Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Spondylolisthesis is a prevalent spine disease that recent studies estimate could be detected in 9% of the population. High-grade spondylolisthesis (HGS), however, is much less frequent, which makes it difficult to develop a general recommendation for its treatment. Posterior transdiscal fixation was proposed in 1994 for HGS, and the use of spine navigation could make this technique more accessible and reduce the morbidity associated with the procedure. The purpose of this study was to present a case series involving adult patients with HGS and correct spinal alignment who were treated with transdiscal pedicle screw placement guided with neuronavigation and compare the results to those achieved previously without image guidance.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors reviewed all cases in which adult patients with correct spinal alignment were treated for HGS with posterior transdiscal instrumentation placement guided with navigation between 2014 and 2016 at their institution. The authors compared preoperative and postoperative spinopelvic parameters on standing radiographs as well as Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for low-back pain. Follow-up CT and MRI studies and postoperative radiographs were evaluated to identify any screw malplacement or instrumentation failure. Any other intraoperative or postoperative complications were also recorded.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Eight patients underwent posterior transdiscal navigated instrumentation placement during this period, with a mean duration of follow-up of 16 months (range 9–24 months). Six of the patients presented with Meyerding grade III spondylolisthesis and 2 with Meyerding grade IV. In 5 cases, L4–S1 instrumentation was placed, while in the other 3 cases, surgery consisted of transdiscal L5–S1 fixation. There was no significant difference between preoperative and postoperative spinopelvic parameters. However, there was a statistically significant improvement in the mean VAS score for low-back pain (6.5 ± 1.5 vs 4 ± 1.7) and the mean ODI score (49.2 ± 19.4 vs 37.7 ± 22) (p = 0.01 and p = 0.012, respectively). Six patients reduced their use of pain medication. There were no intraoperative or postoperative complications during the hospital stay, and as of the most recent follow-up, no complications related to pseudarthrosis or hardware failure had been observed.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Treatment with posterior transdiscal pedicle screws with in situ fusion achieved good clinical and radiological outcomes in patients with HGS and good sagittal spinal balance. The use of navigation and image guidance was associated with improved results in this technique, including a reduction in postoperative and intraoperative complications related to screw malplacement, pseudarthrosis, and instrumentation failure.</jats:p></jats:sec>

Sacrolumbar Interbody Fusion (SLIF): Feasibility, Technical Nuances, Biomechanical Assessment, and Clinical Outcomes

“…Such nonunions were not encountered in our study, indicating that SLIF is probably more robust than previous techniques. Fourth, this study showed that SLTS can be implanted under standard intraoperative fluoroscopy without requiring image guidance, as was previously proposed 22 . These innovations may profoundly affect clinical practice.…”

Delta Fixation for High-Grade Spondylolisthesis: Technique, Indications and an Adult Case Report

“…Another noteworthy study was by Juan Delgado-Fernandez et al [11] in which they studied posterior transdiscal fusion in HGS cases in their tertiary care center. Six Meyerding grade III spondylolisthesis and 2 with Meyerding grade IV cases were enrolled.…”

Simulation with 3D Neuronavigation for Learning Cortical Bone Trajectory Screw Placement

“…16 In the last few years, there have been new proposals for different trajectories for pedicle screws in different spine pathologies. 17 Cortical bone trajectory (CBT) screws, that have been proposed by Santoni et al 18 obtain a better pullout strength in osteoporotic patients, has good biomechanical properties and also allow a minimal invasive technique due to a lesser exposure. Although, as Dabbous et al 19 explained, this technique is quite straightforward because of the similarity to the traditional procedure, we believe that a learning curve exists and that the technique has to be trained before using it as a standard procedure in a department.…”