Vertebral Slip Morphology in Dysplastic Spondylolisthesis as a Criterion for the Choice of the L5/S1 Support (ALIF, PLIF, Fibular Graft) in Surgical Treatment

Abstract

Dysplastic spondylolisthesis is a severe pathological condition, based on dysplastic changes in the lumbosacral part of the spine, that causes the asymmetry of the lumbosacral junction. The appropriate therapeutic algorithm remains controversial. As the gold standard, the surgical reposition of the slipped vertebra and 360° fusion of the affected spinal segment is preferred. Thirty-two patients were operated on between the years 2005 and 2018. Different techniques of 360° fusion, based on the severity of the displacement of the affected vertebral segment, were used. Herein, the advantages and disadvantages of different techniques of interbody fusion are discussed. The slippage and retention after reduction in the vertebrae are evaluated prior to the operation, postoperatively, one year after the surgery, and during follow-up, which was 7 years on average (minimum 2 years for a follow-up). Complications associated with the surgery are evaluated, in addition to the operation time, blood loss, spinopelvic parameters, and patient satisfaction with the surgery. All surgical techniques improved the slippage compared to preoperative conditions. The retention of the reposition was not changed significantly in postoperative controls. The incidence of neurological complications reached 12.5%. Surgical treatment is the only treatment option that successfully addressed the pathological principle of dysplastic spondylolisthesis. All of the surgical methods used led to restoring the symmetry of the lumbar spine, and to the improvement in both radiological parameters and the alleviation of subjective difficulties. The aim of this article is to summarize surgical methods in patients having dysplastic spondylolisthesis with a slip of more than 25%, who were operated on, and to determine the optimal treatment algorithm according to the severity of the slip.