Treatment of Severe Spondylolisthesis in Adolescence With Reduction or Fusion In Situ: Long-term Clinical, Radiologic, and Functional Outcome

Poussa, Mikko; Remes, Ville; Lamberg, Tommi; Tervahartiala, Pekka; Schlenzka, Dietrich; Yrjönen, Timo; Osterman, K; Seitsalo, Seppo; Helenius, Ilkka

doi:10.1097/01.brs.0000201401.17944.f7

Cited by 109 publications

(87 citation statements)

References 31 publications

(27 reference statements)

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“…Although slip reduction can provide better function of the lumbosacral junction, at least in theory, several authors have recommended in situ fusion surgery rather than reduction surgery, considering postoperative complications such as neurological deficits. 1,[4][5][6]11,13,17,20,26,27,29 On the other hand, previous reports have detailed that pseudarthrosis rates were decreased by reduction. 2,3,12,19,28,30,31,33 Therefore, surgery for isthmic spondylolisthesis requires management of both postoperative neurological deficits and the union rate.…”

Section: Discussionmentioning

confidence: 99%

Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes

Okuda

Oda

Yamasaki

et al. 2014

SPI

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Object The management of isthmic spondylolisthesis remains controversial, especially with respect to reduction. There have been no reports regarding appropriate slip reduction. The purpose of this study was to investigate the following issues: 1) surgical outcomes of posterior lumbar interbody fusion (PLIF) with total facetectomy for low-dysplastic isthmic spondylolisthesis, including postoperative complications; 2) effects of slip reduction on surgical outcomes; and 3) appropriate slip reduction. Methods A total of 106 patients who underwent PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis and who were followed for at least 2 years were reviewed. The average follow-up period was 8 years. Surgical outcomes, including the scores assessed using the Japanese Orthopaedic Association scoring system, the recovery rate, and postoperative complications were investigated. As for radiographic evaluations, pre- and postoperative slip and disc height, instrumentation failure, and fusion status were also examined. Results The pre- and postoperative average Japanese Orthopaedic Association scores were 14 (range 3–25) and 25 (range 11–29) points, respectively. The average recovery rate was 73% (range 0%–100%). The average pre- and postoperative slip was 24% and 10%, respectively. A significant correlation between postoperative slip and clinical outcomes was found; clinical outcomes were better in proportion to slip reduction. Although no statistical difference was detected in clinical outcomes between postoperative slip of less than 10% and from 10% to 20%, patients with postoperative slip of more than 20% showed significantly worse clinical outcomes. Postoperative complications included neurological deficits in 7 patients (transient motor loss in 6 and permanent motor loss in 1), instrumentation failures in 7, adjacent-segment degeneration in 5, and nonunion in 4. Instrumentation failures occurred significantly more often in patients with more slip reduction, although slip reduction did not affect the other postoperative complications. All patients with instrumentation failure showed postoperative slip reduction within 10%. Conclusions The use of PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis appears to produce satisfactory clinical outcomes, with an average of 73% recovery rate and few postoperative complications. Although clinical outcomes were better in proportion to slip reduction, excessive reduction caused instrumentation failure, and patients with less reduction demonstrated worse clinical outcomes. Appropriate reduction resulted in a postoperative slip ranging from 10% to 20%.

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Section: Discussionmentioning

confidence: 99%

Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes

Okuda

Oda

Yamasaki

et al. 2014

SPI

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“…We, therefore, recommend decompression only when patients present with radicular symptoms. Though there is no significant reduction of slip in insitu fusion as against instrumented reduction, the ODI and SRS scores were significantly better in the fusion in situ group than in the reduction group [10]. Disc degeneration above the fusion was more common in the reduction group than in the fusion in situ group on longterm MRI follow-up [13].…”

Section: Results-analysis Of Outcomementioning

confidence: 99%

“…Despite modern neurophysiologic monitoring (somatosensory and motor evoked potentials), these instrumented reduction procedures present the possibility of severe neurological complications [10]. According to available literature, instrumented reduction of L5-S1 highgrade spondylolisthesis is associated with an 8-30% rate of postoperative neurological compromise, mostly consisting of nerve root injuries or cauda equina syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Despite no reduction in the translational deformity, uninstrumented in situ fusion offers better longterm clinical, radiological and functional outcomes than instrumented reduction has in the same patient population [10]. In situ posterolateral fusion in children with severe spondylolisthesis was followed by deterioration of olisthesis in 25% of the cases [12].…”

Section: Discussionmentioning

confidence: 99%

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Surgical treatment of high-dysplastic developmental spondylolisthesis in a child: A case report

Uvaraj¹,

Bosco²

2014

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Case Report: This case describes a 12-year-old girl with high-grade dysplastic L5-S1 spondylolisthesis with instability pain, managed with uninstrumented in situ circumferential fusion. The patient showed excellent clinical, functional and radiological outcomes at followup of 48th month. Since, plain radiographs and conventional computed tomography (CT) scan failed to show convincing anterior intercorporal fusion, we did fusion analysis with a multi-slice helical tomography scan with multiplanar reconstruction. The reconstructed multiplanar images defined a good posterolateral and anterior intercorporal fusion, Conclusion: Uninstrumented in situ circumferential fusion is a safe and effective surgical option in the management of high-grade L5-S1 dysplastic spondylolisthesis in children and adolescents. Multi-slice helical CT scan with multiplanar reconstruction is the modality of choice in the evaluation of interbody fusion and its progression. IJCRI publishes

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“…Lonner et al showed that reduction benefits included a decrease in shear stresses, restoration of sagittal alignment and lumbosacral spine balance, and improvement in clinical deformity [18]; however, Poussa et al showed that the fusion in situ group seemed to perform better in almost all clinical parameters measured. These findings suggest that fusion in situ should be considered as the method of choice in isthmic spondylolisthesis [21].…”

Section: Introductionmentioning

confidence: 98%

Analysis of factors related to prognosis and curative effect for posterolateral fusion of lumbar low-grade isthmic spondylolisthesis

Feng

Shen

Yimin

et al. 2008

International Orthopaedics (SICOT)

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The objective of this study was to select factors related to the prognosis and curative effect for posterolateral fusion (PLF) of lumbar low-grade isthmic spondylolisthesis (LGIS). Of 125 patients who accepted PLF treatment, 119 obtained solid union in this prospective study. Statistical analysis was used to evaluate factors related to the prognosis and curative effect. Spondylolisthetic position (L4, L5), gender and postoperative percent disc height were not significant factors for the prognosis and curative effect. Length of disease history (LDH), preoperative Japanese Orthopaedic Association (JOA) score and postoperative percentage of slipping (% slip) were significantly related to postoperative JOA score and postoperative improved JOA score. LDH and postoperative % slip were significantly related to postoperative recovery rate. LDH, preoperative JOA score and postoperative % slip were independent related factors for the prognosis and improvement of LGIS. LDH and postoperative % slip were independent related factors for the curative effect. However, age, gender, spondylolisthetic position and postoperative percent disc height were not significant factors.

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Treatment of Severe Spondylolisthesis in Adolescence With Reduction or Fusion In Situ: Long-term Clinical, Radiologic, and Functional Outcome

Abstract: The fusion in situ group seems to perform better in almost all clinical parameters measured. These findings suggest that fusion in situ should be considered as a method of choice in severe L5 isthmic spondylolisthesis.

Cited by 109 publications

References 31 publications

Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes

Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes

Surgical treatment of high-dysplastic developmental spondylolisthesis in a child: A case report

Analysis of factors related to prognosis and curative effect for posterolateral fusion of lumbar low-grade isthmic spondylolisthesis

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