Retrospective radiographic analysis of anterior lumbar fusion for high grade lumbar spondylolisthesis

Kalani, Maziyar A.; Kouloumberis, Pelagia; Richards, Alexandra E.; Lyons, Mark; Davila, Victor J.; Neal, Matthew T.

doi:10.21037/jss-20-597

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…Most studies investigating the reduction of spondylolisthesis after ALIF have relatively low sample size numbers, with case numbers between 5 and 65 participants (3-5, 11, 13, 14, 17) and most studies having fewer than 30 participants (4,5,11,14,17). With 96 cases, we present, to our knowledge, one of the most extensive single-center studies investigating this topic.…”

Section: Discussionmentioning

confidence: 97%

“…et al ( 2016) found an LL increase of 7° (16) and Caprariu et al (2021) an increase of 8° (16, 17). Kalani et al detected increases in mean SL, de ned as L4-S1 lordosis, and overall (L1-S1) LL after ALIF with dorsal instrumentation of 23.6% and 16.6%, respectively (11).…”

Section: Discussionmentioning

confidence: 99%

“…Our ndings are similar to the reductions reported in the literature. In 2020, Kalani et al reported a mean reduction of spondylolisthesis by 58.7% in combined procedures with anterior fusion and dorsal instrumentation (11) 2013) report a mean spondylolisthesis reduction of 30% (3,4). In a meta-analysis of 2019, Cho et al ( 12) compared anterior and posterior approaches for spondylolisthesis treatment.…”

Section: Discussionmentioning

confidence: 99%

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Reduction of spondylolisthesis and restoration of lumbar lordosis after anterior lumbar interbody fusion (ALIF)

Aspalter

Stefanits

Maier

et al. 2023

Preprint

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Background Anterior lumbar interbody fusion (ALIF) is a well-established surgical treatment option for various diseases of the lumbar spine, including spondylolisthesis. This study aimed to evaluate the postoperative correction of spondylolisthesis and restoration of lumbar and segmental lordosis after ALIF Methods Patients with spondylolisthesis who underwent ALIF between 2013 and 2019 were retrospectively assessed. We assessed the following parameters pre-and postoperatively (6-months follow-up): Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), lumbar lordosis (LL), segmental lordosis (SL), L4/S1 lordosis, and degree of spondylolisthesis. Results 96 patients were included. In 84 cases (87.50%), additional dorsal instrumentation was performed. The most frequent diagnosis was isthmic spondylolisthesis (73.96%). VAS was reduced postoperatively, from 70 to 40, as was ODI (50–32%). LL increased from 59.15° to 64.45°, as did SL (18.95° to 28.55°) and L4/S1 lordosis (37.90° to 44.00°). Preoperative spondylolisthesis was 8.90mm and was reduced to 6.05mm postoperatively. Relative spondylolisthesis was 21.63% preoperatively and 13.71% postoperatively. All clinical and radiological improvements were significant (all p < 0.001). No significant difference considering the lordosis values nor spondylolisthesis was found between patients who underwent ALIF surgery without dorsal instrumentation and patients who received additional dorsal instrumentation. Venous laceration was the most frequent complication (10.42%). Conclusions With ALIF, good clinical results and safe and effective reduction of spondylolisthesis and restoration of lordosis can be achieved. Additional dorsal instrumentation does not significantly affect postoperative lordosis or spondylolisthesis. Individual vascular anatomy must be reviewed preoperatively before considering ALIF.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reduction of spondylolisthesis and restoration of lumbar lordosis after anterior lumbar interbody fusion (ALIF)

Aspalter

Stefanits

Maier

et al. 2023

Preprint

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“…In non-EDS patients, addressing high-grade spondylolisthesis has often involved a 2-stage anterior and posterior approach, and an open posterior approach has also been reported. [12][13][14] Open surgical techniques were associated with significant morbidities. [15][16][17] Compared with open spinal fusion surgery, MI spinal surgery is associated with less tissue injury, less blood loss, and shorter hospital stay, whereas the benefits regarding complications and functional outcomes remain inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Sagittal adjusting screws for the correction of grade IV spondylolisthesis in a patient with Ehlers-Danlos syndrome: illustrative case

Tong

Hanson

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Ehlers-Danlos syndrome (EDS) and its connective tissue laxity often result in high-grade lumbosacral spondylolisthesis. Patients present with debilitating symptoms and neurological deficits. Reports of surgical techniques in non-EDS patients for the treatment of high-grade lumbosacral spondylolisthesis mainly described an open approach, multilevel fusions, and multiple stages with different circumferential approaches. Sagittal adjusting screws (SASs) can be used in a minimally invasive (MI) fashion, allowing intraoperative reduction. OBSERVATIONS A 17-year-old female with EDS presented to the authors’ institute with severe lower back and left L5 radicular pain in 2017. She presented with a left foot drop and difficulty ambulating. Magnetic resonance imaging showed grade IV L5–S1 spondylolisthesis. She underwent lumbar fusion for intractable back pain with radiculopathy. Intraoperatively, percutaneous SASs and extension towers were used to distract the L5–S1 disc space and reduce the spondylolisthesis. MI transforaminal lumbar interbody fusion was completed with significant symptomatic relief postoperatively. The patient was discharged to home 3 days postoperatively. Routine follow-up visits up to 3 years later demonstrated solid fusion radiographically and favorable patient-reported outcomes. LESSONS The authors used SASs in a MI approach to successfully correct and stabilize grade IV spondylolisthesis in an EDS patient with a favorable long-term patient-reported outcome.

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“…Nonoperative management tends to be considered for minimally symptomatic or asymptomatic adolescents with low-grade spondylolisthesis (12). At the same time, surgical treatment provides a better outcome for those who are unresponsive to conservative therapy, such as individuals with high-grade spondylolisthesis, continual symptomatology, or neurological deficits (13)(14)(15)(16). In terms of surgical management, arthrodesis has shown to be effective for lumbar spondylolisthesis (17), but consensus has yet to be reached on whether reduction or arthrodesis in situ is the more suitable technique for adolescent spondylolisthesis.…”

Section: Introductionmentioning

confidence: 99%

Is reduction or arthrodesis in situ the optimal choice for adolescent spondylolisthesis?—a systematic review and meta- analysis

Zhan¹,

Xi²,

Li³

et al. 2021

Ann Palliat Med

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Background: Controversy remains about the choice of reduction or arthrodesis in situ for surgical management of adolescent spondylolisthesis, while no systematic review and meta-analysis were performed to determine which one is the optimal surgical choice. The study aims to compare outcomes of the two surgical strategies for adolescent spondylolisthesis. Methods: A comprehensive search was performed through PubMed, Web of Science, Cochrane Library, Embase, OVID/MEDLINE, CBM, CNKI, and Wanfang with a cutoff date of May 21 st , 2021. Search terms included "spondylolisthesis", "in situ" and "reduction". Included studies had following characteristics: (I) participants: adolescents with spondylolisthesis. (II) Intervention: reduction following arthrodesis. (III) Control: arthrodesis in situ. (IV) Outcomes: postoperative clinical and/or radiographic results. (V) Study design: randomized controlled trial (RCT), cohort or case-control study. Data were analyzed with Review Manager 5.4, and risk of bias assessment of studies was assessed via Newcastle-Ottawa quality assessment scale (NOS).Results: Six cohort studies were included, with NOS scores of all ≥6. There were no significant differences regarding operative time [mean difference (MD) =152.62; 95% [confidence interval (CI)]: −54.02 to 359.26; I 2 =96%; P=0.15], blood loss (MD =786.61; 95% CI: −646.82 to 2,220.04; I 2 =90%; P=0.28), patient satisfaction (MD =1.98; 95% CI: 0.72 to 5.43; I 2 =0%; P=0.18), neurological complications (MD =1.02; 95% CI: 0.25 to 4.18; I 2 =0%; P=0.98), or total complications (MD =0.59; 95% CI: 0.29 to 1.19; I 2 =0%; P=0.14). However, patients undergoing reduction achieved better radiographic results: fusion rate (MD =3.09; 95% CI: 1.22 to 7.84;I 2 =40%; P=0.02), postoperative pseudarthrosis (MD =0.35; 95% CI: 0.15 to 0.79; I 2 =24%; P=0.01), percentage of slippage (MD =−20.58; 95% CI: −26.32 to −14.84; I 2 =0%; P<0.00001), and slipping angle (MD =−10.05; 95% CI: −14.55 to −5.54; I 2 =0%; P<0.0001). And no overt publication bias was found in the studies.Discussion: Both reduction and arthrodesis in situ in adolescent spondylolisthesis are safe and demonstrate good clinical outcomes. However, reduction showed better radiographic results and was associated with less pseudarthrosis, better relief of disability, and improvements in self-image. In conclusion, reduction may be the optimal choice compared with arthrodesis in situ, but further verification of these findings is recommended using RCTs.

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Retrospective radiographic analysis of anterior lumbar fusion for high grade lumbar spondylolisthesis

Cited by 5 publications

References 23 publications

Reduction of spondylolisthesis and restoration of lumbar lordosis after anterior lumbar interbody fusion (ALIF)

Reduction of spondylolisthesis and restoration of lumbar lordosis after anterior lumbar interbody fusion (ALIF)

Sagittal adjusting screws for the correction of grade IV spondylolisthesis in a patient with Ehlers-Danlos syndrome: illustrative case

Is reduction or arthrodesis in situ the optimal choice for adolescent spondylolisthesis?—a systematic review and meta- analysis

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