Two-stage decompression, reduction, and interbody fusion for lumbosacral spondyloptosis through a posterior approach using Ilizarov external fixation.

The suggested methods of treatment for spondyloptosis have included benign neglect, in situ fusion and variations, decompression and fusion, and vertebrectomy (the Gaines procedure). On review of the literature, the authors found no previous report in the English-language literature in which external fixation was used in the treatment of spondyloptosis. This 33-year-old woman with spondyloptosis underwent a 2-stage operation involving decompression, reduction, and posterior fusion in which an Ilizarov external fixator and transpedicular fixation system were used. Spondylolisthesis with a slippage of angle 78 degrees and > 100% slippage was partially reduced to 30 degrees and 60% without neurological alterations and without complications. The postoperative follow-up showed marked improvement in her symptoms and a good cosmetic result. Reconstructed computed tomography scanning at 18 months demonstrated complete fusion. The use of external fixation in the treatment of spondyloptosis may be preferable because of its neurological safety, despite the longer duration of treatment, than single-stage operation. The authors believe posterior decompression of the cauda equina, partial reduction of the spondylolisthetic deformity, interbody fusion, and stabilization with an external fixator and transpedicular fixation system can be successfully and safely used as a 2-stage treatment for adult high-grade spondyloptosis.