“In situ” fusion or reduction in high-grade high dysplastic developmental spondylolisthesis (HDSS)

Martiniani, Monia; Lamartina, Claudio; Specchia, Nicola

doi:10.1007/s00586-012-2230-2

Cited by 45 publications

(35 citation statements)

References 25 publications

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“…This has contributed to the correction of the patients' clinical deformity and therefore the overall spinal balance which in turn may decrease adjacent level disease in the future. These improvements follow other published data 7,13 . In this case series the fusion was always extended to LV4 vertebra.…”

Section: Discussionsupporting

confidence: 91%

“…In-between, partial reductions and trans-sacral fixation using screws or fibular allografts have also been suggested 8,24,26 . Although the concept of reducing spinal deformity before fusion is attractive, the issue of surgical reduction versus in situ fusion remains controversial 13,16,19,27 . Harms and Jeszenszky 3 suggested a modification of the traditional PLIF that involved the placement of bone graft and titanium mesh cages, via a transforaminal route (TLIF), into the disc space that had previously been distracted using pedicle screw instrumentation.…”

Section: Introductionmentioning

confidence: 99%

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Instrumented Reduction and TLIF for Adult Grade Four Isthmic Spondylolisthesis.

Taha¹

2012

Egyptian Spine Journal

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Background Data: The management of high grade spondylolisthesis remains controversial; with advocates for in-situ fusion and others for reduction. Purpose: To report the clinical and radiological results and the operative technique of a personal case series of adult Grade 4 isthmic spondylolisthesis that underwent instrumented reduction and TLIF. Study Design: Retrospective clinical and radiological evaluation of a case series. Patients and Methods: Twelve patients with grade 4 isthmic spondylolisthesis were retrospectively reviewed. All patients presented with disabling back pain, 83% with leg pain, 66% crouched while walking and 16.5% presented with caudae quina syndrome. They all underwent posterior decompression, instrumented reduction and TLIF at the slipped level. Results: The mean preoperative VAS for back pain of 7.3 dropped to 2.2 and of 8 to 1.9 for leg pain. The mean preoperative ODI of 41 dropped to 12 at the latest follow up. Solid fusion was obtained in 75% with another 16.7% stable constructs without bridging bony fusion. Conclusion: Instrumented surgical reduction and TLIF provides a safe and effective way of treating adult high grade spondylolisthesis. (2012ESJ023)

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Instrumented Reduction and TLIF for Adult Grade Four Isthmic Spondylolisthesis.

Taha¹

2012

Egyptian Spine Journal

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“…22 Although in situ fusion is an effective treatment for lower grades of pediatric spondylolisthesis, studies have reported that this technique results in a high rate of pseudarthrosis, slip progression, and persistent cosmetic deformity in HDDS patients. 2,20 In patients with HDDS treated using in situ fusion, adjacent mobile segments in the upper lumbar spine, pelvis orientation, and thoracic spine compensate for the local sagittal imbalance of the lumbosacral junction. The result is a suboptimal, but satisfactory global sagittal balance of the trunk, even in the most severe grade of slipping.…”

Section: Discussionmentioning

confidence: 99%

Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity

Thomas

Bachy

Courvoisier

et al. 2015

SPI

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OBJECT Spinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS. METHODS The records of 15 patients with HDDS who underwent surgery between 2005 and 2010 were reviewed. The treatment consisted of L4–sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position. Radiographic measurements included pelvic incidence, sacral slope, lumbar lordosis, and thoracic kyphosis. The degree of lumbosacral kyphosis was evaluated by the lumbosacral angle. Because of the small number of patients, nonparametric tests were considered for data analysis. RESULTS Preoperative lumbosacral kyphosis and L-5 anterior slip were corrected by instrumentation. Transient neurological complications were noted in 5 patients. Statistical analysis showed a significant increase of thoracic kyphosis on 6-month postoperative and final follow-up radiographs (p < 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p < 0.001) and between preoperative and final follow-up radiographs (p < 0.001). CONCLUSIONS Based on the authors' observations, this technique resulted in an effective reduction of L-5 anterior slip and significant reduction of lumbosacral kyphosis (from 69.8° to 105.13°). Due to complete reduction of lumbosacral kyphosis and anterior trunk displacement associated with L-5 anterior slipping, lumbar lordosis progressively decreased and thoracic kyphosis progressively increased postoperatively. Adjusting the sagittal trunk balance produced not only pelvic anteversion, but also reciprocal adjustment of lumbar lordosis and thoracic kyphosis, creating a satisfactory level of compensated global sagittal balance.

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“…Lamartina also introduced the concepts of Severity Index and Unstable Zone that could be always defined and studied, when surgeons decide to treat this kind of listhesis. Other authors [12][13][14][15][16] proposed postero-lateral fusion only, even without decompression [17,18], as surgical treatment, showing relative good results, in their series.…”

Section: Introductionmentioning

confidence: 97%

Treatment of high-grade spondylolisthesis with Schanz recoil screws: our experience

et al. 2013

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Purpose Spondylolisthesis surgical treatment is often difficult with higher degree of slip and related techniques still debated. We have taken into consideration double thread recoil Schanz screws. This system should allow the best reduction of the slip, treating only the affected vertebrae. Methods We retrospectively analyzed 46 patients affected by grade II or higher spondylolisthesis, treated with circumferential arthrodesis using Schanz screws. Duration of surgery, complications, reduction, and rate of fusion have been recorded. Results We found that duration of surgery and complications were similar or slightly lower if compared to our standard Posterior Lumbar Interbody Fusion procedures. However, radiological results and clinical outcome appear better in cases treated with Schanz screws. Conclusions Fixation system with Schanz screws seems to be effective in reducing the slip, treating only the affected level, in high grade of spondylolisthesis.

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“In situ” fusion or reduction in high-grade high dysplastic developmental spondylolisthesis (HDSS)

Cited by 45 publications

References 25 publications

Instrumented Reduction and TLIF for Adult Grade Four Isthmic Spondylolisthesis.

Instrumented Reduction and TLIF for Adult Grade Four Isthmic Spondylolisthesis.

Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity

Treatment of high-grade spondylolisthesis with Schanz recoil screws: our experience

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