in the nonfusion group.
  
  
  CONCLUSIONS
  The disc vacuum phenomenon is not equal to anterior instability absolutely. Determination of stability or instability in a vacuum disc should be considered by a combination of dynamic radiographs. In the present study, vacuum discs in the DS group showed more instability and a higher posterolateral pseudoarthrosis rate.
authors.forename: Tung-Yi
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, No,_5, Fu-Shin Street, Kweishian, Taoyuan 333, Taiwan. jcl1265@adm.cgmh.org.tw.
authors.forename: Jen-Chung
authors.initials: JC
authors.lastname: Liao
authors.forename: Tsung-Ting
authors.initials: TT
authors.lastname: Tsai
authors.forename: Meng-Ling
authors.initials: ML
authors.lastname: Lu
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
authors.forename: Lih-Hui
authors.initials: LH
authors.lastname: Chen
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014618:Vacuum