Spondylolysis and spondylolisthesis after five-level lumbosacral laminectomy for selective posterior rhizotomy in cerebral palsy

Abstract

Of 163 children who have undergone five-level lumbosacral laminectomies for selective posterior rhizotomy, 20% of those re-X-rayed post-operatively (19/99) have developed incidental isthmic spondylolysis or grade I spondylolisthesis. The majority of patients were ambulatory, active, spastic diplegics. There were five children with isthmic defects at L3-4, three at L4-5 and 11 at L5-S1. Six of the 19 children had grade I spondylolisthesis, but none were symptomatic nor has there been any evidence of further slipping to date. It is postulated that the laminectomy, associated lordosis and increased mobility after rhizotomy may be factors in the causation.

Replacement La, inoplasty in Selective Dorsal Rhizotomy: Possible Protection against the Development of Musculoskeletal Pain

“…However, evidence exists of postlaminectomy lum bar spinal deformity [4,5]. Recently reported is the increased incidence of spondylolysis and spondylolisthe sis following five-level laminectomy for SDR [6], This is suggestive that such a procedure may not be without con sequence.…”

“…The prima ry objective is prevention of spinal instability with associ ated neural compromise [2], Osseous protection of the neural elements from trauma is also a reported benefit [3], Initial concerns about the increased operative time and the development of pseudoarthrosis [2] and spinal canal stenosis have been largely resolved [3], However, justifi cation for the procedure presently rests on theoretical grounds. Therefore, although postlaminectomy deformity of the pediatric lumbar spine has been reported [4][5][6], the evidence for consequent instability is lacking. This study retrospectively reviews 35 patients who have undergone SDR between 1990 and 1992 at Arkansas Children's Hospital.…”

Selective Dorsal Rhizotomy for the Treatment of Childhood Spasticity

“…Children post SDR can also be bothered by low back pain. Peter reported a 4% incidence and Steinbok a 14% incidence of this [10,11]. The risk for these back problems occurring can be lessened by taking care to keep the laminotomy/laminectomy well medial to the facet joints.…”

Infra-Conus Single-Level Laminectomy for Selective Dorsal Rhizotomy: Technical Advance

“…Given the effectiveness of SDR across different surgical techniques, the goal of surgical variation is to simplify surgical technique and reduce any possible morbidity. Prior variations in SDR technique utilizing multiple laminectomies to identify the nerve roots as they exit [14] continue to raise concern for possible contribution to spinal deformity after SDR [15]. The issue of spinal deformity after surgical intervention is somewhat contentious as it is well known that patients with CP are at higher risk of spinal deformity because of their underlying neuromuscular disease [16].…”