Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Bouras, Theodoros; Korovessis, Panagiotis

doi:10.1007/s00590-014-1560-7

Cited by 72 publications

(55 citation statements)

References 69 publications

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“…The surgical management of symptomatic low grade IS in the adult population is well described in the literature and generally involves interbody fusion with instrumentation at the level of spondylolisthesis. 13 Use of minimally invasive techniques has been shown to be as effective as traditional open techniques for management of single level fusions for DS. 2 However, there is limited evidence examining the use of MIS-TLIF for treatment of lowgrade IS (grade I versus grade II).…”

Section: Discussionmentioning

confidence: 99%

“…8,11,13 Indications for surgical management of IS include failed conservative management for greater than 6 months, progressive symptomatic low-grade IS, or any high-grade IS in order to prevent neurologic dysfunction, additional deformity, and pain. 7,11,13,14 However, due to the potentially complicated anatomy and technical difficultly associated with the complex three-dimensional deformity, the treatment options for high-grade IS remain controversial. 8 Common procedures performed to treat IS include decompression, in situ or instrumented fusion and reduction, anterior (ALIF), lateral (LLIF), posterior (PLIF), and transforaminal (TLIF) lumbar interbody fusion.…”

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Grade I Versus Grade II Isthmic Spondylolisthesis

et al. 2020

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Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is often used to treat lowgrade isthmic spondylolisthesis (IS). No studies have compared surgical outcomes for grade I and II IS following MIS-TLIF. Therefore, the objective of the current study was to compare outcomes between patients with grade I and II IS following MIS-TLIF. Methods: A retrospective cohort analysis was performed on a prospectively maintained database of patients who underwent a primary 1-level MIS-TLIF for treatment of IS between 2007 and 2015. Grade I patients underwent a unilateral tubular approach with a single interbody cage and bilateral pedicle screw instrumentation. Grade II patients underwent a bilateral tubular approach with bilateral interbody cage and pedicle screw placement. Baseline patient demographics and characteristics were compared using Student t test and v 2 analysis. Differences in peri-and postoperative outcomes were assessed using Poisson regression with robust error variance or linear regression adjusted for perioperative variables. Results: A total of 58 patients with IS underwent MIS-TLIF; 21 (36.2%) were grade I and 37 (63.8%) were grade II. The grade I cohort was younger (42.2 versus 50.6 years, P ¼ .029); no other differences in preoperative variables were observed. No significant differences in operative time, estimated blood loss, length of hospital stay, postoperative visual analogue scale scores, or complication and revision rates were demonstrated between cohorts. Arthrodesis rate was lower in the grade I cohort, though not statistically significant. Conclusions: Despite the grade I cohort being younger with less-severe diagnoses, the grade II cohort experienced similar outcomes. This finding may be due to the grade II cohort receiving bilateral cages, potentially providing a better fusion environment. Clinical Relevance: These results suggest that MIS-TLIF provides sufficient stabilization and fusion for treatment of grade II IS despite increased vertebral body displacement. In addition, MIS-TLIF with bilateral approach and interbody cage placement should be examined for treatment of high-grade IS cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Grade I Versus Grade II Isthmic Spondylolisthesis

et al. 2020

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“…Pars repair techniques have been used in an attempt to spare spinal motion segments and minimize fusing the spine. These techniques include direct pars repair with cortical screws, indirect pars repair with posterior wiring, or a combination of pedicle screw instrumentation and some type of instrumentation to apply compression (laminar hooks, wiring, among others) (5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In adult cases or older pediatric patients with significant degenerative disc disease or high-grade spondylolisthesis, fusion techniques have been recommended (18,(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

“…This condition is a common cause of back pain in the pediatric population. Historically, non-operative treatments have had a very high success rate (3)(4)(5). Pain that is not manageable with conservative treatment, however, presents a dilemma for spine surgeons.…”

Section: Introductionmentioning

confidence: 99%

Indirect pars repair for pediatric isthmic spondylolysis: a case series

Raudenbush¹,

Chambers²,

Silverstein³

et al. 2017

J. Spine Surg.

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“…This often results in an acquired bilateral defect, or spondylolysis, of the pars interarticularis at L5 and anterolisthetic progression of L5 over S1. 5,6 In conjunction with the intervertebral discs, the main function of the facet joints are to counteract anterior shear and torsion forces at their specific vertebral segment, acting as static stabilizers. Due to the interruption of the posterior elements, a lowgrade IS patient has an inherent instability that may result in greater anterolisthetic progression compared to a low-grade DS patient.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Isthmic Versus Degenerative Spondylolisthesis

et al. 2020

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Background: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is a common surgical procedure for treatment of degenerative spondylolisthesis (DS) but remains controversial for treatment of isthmic spondylolisthesis (IS). Few studies have compared IS and DS outcomes after MIS TLIF. Therefore, the objective of the current study was to compare outcomes of patients with IS and DS after MIS TLIF.Methods: A retrospective cohort analysis was performed on a prospectively maintained database of patients who underwent a primary, 1-level MIS TLIF for grade I or II IS or DS. Grade I and II DS and grade I IS patients were treated with MIS TLIF via a unilateral tubular approach, whereas the grade II IS patients were treated via a bilateral tubular approach. Differences in patient demographics and preoperative characteristics were assessed using independent sample t tests and v 2 tests. The type of spondylolisthesis and its effect on postoperative outcomes was analyzed using Poisson regression with robust error variance (binary outcomes) or linear regression (continuous outcomes) adjusted for preoperative characteristics. Subgroup analysis comparing grade I IS versus DS and grade II IS versus DS was performed.Results: A total of 223 patients were included (IS: 62 [27.8%]; DS: 161 [72.2%]). IS patients were younger (P , .001), had a lower comorbidity burden (P , .001), and a greater incidence of grade II spondylolisthesis (P , .001) at L5-S1 (P , .001) than the DS cohort. Patients with IS experienced longer operative times (P , .001) and lower, but not statistically significant, arthrodesis rates compared to the DS cohort. No differences were observed in the remaining preoperative patient characteristics, perioperative or postoperative outcomes.Conclusions: Despite being younger and having a lower comorbidity burden than the DS cohort, similar outcomes were observed after MIS TLIF for IS patients.Level of Evidence: 3. Clinical Relevance: These results suggest MIS TLIF is an appropriate treatment option for IS patients despite the increased instability inherent with IS. Minimally Invasive SurgeryKeywords: minimally invasive spine surgery, transforaminal lumbar interbody fusion, degenerative spondylolisthesis, isthmic spondylolisthesis, unilateral interbody cage, bilateral interbody cage, low-grade spondylolisthesis

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Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Cited by 72 publications

References 69 publications

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Grade I Versus Grade II Isthmic Spondylolisthesis

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Grade I Versus Grade II Isthmic Spondylolisthesis

Indirect pars repair for pediatric isthmic spondylolysis: a case series

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Isthmic Versus Degenerative Spondylolisthesis

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