Treatment of L5-S1 spondyloptosis by staged L5 resection with reduction and fusion of L4 onto S1 (Gaines procedure).

STUDY DESIGN AND
OBJECTIVES: A retrospective study was performed on the two-stage Gaines procedure for the treatment of spondyloptosis, evaluating indications, techniques, results, and patient satisfaction. SUMMARY OF BACKGROUND DATA: Sixteen consecutive patients from two institutions were included. Their average age was 24 years. Average follow-up was 3.9 years, with 11 patients included in follow-up 2 or more years. Ten patients (63%) had a preoperative neurologic deficit--three with cauda equina syndrome, one with foot drop. All patients had severe back or radicular symptoms and significant disability or severe deformity.
METHODS: Patient examinations, interviews, chart review, and radiographic measurements all were performed independently. A subjective questionnaire was administered to each patient comparing preoperative with postoperative changes in pain, function, and appearance, as well as their overall outcome assessment.
RESULTS: Postoperatively, 12 patients (75%) had early neurologic deficits, with seven of these having had a preoperative deficit. Four of these seven had a persistent deficit at follow-up, one with a permanent foot drop and three with documented weakness that was still improving at follow-up. The patient with preoperative foot drop remained unchanged, and the remaining seven patients with early deficit all recovered within 1 year. All three patients with preoperative cauda equina syndrome recovered postoperatively. The subjective questionnaire results revealed extremely high patient satisfaction. They reported significant improvement in pain, function, and appearance.
CONCLUSIONS: Despite the relatively high complication rate, with appropriate patient selection, planning, and surgical technique, this procedure appears to be a sound method for treating severe cases of spondyloptosis, yielding very high patient satisfaction.