STUDY DESIGN: A retrospective review of the clinical and radiographic outcomes of reduction by temporary instrumentation of L4 and monosegmental fusion of L5/S1 in patients with high-grade developmental spondylolisthesis. OBJECTIVE: To assess the efficacy of this technique in the reduction of local deformity and correction of overall sagittal profile. SUMMARY OF BACKGROUND DATA: In situ fusions as well as partial reduction with fusion L4-S1 via various approaches have been described previously. To date and to our knowledge, there have been no reports describing complete reduction and monosegmental fusion for high-grade developmental spondylolisthesis. METHODS: A total of 27 consecutive patients with severe developmental spondylolisthesis of L5/S1 were treated with operative reduction via temporary instrumentation of L4 and monosegmental fusion of L5/S1. The clinical and radiographic outcomes were retrospectively reviewed for each case at a minimum of 2 years (mean follow-up of 45 months; range 24-80). Mean age at surgery was 16.7 years (range 9-29). RESULTS: At most recent follow-up, 23 patients were pain free. There were 4 patients who had moderate pain. All radiographic parameters improved. Mean slippage improved from 74.0% before surgery to 11.0% after surgery and 10.0% at latest follow-up. Slip angle improved from 36.6 degrees before surgery to 8.1 degrees after surgery and 7.6 degrees at latest follow-up. Sacral inclination improved from 34.6 degrees before surgery to 43.4 degrees after surgery and 47.2 degrees at latest follow-up. The overall sagittal profile improved dramatically. There was 1 superficial infection, 6 patients had L5 root symptoms (5 of these resolved, 1 patient had a persistent sensory deficit). Four patients had decompensation at L4/5 (2 reoperations). CONCLUSIONS: Reduction of L5/S1 with temporary instrumentation of L4 and monosegmental fusion of L5/S1 is an effective technique for the treatment of high-grade developmental spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal profile can be achieved. Fusion of the primarily healthy segment L4/5 can be avoided.
STUDY DESIGN: A retrospective review of the clinical and radiographic outcomes of reduction by temporary instrumentation of L4 and monosegmental fusion of L5/S1 in patients with high-grade developmental spondylolisthesis. OBJECTIVE: To assess the efficacy of this technique in the reduction of local deformity and correction of overall sagittal profile. SUMMARY OF BACKGROUND DATA: In situ fusions as well as partial reduction with fusion L4-S1 via various approaches have been described previously. To date and to our knowledge, there have been no reports describing complete reduction and monosegmental fusion for high-grade developmental spondylolisthesis. METHODS: A total of 27 consecutive patients with severe developmental spondylolisthesis of L5/S1 were treated with operative reduction via temporary instrumentation of L4 and monosegmental fusion of L5/S1. The clinical and radiographic outcomes were retrospectively reviewed for each case at a minimum of 2 years (mean follow-up of 45 months; range 24-80). Mean age at surgery was 16.7 years (range 9-29). RESULTS: At most recent follow-up, 23 patients were pain free. There were 4 patients who had moderate pain. All radiographic parameters improved. Mean slippage improved from 74.0% before surgery to 11.0% after surgery and 10.0% at latest follow-up. Slip angle improved from 36.6 degrees before surgery to 8.1 degrees after surgery and 7.6 degrees at latest follow-up. Sacral inclination improved from 34.6 degrees before surgery to 43.4 degrees after surgery and 47.2 degrees at latest follow-up. The overall sagittal profile improved dramatically. There was 1 superficial infection, 6 patients had L5 root symptoms (5 of these resolved, 1 patient had a persistent sensory deficit). Four patients had decompensation at L4/5 (2 reoperations). CONCLUSIONS: Reduction of L5/S1 with temporary instrumentation of L4 and monosegmental fusion of L5/S1 is an effective technique for the treatment of high-grade developmental spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal profile can be achieved. Fusion of the primarily healthy segment L4/5 can be avoided.
Authors: Nabil A Ebraheim; Jiayong Liu; Satheesh K Ramineni; Haitham Elsamaloty; Alan H Lee; Vishwas Patil; Richard A Yeasting; Huilin Yang Journal: Surg Radiol Anat Date: 2008-07-19 Impact factor: 1.246
Authors: Francesco Lombardi; Viola Marta Custodi; Raffaelino Pugliese; Andrea Risso; Paolo Gaetani; Giorgio Butti Journal: Eur Spine J Date: 2013-10-22 Impact factor: 3.134
Authors: Ralph T Schär; Martin Sutter; Anne F Mannion; Andreas Eggspühler; Dezsö Jeszenszky; Tamas F Fekete; Frank Kleinstück; Daniel Haschtmann Journal: Eur Spine J Date: 2017-01-31 Impact factor: 3.134