Reduction and monosegmental fusion for lumbar spondylolisthesis with a long tab percutaneous pedicle screw system: “swing” technique

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>With the development of minimally invasive procedures, percutaneous pedicle screw systems have been used to attempt to correct spondylolisthesis. No previous studies have reported on reduction measures using long tab percutaneous pedicle screws for spondylolisthesis. Additional intraoperative correction has been proposed with the “swing” technique. This study was conducted to compare the efficacy of standard minimally invasive transforaminal interbody fusion (MIS-TLIF) with the efficacy of MIS-TLIF with the “swing” technique (MIS-TLIF and swing) in lumbar spondylolisthesis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This was a matched-control study and included 30 consecutive patients who were followed up for 6 months after surgery. Of those patients, 15 were treated with operative reduction via MIS-TLIF with the “swing” technique, whereas the other 15 were treated with the standard MIS-TLIF procedure. The swing technique is a new reduction procedure for use with long tab percutaneous screws. In the swing technique, the entire system is swung back and forth several times after all constructs are placed. Only patients with Meyerding grade I or II lumbar spondylolisthesis were included in the study (18 with grade I and 12 with grade II). Perioperative and clinical outcomes, radiological parameters (Meyerding grade, percentage of slip, slip correction rate, segmental lordosis, and lumbar lordosis) were compared between groups at 6 months after surgery.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Demographic data did not differ significantly between the 2 groups. Postoperative clinical outcomes showed significant improvement in both groups. Postoperative radiological parameters showed that the degree of spondylolisthesis (swing: 4.7% vs standard: 8.9%) and reduction rate (swing: 77.3% vs standard: 57.1%) favored the swing group. The swing technique effectively decreased the degree of spondylolisthesis (swing: 24.1% to 4.7% vs standard: 21.8% to 8.9%). No complications related to the procedure were reported.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>MIS-TLIF with the “swing” technique with long tab percutaneous pedicle screws is a safe and effective reduction method for monosegmental spondylolisthesis. This technique cannot only alleviate symptoms but also achieve nearly completely reduction of slippage.</jats:p></jats:sec>

Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case

“…Reduction screws are used in the thoracolumbar spine in instances of trauma and spondylolisthesis for both open and minimally invasive surgical applications. 24 , 25 Until recently, reduction screws have not been available for the cervical spine, which changed in 2019 with the approval of the Symphony OCT system (DePuy Synthes) by the Food and Drug Administration. These are polyaxial screws that allow 10 mm of threaded reduction over the length of the tulip head.…”

What Affects Segmental Lordosis of the Surgical Site after Minimally Invasive Transforaminal Lumbar Interbody Fusion?

“…Surgery was performed by a single surgeon at a single institute who has written numerous articles about MIS-TLIF and has obtained more than 15 years of experience with performing MIS-TLIF operations. 5 6 24 25 26 27 28 The surgical techniques for MIS-TLIF were the same as those described in our previous study. 5 6 25 We also performed contralateral decompression, although contralateral facets were not removed.…”

“… 5 6 24 25 26 27 28 The surgical techniques for MIS-TLIF were the same as those described in our previous study. 5 6 25 We also performed contralateral decompression, although contralateral facets were not removed. We used a specific process to place cages more anterior for more effective creation of lordosis.…”

Surgical treatment of spondylolisthesis using long arm screw: A literature review

“…Study conducted by Park et al [ 17 ] used minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) mono-segmental reduction in lumbar spondylolisthesis. This study used long tab type percutaneous screw system regarding its simplicity and similarity to conventional pedicle screw system, but easier for manipulation in the last step of surgery.…”

“…This study includes only patients with Meyerding grade I or II. Swing technique resulted in better improvement of degree of spondylolisthesis and reduction rate compared to conventional screw systems [ 17 ]. Other studies also showed successful procedure in high-grade spondylolisthesis [ 18 ].…”