One-Stage Decompression and Posterolateral and Interbody Fusion for Severe Spondylolisthesis

Roca, Joaquím; Ubierna, María Teresa Viadero; Cáceres, Enrique Cerrillo Martín de; Iborra, M.

doi:10.1097/00007632-199904010-00019

Cited by 75 publications

(44 citation statements)

References 48 publications

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“…3,9,28,30,38 In addition to laminectomy decompression of the cauda equina can be accomplished by resecting the dome of the sacrum. 3,5,7,16,17,23,34,39,40 Smith and Bohlman performed a sacral dome osteotomy when the preoperative myelogram demonstrated a high-grade block due to the sacral prominence. 23 The sacral osteotomy was performed following laminectomies of L4 through S1 and before placement of their fibular dowel graft.…”

Section: Operative Treatmentmentioning

confidence: 99%

Evaluation and Management of High-Grade Spondylolisthesis in Adults

DeWald

Vartabedian²,

Rodts³

et al. 2005

Spine

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Adult patients with high-grade spondylolisthesis not responding to nonoperative treatment can be stabilized in situ with posterior instrumentation from L4 to S1. The use of adjunctive fixation with iliac screws and/or transvertebral screws is recommended for the adult patient, particularly in revision or unstable cases. Reduction of the slipped vertebrae remains controversial for all grades of spondylolisthesis and more so for the adult patient. Partial reduction of the slip angle, decreasing the lumbosacral kyphosis, should be considered if significant sagittal malalignment is present or to improve arthrodesis success. Anterior column support should be performed, particularly when reduction has been obtained. Anterior column support can be performed, anteriorly or posteriorly, either by using inter vertebral body structural strut support or with a transsacral fibular dowel to improve stability and success of arthrodesis.

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Section: Operative Treatmentmentioning

confidence: 99%

Evaluation and Management of High-Grade Spondylolisthesis in Adults

DeWald

Vartabedian²,

Rodts³

et al. 2005

Spine

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“…Concerns regarding the original Bohlman transsacral interbody fusion technique have included graft site morbidity, late graft fracture, and incomplete reduction of the slip angle of the spondylolisthesis. 2,3,6,9,15,16,27,33,35 Given these issues, several authors have advocated complete reduction of anterolisthesis by using pedicle screw instrumentation. This approach has resulted in L-5 nerve root palsies in some patients, as well as instrumentation failures, particularly at the sacrum.…”

mentioning

confidence: 99%

High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons

Hart

Domes

Goodwin

et al. 2014

SPI

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Object The ideal surgical management of high-grade spondylolisthesis remains unclear. Concerns regarding the original Bohlman transsacral interbody fusion technique with stand-alone autologous fibular strut include late graft fracture and incomplete reduction of lumbosacral kyphosis. The authors' goal was to evaluate the radiographic and surgical outcomes of patients treated for high-grade spondylolisthesis with either transsacral S-1 screws or standard pedicle screw fixation augmenting the Bohlman posterior transsacral interbody fusion technique. Methods A retrospective review of patients who underwent fusion for high-grade spondylolisthesis in which a Bohlman oblique posterior interbody fusion augmented with either transsacral or standard pedicle screw fixation was performed by 4 spine surgeons was completed. Estimated blood loss, operating time, perioperative complications, and need for revision surgery were evaluated. Upright pre- and postsurgical lumbar spine radiographs were compared for slip percent and slip angle. Results Sixteen patients (12 female and 4 male) with an average age of 29 years (range 9–66 years) were evaluated. The average clinical follow-up was 78 months (range 5–137 months) and the average radiographic follow-up was 48 months (range 5–108 months). Ten L4–S1 and 6 L5–S1 fusions were performed. Five fibular struts and 11 titanium mesh cages were used for interbody fusion. Six patients had isolated transsacral screws placed, with 2 (33%) of the 6 requiring revision surgery for nonunion. No nonunions were observed in patients undergoing spanning pedicle screw fixation augmenting the interbody graft. Six patients experienced perioperative complications including 3 iliac crest site infections, 1 L-5 radiculopathy without motor involvement, 1 deep vein thrombosis, and 1 epidural hematoma requiring irrigation and debridement. The average estimated blood loss and operating times were 763 ml and 360 minutes, respectively. Slip percent improved from an average of 62% to 37% (n = 16; p < 0.01) and slip angle improved from an average of 18° to 8° (n = 16; p < 0.01). No patient experienced L-5 or other motor deficit postoperatively. Conclusions The modified Bohlman technique for treatment of high-grade spondylolisthesis has reproducible outcomes among multiple surgeons and results in significant improvements in slip percent and slip angle. Fusion rates were high (14 of 16; 88%), especially with spanning instrumentation augmenting the oblique interbody fusion. Rates of L-5 motor deficit were low in comparison with techniques involving reduction of the anterolisthesis.

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“…Sie ist jedoch nicht in der Lage, die Fehlstellung und damit das sagittale Profil zu korrigieren. Auch verbleiben pathologisch erhöhte Scherkräfte, die zu einer sehr hohen Pseudarthrosenrate führen [3,4,7,8,18,19]. Trotz konsolidierter Fusion kann die Fehlstellung weiter zunehmen [4,8,20].…”

Section: Diskussionunclassified

Anatomische Reposition und monosegmentale Fusion bei hochgradiger dysplastischer Spondylolisthese L5/S1

Ruf

Melcher

Merk

et al. 2006

Z Orthop Ihre Grenzgeb

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One-Stage Decompression and Posterolateral and Interbody Fusion for Severe Spondylolisthesis

Abstract: Posterior decompression of the spinal canal combined with anterior and posterior arthrodesis performed at one stage through a posterior approach is a safe and effective technique for managing severe spondylolisthesis.

Cited by 75 publications

References 48 publications

Evaluation and Management of High-Grade Spondylolisthesis in Adults

Evaluation and Management of High-Grade Spondylolisthesis in Adults

High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons

Anatomische Reposition und monosegmentale Fusion bei hochgradiger dysplastischer Spondylolisthese L5/S1

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