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Longo UG, De Salvatore S, Denaro L, Mazzola A, Piergentili I, Denaro V. Epidemiology of Spondylolisthesis: A Nationwide Study From 2001 to 2016 in the Italian Population. Clin Spine Surg 2024; 37:E297-E302. [PMID: 38531826 DOI: 10.1097/bsd.0000000000001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/29/2023] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Epidemiological study. OBJECTIVE This study aimed to evaluate the annual incidence of spondylolisthesis requiring surgery in Italy and the epidemiological characteristics of the patients. BACKGROUND The health care system continues to incur considerable costs as a result of low-back pain. Segmental instability of the lumbar spine has attracted significant interest from researchers as a potential mechanism leading to mechanical low back pain. MATERIALS AND METHODS The Italian Ministry of Health's National Hospital Discharge Reports database in the 2001-2016 period was considered. RESULTS A total of 55,804 hospital admissions for spondylolisthesis were performed in Italy. The cumulative incidence was 6.8 interventions for every 100,000 Italian adult residents. The highest amount of procedures was recorded in the 65-69 years of age group. The overall patient's age was 56.8 ± 15.1 years. The 62.2% of patients were females. The average hospital stay length was 8.1 ± 7.3 days. On average, older patients require more days of hospital stay. Over the study period, it was observed a decreasing trend in the average number of days of hospital stay. The main primary diagnoses included were "acquired spondylolisthesis" [International Classification of Diseases (ICD) code: 738.4; 57.8%] and "spondylolisthesis" (ICD code: 756.12; 42.2%). By far, the main primary procedure performed was "lumbar and lumbosacral fusion of the anterior column, posterior technique" (ICD code: 81.08; 60.3%). CONCLUSIONS Spondylolisthesis is a problem in Italy and a leading cause requiring spine surgery. Females were the majority of patients requiring surgery for spondylolisthesis. However, for younger age groups, males showed superior or equal need for spine surgery. The socioeconomic impact of spondylolisthesis in Italy is relevant, affecting patients still in the working population. The increasing trend of spine surgery for spondylolisthesis in Italy may be attributable to the widespread diffusion of modern diagnostic and surgical technologies. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, Rome
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome
- Department of Orthopedics, Children's Hospital Bambino Gesù, Palidoro, Rome
| | - Luca Denaro
- Department of Neurosciences, Academic Neurosurgery, University of Padua, Padua
| | - Alessandro Mazzola
- Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, Rome
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome
| | - Ilaria Piergentili
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, Rome
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome
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Bredow J, Prasse T, Beyer F, Budde S, Sobottke R. [Slipped vertebrae (Spondylolysis): the underestimated weak point of the (pre)professional football player-an algorithm]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:427-437. [PMID: 38777842 DOI: 10.1007/s00132-024-04510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Isthmic spondylolysis represents the most common cause of spinal pain in adolescent athletes. This article provides an overview of the classification, diagnosis, and treatment options for these conditions, including conservative and operative measures. It also provides a treatment pathway to how young athletes with spondylolysis should be treated. DIAGNOSTICS Diagnostic imaging techniques are essential for an accurate diagnosis, with CT scans providing additional information for surgical planning. TREATMENT Conservative treatment focuses on activity modification and physiotherapy, with a phased approach tailored to individual patient needs. Operative intervention may be considered if conservative measures fail, with minimally invasive techniques such as Buck's screw fixation showing promising results. The decision between conservative and operative management should consider factors of the patients' individual profile. In this paper, we present the first treatment algorithm for the treatment of isthmic spondylolysis. Long-term prognosis varies, with most athletes able to return to sport following treatment.
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Affiliation(s)
- Jan Bredow
- Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Porz am Rhein gGmbH, Urbacher Weg 19, 51149, Köln, Deutschland.
| | - Tobias Prasse
- Klinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Frank Beyer
- Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Porz am Rhein gGmbH, Urbacher Weg 19, 51149, Köln, Deutschland
| | - Stefan Budde
- Klinik für Unfallchirurgie und Orthopädie, Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Deutschland
| | - Rolf Sobottke
- Klinik für Wirbelsäulenchirurgie, Neurochirurgie und Spezielle Orthopädie Rhein-Maas Klinikum GmbH, Würselen, Deutschland
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Konieczny MR, Jäger M. [Spondylolisthesis]. Schmerz 2024; 38:157-166. [PMID: 38446187 DOI: 10.1007/s00482-024-00804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.
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Affiliation(s)
- M R Konieczny
- Klinik für Wirbelsäulenchirurgie, Orthopädische Klinik Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter (Ruhr), Deutschland.
| | - M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, St. Marien Hospital Mülheim a. d. Ruhr, Mühlheim a. d. Ruhr, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus, Essen, Deutschland
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Konieczny MR, Jäger M. [Spondylolisthesis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:931-940. [PMID: 37792012 DOI: 10.1007/s00132-023-04443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/05/2023]
Abstract
Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.
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Affiliation(s)
- M R Konieczny
- Klinik für Wirbelsäulenchirurgie, Orthopädische Klinik Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter (Ruhr), Deutschland.
| | - M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, St. Marien Hospital Mülheim a. d. Ruhr, Mühlheim a. d. Ruhr, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus, Essen, Deutschland
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Lan Z, Yan J, Yang Y, Xu Q, Jin Q. A Review of the Main Classifications of Lumbar Spondylolisthesis. World Neurosurg 2023; 171:94-102. [PMID: 36584893 DOI: 10.1016/j.wneu.2022.12.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study was conducted to review the main classifications and to present author's recommendations. METHODS Review of English language medical literature. RESULTS In recent decades, classification systems of lumbar spondylolisthesis have been proposed based on many factors, from essential causes to combinations of imaging features and clinical manifestations; the latter type of system is more clinically practical. We have systematically listed the main types of classification systems in chronological order to make it easier for clinicians to find the type of diagnosis and treatment suitable for their patients and develop an appropriate treatment plan. CONCLUSIONS Classification systems for lumbar spondylolisthesis have been proposed that have been based on the study of the essential causes or the combination of imaging features and clinical manifestations; the latter type of system is more clinically practical. We still have much work to do in exploring a more applicable classification of lumbar spondylolisthesis.
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Affiliation(s)
- Zhibin Lan
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China; Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiangbo Yan
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yang Yang
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qu Xu
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qunhua Jin
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China; Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
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Koucheki R, Rocos B, Gandhi R, Lewis SJ, Lebel DE. Surgical management of high-grade paediatric spondylolisthesis: meta-analysis and systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:436-446. [PMID: 36197510 DOI: 10.1007/s00586-022-07408-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/28/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE There is currently no consensus on the management of high-grade spondylolisthesis (HGS) in paediatric populations. The objective of this analysis is to compare the outcomes of reduction followed by fusion (RFF) or in situ fusion (ISF) in paediatric patients. METHODS Using major databases, a systematic literature search was performed. Primary studies comparing ISF with RFF in paediatric and adolescent patients were identified. Study data including patient-reported outcomes, complications, and spinopelvic parameters were collected and analysed. RESULTS Seven studies were included, comprising 97 ISF and 131 RFF. Average patient age was 14.4 ± 2.1 years and follow up was 8.2 ± 5.1 years. Patients undergoing RFF compared to patients undergoing ISF alone were less likely to develop pseudarthrosis (RR 0.51, 95% CI, [0.26, 0.99], p = 0.05). On average, RFF led to 11.97º more reduction in slip angle and 34.8% more reduction in sagittal translation (p < 0.00001) compared to ISF. There was no significant difference between patient satisfaction and pain at follow up. Neurologic complications and reoperation rates were not significantly different. CONCLUSIONS Both RFF and ISF are effective techniques for managing HGS. Performing a reduction followed by fusion reduces the likelihood of pseudarthrosis in paediatric patients. The difference between risk of neurologic complications, need for reoperation, patient satisfaction, and pain outcomes did not reach statistical significance. Correlation with patient-reported outcomes still needs to be further explored. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.
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Affiliation(s)
- Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, Toronto, ON, Canada
| | - Brett Rocos
- Department of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Orthopaedic Surgery, Toronto Western Hospital (UHN), Toronto, ON, Canada
| | - Rajiv Gandhi
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Orthopaedic Surgery, Toronto Western Hospital (UHN), Toronto, ON, Canada
| | - Stephen J Lewis
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - David E Lebel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
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Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia) 2022; 14:36917. [PMID: 35910544 DOI: 10.52965/001c.36917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022] Open
Abstract
Spondylolisthesis refers to the anterior, lateral, or posterior slippage of a superior vertebral disc over the adjacent inferior disc, and is often separated into categories based on the causative etiology. Spondylolisthesis is often asymptomatic but may present with low back pain and neurogenic claudication which is worsened with spinal extension and activity. A detailed history and physical exam, along with appropriate imaging tests are useful in making the diagnosis. Conservative therapy is first-line and includes pain management with physical therapy. Patients who fail conservative therapy may consider surgical decompression, stabilization, and fusion. This review aims to discuss the epidemiology, pathophysiology, presentation, and treatment options of spondylolisthesis.
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Affiliation(s)
| | | | | | | | | | - Alan Kaye
- Louisiana State University Shreveport
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Wu HH, Brown K, Flores M, Cazzulino A, Swarup I. Diagnosis and Management of Spondylolysis and Spondylolisthesis in Children. JBJS Rev 2022; 10:01874474-202203000-00010. [PMID: 35611834 DOI: 10.2106/jbjs.rvw.21.00176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Spondylolysis is defined as a defect of the pars interarticularis, and spondylolisthesis is defined as a slippage of a vertebra relative to the immediately caudal vertebra. » Most cases of spondylolysis and low-grade spondylolisthesis can be treated nonoperatively. Depending on a patient's age, nonoperative treatment may include a thoracolumbosacral orthosis (TLSO), physical therapy, and activity modification. Bracing and physical therapy have been found to be more effective than activity modification alone. » Patients with dysplastic spondylolisthesis are at higher risk for progression and should be monitored with serial radiographs every 6 to 9 months. » Operative management is recommended for symptomatic patients with failure of at least 6 months of nonoperative management or patients with high-grade spondylolisthesis. » Surgical techniques include pars defect repair, reduction, and fusion, which may include posterior-only, anterior-only, or circumferential fusion.
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Song B, You SK, Lee JE, Lee SM, Cho HH. Prevalence of Incidentally Detected Spondylolysis in Children. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:127-137. [PMID: 36237345 PMCID: PMC9238207 DOI: 10.3348/jksr.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 11/15/2022]
Abstract
Purpose To assess the prevalence of incidentally detected lumbar spondylolysis in children. Materials and Methods We retrospectively reviewed the data of 809 patients under the age of 11 years (mean age, 7.0 ± 2.7 years; boys:girls = 479:330) who underwent abdominal and pelvic CT between March 2014 and December 2018. We recorded the presence, level, and laterality (unilateral or bilateral) of spondylolysis. Patients were divided into two groups based on the presence of spondylolysis: the spondylolysis (SP) and non-SP groups. Results In total, 21 cases of spondylolysis were detected in 20 patients (20/809, 2.5%). The mean age of the SP group was higher than that of the non-SP group (7.8 ± 1.8 vs. 6.9 ± 2.7 years, p > 0.05). The prevalence of spondylolysis in boys was higher than that in girls (15/479 [3.1%] vs. 5/330 [1.5%], p > 0.05). The prevalence of spondylolysis in school-age children (6–10 year olds) was higher than that in preschool-age children (0–5 year olds) (17/538 [3.2%] vs. 3/271 [1.1%], p > 0.05). L5 was the most common level of spondylolysis (76.2%); one 8-year-old boy had twolevel spondylolysis. One case of isthmic spondylolisthesis was detected in a 10-year-old boy (1/809, 0.1%). There were 11 unilateral spondylolysis cases (11/21, 52.4%). Conclusion In our study, the prevalence of spondylolysis in children under the age of 11 was 2.5%. The prevalence was higher in boys than in girls and in school-age than in preschool-age children, despite the lack of any statistically significant differences.
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Affiliation(s)
- Boram Song
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun-Hae Cho
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
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Pinter ZW, Kolz JM, Elder BD, Sebastian AS. Is Reduction and Fusion Required for High-grade Spondylolisthesis? Clin Spine Surg 2021; 34:237-240. [PMID: 32554987 DOI: 10.1097/bsd.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022]
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Fedorchuk C, Comer RD, Stockwell TL, Stockwell J, Stockwell R, Lightstone DF. Prevalence of Cervical Spondylolisthesis in the Sagittal Plane Using Radiographic Imaging in a Pediatric Population: A Cross Sectional Analysis of Vertebral Subluxation. J Radiol Case Rep 2021; 15:1-18. [PMID: 34276876 PMCID: PMC8253154 DOI: 10.3941/jrcr.v15i6.4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cervical Spondylolisthesis (CS) in children is under-studied. This cross-sectional study reports the CS prevalence in children. MATERIALS & METHODS Subjects were selected from a private practice. Inclusion criteria: 0-17 years of age; documented demographics and health complaints; neutral lateral cervical (NLC) radiographs; and CS. Exclusion criteria: pseudosubluxation. RESULTS 342 NLC radiographs were analyzed. 73 (21.3%) had CS greater than 2.0 mm. 42 (57.5%) had no musculoskeletal complaints. 8 (2.3%) had the presence of a CS greater than 3.5 mm. 5 (62.5%) had no musculoskeletal complaints. DISCUSSION Pediatric populations endure various traumas. Pediatric cervical spine biomechanics has an increased risk of upper cervical spine injury. Regular spinal radiographic exams may help identify serious spinal conditions in their pre-symptomatic state. CONCLUSION CS in pediatric populations is under-studied. CS is present in children and adolescents with and without symptoms.
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Yokoe T, Tajima T, Sugimura H, Kubo S, Nozaki S, Yamaguchi N, Morita Y, Chosa E. Predictors of Spondylolysis on Magnetic Resonance Imaging in Adolescent Athletes With Low Back Pain. Orthop J Sports Med 2021; 9:2325967121995466. [PMID: 33889645 PMCID: PMC8040580 DOI: 10.1177/2325967121995466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Spondylolysis and undiagnosed mechanical low back pain (UMLBP) are the main causes of low back pain (LBP) in adolescent athletes. No studies have evaluated the difference in clinical and radiographic factors between these 2 conditions. Furthermore, it remains unclear which adolescent athletes with LBP should undergo advanced imaging examination for spondylolysis. Purpose: To compare the clinical and radiographic factors of adolescent athletes with spondylolysis and UMLBP who did not have neurological symptoms or findings before magnetic resonance imaging (MRI) evaluation and to determine the predictors of spondylolysis findings on MRI. Study Design: Cohort study, Level of evidence, 3. Methods: The study population included 122 adolescent athletes aged 11 to 18 years who had LBP without neurological symptoms or findings and who underwent MRI. Of these participants, 75 were ultimately diagnosed with spondylolysis, and 47 were diagnosed with UMLBP. Clinical factors and the following radiographic parameters were compared between the 2 groups: spina bifida occulta, lumbar lordosis (LL) angle, and the ratio of the interfacet distance of L1 to that of L5 (L1:L5 ratio, %). A logistic regression analysis was performed to evaluate independent predictors of spondylolysis on MRI scans. Results: Significantly more athletes with spondylolysis were male (82.7% vs 48.9%; P < .001), had a greater LL angle (22.8° ± 8.1° vs 19.3° ± 8.5°; P = .02), and had a higher L1:L5 ratio (67.4% ± 6.3% vs 63.4% ± 6.6%; P = .001) versus athletes with UMLBP. A multivariate analysis revealed that male sex (odds ratio [OR], 4.66; P < .001) and an L1:L5 ratio of >65% (OR, 3.48; P = .003) were independent predictors of positive findings of spondylolysis on MRI scans. Conclusion: The study findings indicated that sex and the L1:L5 ratio are important indicators for whether to perform MRI as an advanced imaging examination for adolescent athletes with LBP who have no neurological symptoms and findings.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
- Takuji Yokoe, MD, Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan ()
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Hiroshi Sugimura
- Department of Radiology, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Shinichirou Kubo
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Shotarou Nozaki
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
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What is the Optimal Surgical Method for Achieving Correction and Avoiding Neurological Complications in Pediatric High-grade Spondylolisthesis? J Pediatr Orthop 2021; 41:e217-e225. [PMID: 33165266 DOI: 10.1097/bpo.0000000000001707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Controversy persists in the treatment of high-grade spondylolisthesis (HGS). Surgery is recommended in patients with intrusive symptoms and evidence debates the competing strategies. This study compares the radiologic outcomes and postoperative complications at a minimum of 2 years follow-up for patients with HGS treated with instrumented fusion with partial reduction (IFIS) with those treated with reduction, decompression, and instrumented fusion (RIF). We hypothesize that IFIS leads to a lower rate of complication and revision surgery than RIF. METHODS A retrospective comparative methodology was used to analyze consecutive HGS treated surgically between 2006 and 2017. Patients diagnosed with ≥grade 3 spondylolisthesis treated with arthrodesis before the age of 18 years with a minimum of 2 years follow-up were included. Patients were excluded if surgery did not aim to achieve arthrodesis or was a revision procedure. Cases were identified through departmental and neurophysiological records. RESULTS Thirty patients met the inclusion criteria. Mean follow-up was 4 years. Ten patients underwent IFIS and the remaining 20 underwent RIF. The 2 groups showed no difference in demographics, grade of slip, deformity or presenting symptoms. Of 10 treated with IFIS, the SA reduced by a mean of 10 degrees and C7 sagittal vertical line changed by 31 mm. In the RIF cohort, SA reduced by 16 degrees and C7 sagittal vertical line reduced by 26 mm. PT was unchanged in both groups. In IFIS cohort, 2 patients showed postoperative weakness, resolved by 2 years. None required revision surgery. In the RIF group, 4 sustained dural tears and 1 a laminar fracture, 7 showed postoperative weakness or dysaesthesia, 3 of which had not resolved by 2 years. Eight patients underwent unplanned further surgery, 3 for pseudarthrosis. CONCLUSIONS RIF and IFIS show similar radiologic outcomes. RIF shows a higher rate of unplanned return to surgery, pseudarthrosis and persisting neurological changes. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Zhang D, Zhang W, Zhou X, Jin S. [Comparison of CLIF and TLIF in treatment of degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:210-216. [PMID: 33624476 DOI: 10.7507/1002-1892.202008092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To observe the difference between crenel lateral interbody fusion (CLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS) combined with lumbar spinal stenosis (LSS). Methods The clinical data of DLS combined with LSS patients meeting the selection criteria admitted between May 2018 and May 2019 were retrospectively analyzed. According to different surgical methods, the patients were divided into CLIF group (33 cases) and TLIF group (32 cases). There were no significant differences ( P>0.05) between the two groups in gender, age, disease duration, lesion segments, lumbar bone mineral density, degree of lumbar spondylolisthesis, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), intervertebral space height, intervertebral foramen height, lumbar lordosis (LL), and segmental lordosis (SL). The operation time, intraoperative blood loss, and perioperative complications were recorded and compared between the two groups. Lumbar CT scan was performed at last follow-up to compare the intervertebral fusion rate between the two groups. Intervertebral space height, intervertebral foramen height, LL, and SL were measured before operation, at 2 weeks, 3 months after operation, and at last follow-up. VAS score and ODI were used to evaluate the pain and improvement of the quality of life of the patients. Results There were no neurological and vascular complications in the two groups. The operation time and intraoperative blood loss in CLIF group were significantly less than those in TLIF group ( P<0.05). Patients in both groups were followed up for a median time of 18 months. All the incisions healed by first intention except 1 incision in TLIF group because of poor blood glucose control. No complications such as bedsore, falling pneumonia, and deep venous thrombosis were found in both groups. At last follow-up, the intervertebral fusion rates in CLIF and TLIF group were 90.91% (30/33) and 93.75% (30/32), respectively, showing no significant difference ( χ 2=0.185, P=0.667). The VAS score, ODI, intervertebral space height, intervertebral foramen height, LL, and SL were significantly improved in both groups at each time point after operation ( P<0.05). Except that VAS score in CLIF group was significantly lower than that in TLIF group at 2 weeks after operation ( Z=-4.303, P=0.000), there were no significant differences in VAS score and ODI between the two groups at other time points ( P>0.05). The intervertebral space height, intervertebral foramen height, LL, and SL in CLIF group were significantly higher than those in TLIF group at each time point after operation, and the differences were significant ( P<0.05). Conclusion CLIF in the treatment of DLS combined with LSS can achieve the similar effectiveness with traditional TLIF, and has such advantages as minimal invasion and faster recovery.
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Affiliation(s)
- Di Zhang
- Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen Guangdong, 518033, P.R.China;Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450000, P.R.China
| | - Wenming Zhang
- Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450000, P.R.China
| | - Xianwei Zhou
- Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450000, P.R.China
| | - Song Jin
- Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen Guangdong, 518033, P.R.China
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Health-Related Quality of Life Outcomes of Instrumented Circumferential Spinal Fusion for Pediatric Spondylolisthesis: A Comparison With Age and Sex Matched Healthy Controls. Spine (Phila Pa 1976) 2020; 45:E1572-E1579. [PMID: 32925683 DOI: 10.1097/brs.0000000000003681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study on the clinical, radiographic, and the health-related quality of life (HRQOL) outcomes in adolescents with spondylolisthesis undergoing instrumented circumferential spinal fusion compared with age and sex matched controls. OBJECTIVE To determine the outcomes of pediatric spondylolisthesis patients minimum 2 years after surgery and to compare their HRQOL with age and sex matched controls. SUMMARY OF BACKGROUND DATA There is limited evidence of the HRQOL of adolescent spondylolisthesis patients after surgery and no studies comparing it with healthy controls. METHODS Twenty-six consecutive adolescents (mean age 14.7 yr, range 10-18 yr) undergoing instrumented reduction with intercorporeal spinal fusion for spondylolisthesis (11 low-grade, 15 high-grade) by a single orthopedic surgeon were included to this study cohort and matched by age and sex with two controls. The HRQOL was measured with Scoliosis Research Society-24 (SRS-24) questionnaire before surgery, 6 months and 2 years after the surgery. RESULTS The mean (SD) vertebral slip in the low-grade patients was 25% (13%) and 67% (15%) in the high-grade patients and 6% (7%) and 21% (25%) postoperatively, respectively (P ≤ 0.041 for both comparisons). Three (12%) patients developed a non-union during follow-up. None of the patients developed a persistent neurologic deficit, but two (8%) patients presented with chronic postsurgical pain persisting 24 months. Seven (27%) of the patients had reoperations for any reason during the follow-up. Pain and activity domains of the SRS-24 improved significantly from preoperative to 2-year follow-up (P ≤ 0.007 for both). SRS pain, self-image, function domains, and total score were significantly worse as compared with the 52 controls (P ≤ 0.020 for all comparisons). CONCLUSION Risk of non-union is relatively low after instrumented spinal reduction in adolescents with spondylolisthesis. HRQOL improves significantly after instrumented reduction and circumferential spinal fusion in adolescents with spondylolisthesis, but remains at statistically lower level than in the controls. LEVEL OF EVIDENCE 2.
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Joelson A, Danielson BI, Hedlund R, Wretenberg P, Frennered K. Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis. Spine Deform 2020; 8:743-750. [PMID: 32065380 DOI: 10.1007/s43390-020-00085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/29/2019] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Observational study. OBJECTIVES To evaluate adjacent segment disk degeneration (ASD) after fusion without attempted reduction at a young age for high-grade isthmic spondylolisthesis. The clinical relevance of ASD remains unclear. Previous studies have shown that spinal fusion is associated with increased ASD but without influence on clinical outcome. Since high-grade spondylolisthesis is a severe kyphotic deformity, one could hypothesize that fusion without attempted reduction in young patients leads to accelerated adjacent segment disk degeneration in adult life. METHODS Anterior and posterior disk heights were evaluated on supine radiographs of the spine 8 years and 29 years after fusion without attempted reduction for high-grade spondylolisthesis and also on standing radiographs 8 years and 33 years after surgery. Pelvic parameters were evaluated on standing radiographs obtained 33 years after surgery. Health-related quality of life was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire. RESULTS One segment above fusion the anterior disk height significantly decreased on standing radiographs. Two segments above the fusion, the anterior disk height significantly decreased on supine as well as on standing radiographs. The largest reduction was found two segments above the fusion where the disk height was reduced from 33 to 28% of anterior vertebral height between the measurements at mean 8 years and mean 33 years after surgery. There were no statistically significant decreases in posterior disk heights in any measurement. The disk height showed a moderate negative correlation to PT. There was no correlation between disk height reduction and SRS-22r outcome. CONCLUSIONS In our long-term follow-up of fusion without attempted reduction for high-grade spondylolisthesis in young patients, we found only a minor but statistically significant reduction in adjacent segment disk height which had no apparent impact on clinical outcome. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Anders Joelson
- Department of Orthopaedics, Orebro University School of Medical Sciences, Orebro University Hospital, 701 85, Orebro, Sweden.
| | - Barbro I Danielson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Rune Hedlund
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Per Wretenberg
- Department of Orthopaedics, Orebro University School of Medical Sciences, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Karin Frennered
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, 413 45, Gothenburg, Sweden
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Abstract
STUDY DESIGN Bibliographic analysis. OBJECTIVE The aim of this study is to identify the most cited studies on lumbar spondylolisthesis and report their impact in spine field. METHODS Thomson Reuters Web of Science-Science Citation Index Expanded was searched using title-specific search "spondylolisthesis." All studies published in English language between 1900 and 2019 were included with no restrictions. The top 100 cited articles were identified using "Times cited" arranging articles from high to low according to citation count. Further analysis was made to obtain the following items: article title, author's name and specialty, country of origin, institution, journal of publication, year of publication, citations number, study design. RESULTS The citation count of the top 100 articles ranged from 68 to 589. All published between 1932 and 2016. Among 20 journals, Spine had the highest number of articles (49), with citation number of 6155 out of 13 618. Second ranked was Journal of Bone and Joint Surgery with 15 articles and total citations of 3023. With regard to the primary author's specialty, orthopedic surgeons contributed to the majority of top 100 list with 82 articles, and neurosurgery was the second specialty with 11 articles. The United States had produced more than half of the list with 59 articles. England was the second country with 7 articles. Surgical management of degenerative lumbar spondylolisthesis was the most common discussed topic. CONCLUSION This article identifies the top 100 influential articles on lumbar spondylolisthesis and recognizes an important aspect of knowledge evolution served by leading researchers as they guided today's clinical decision making in spondylolisthesis.
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Affiliation(s)
- Khalifah Aldawsari
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,Khalifah Aldawsari, College of Medicine, King Saud
University, Riyadh 11451, Saudi Arabia.
| | | | - Khalid Alsaleh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,College of Medicine, King Khalid University Hospital, Riyadh, Saudi
Arabia
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Tian W, Lang Z. Treatment of L5-S1 Spondyloptosis with Multiple Pedicle Defects Through a Combined Anterior and Posterior Approach. World Neurosurg 2020; 137:206-210. [PMID: 32036063 DOI: 10.1016/j.wneu.2020.01.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND An anterior dislocation of the L5 vertebral body from the sacrum and decent into the pelvis is considered as spondyloptosis. The surgical treatment of L5-S1 spondyloptosis remains challenging and controversial. We present a case of lumbosacral spondyloptosis with multiple pedicle defects treated through a combined anterior and posterior approach. CASE DESCRIPTION A 38-year-old female patient suffering from L5-S1 spondyloptosis with multiple pedicle defects without any history of trauma presented with lower back pain and bilateral lower leg radiating pain. A 3-stage procedure involving L5 spondylectomy, assisted by intraoperative 3-dimensional (3D) navigation, through a retroperitoneal approach at the first stage was performed. At the second stage, decompression was performed, and pedicle screws and iliac screws were placed into L1-S2, which was assisted by intraoperative 3D navigation. At the third stage, slippage reduction was achieved by placing L4 over onto S1, where a mesh was stuffed with bone from the spondylectomy and was placed into the L4/S1 intervertebral space. The patient experienced transient lower leg weakness but returned to preoperative status soon. Radiography revealed that internal fixation was in good position. No dural tears, postoperative infections, and implantation failure were reported after 3 months of postoperation. CONCLUSIONS The L5 spondylectomy shortens the spine to reduce the strain on the neural elements and facilitates correction of the lumbosacral kyphosis. When long instrumentation is mandatory, such as in multiple pedicle defects, sacropelvic fixation is recommended. Intraoperative 3D navigation is helpful in such a complex case.
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Affiliation(s)
- Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
| | - Zhao Lang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, People's Republic of China
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Spina Bifida Occulta with Bilateral Spondylolysis at the Thoracolumbar Junction Presenting Cauda Equina Syndrome. Case Rep Orthop 2020; 2020:2425637. [PMID: 32082667 PMCID: PMC6983286 DOI: 10.1155/2020/2425637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/04/2020] [Indexed: 11/18/2022] Open
Abstract
Several reports have described the coexistence of spina bifida occulta (SBO) and spondylolysis, but the majority of defects occur at L5. No report has described the coexistence of SBO and spondylolysis at the thoracolumbar junction. We report a case of SBO with spondylolysis at L1, presenting cauda equine syndrome. A 37-year-old man presented with a gait disorder as a result of bilateral motor weakness of the lower extremities. A plain radiograph showed local kyphosis at L1-2 as a result of severe degenerative change and wedging of the vertebral body at L1. Magnetic resonance imaging (MRI) revealed degenerative disc changes and severe canal stenosis at L1-2. Computed tomography (CT) revealed SBO and spondylolysis at L1. He was diagnosed with cauda equina syndrome related to SBO and spondylolysis at L1. Posterior interbody fusion and decompression at L1-2 were performed. After surgery, his muscle power recovered to normal strength. The possible mechanisms in this case are the strain on anterior elements as a result of disruption of the posterior elements due to SBO and spondylolysis. The coexistence of SBO and spondylolysis at the thoracolumbar junction might induce at-risk status of increased strain to the anterior elements that may cause cauda equina syndrome.
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Self-Image and Health-Related Quality of Life Three Decades After Fusion In Situ for High-Grade Isthmic Spondylolisthesis. Spine Deform 2019; 7:293-297. [PMID: 30660224 DOI: 10.1016/j.jspd.2018.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/20/2018] [Accepted: 08/18/2018] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Observational study. OBJECTIVES To evaluate self-image after in situ fusion for high-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA Certain clinical findings such as short trunk or waistline skin folds are often seen in high-grade spondylolisthesis. Since treatment with spinal fusion in situ does not address appearance, self-image and also health-related quality of life might be negatively affected in the short-term as well as the long-term perspective. This observational study evaluated health-related quality of life outcome including self-image three decades after in situ fusion for high-grade isthmic spondylolisthesis in relation to healthy controls. METHODS Thirty-eight of 39 consecutive patients, fused in situ for high-grade isthmic spondylolisthesis at a young age, completed the Scoliosis Research Society (SRS)-22r questionnaire 28-41 years after surgery. The results were compared with the results of an age- and gender-matched control group. RESULTS We found that the SRS-22r self-image domain scores were statistically significantly lower in patients than in controls whereas the pain and mental health scores were similar in patients and controls. Also, the SRS-22r function domain scores were statistically significantly lower in patients but the difference in means was small. We found no correlation between severity of slip and SRS-22r outcome. CONCLUSIONS In situ fusion for high-grade isthmic spondylolisthesis is a safe treatment option in the long term from a function and pain perspective, but the results of our study suggest that self-image is negatively affected long into adult life. LEVEL OF EVIDENCE Level IV.
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Difference of Sagittal Alignment between Adolescents with Symptomatic Lumbar Isthmic Spondylolisthesis and the General Population. Sci Rep 2018; 8:10956. [PMID: 30026509 PMCID: PMC6053459 DOI: 10.1038/s41598-018-29260-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/09/2018] [Indexed: 11/09/2022] Open
Abstract
This case-control study aimed to investigate differences in the sagittal spinal parameters between the symptomatic spondylolisthesis patients and the general population. Twenty-nine adolescent patients with symptomatic lumbar isthmic spondylolisthesis were included. For each patient, two age-matched, gender-matched and BMI-matched controls were enrolled. Comparison analyses detected higher values in the case group for the following parameters: CL (−22.06 ± 7.552° versus −20.36 ± 7.016°, P < 0.001), T1 Slope (19.84 ± 8.708° versus 13.99 ± 6.537°, P = 0.001), PT (21.54 ± 9.082° versus 8.87 ± 7.863°, P < 0.001), PI (64.45 ± 13.957° versus 43.60 ± 9.669°, P < 0.001), SS (42.90 ± 9.183° versus 34.73 ± 8.265°, P < 0.001), LL (−50.82 ± 21.596° versus −43.78 ± 10.356°, P = 0.042), SVA (16.99 ± 14.625 mm versus 0.32 ± 31.824 mm, P = 0.009), L5 Slope (33.95 ± 13.567° versus 19.03 ± 6.809°, P < 0.001), and L5I (8.90 ± 6.556° versus 1.29 ± 6.726°, P < 0.001). Conversely, TS-CL (6.56 ± 6.716° versus 11.04 ± 7.085°, P = 0.006), cSVA (11.31 ± 6.867 mm versus 17.92 ± 11.832 mm, P = 0.007), and TLK (−2.66 ± 10.101° versus 2.71 ± 7.708°, P = 0.007) were smaller in the case group. Slippage percentage was most correlated with PI (r = 0.530, P = 0.003), followed by PT (r = 0.465, P = 0.011) and L5I (r = 0.433, P = 0.019). Results of binary logistic regression showed that the main risk factor of isthmic spondylolisthesis was PI (OR = 1.145, 95%CI = 1.083–1.210, P < 0.001). Further subgroup analysis also showed that PI was the main risk factor of isthmic spondylolisthesis in the female adolescents (OR = 1.237, 95%CI = 1.086–1.493, P = 0.003) and in the male adolescents (OR = 1.523, 95%CI = 1.093–2.123, P = 0.013). PI was the main risk factor for adolescent symptomatic isthmic spondylolisthesis in the Chinese Han adolescents. The greater PI indicated the higher the progressive risk of spondylolisthesis. In these isthmic spondylolisthesis adolescents, the body always inclined forward and lumbar and cervical lordosis increased.
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Faldini C, Perna F, Mazzotti A, Stefanini N, Geraci G, Traina F. Spino-pelvic balance and surgical treatment of L5–S1 isthmic spondylolisthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:574-576. [DOI: 10.1007/s00586-018-5665-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Analysis of Spinopelvic Parameters with L5 as the New Sacrum after Fusion in High-Grade Spondylolisthesis: A Possible Explanation for Satisfactory Results with In-Situ Fusion. Asian Spine J 2018; 12:103-111. [PMID: 29503689 PMCID: PMC5821914 DOI: 10.4184/asj.2018.12.1.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/11/2017] [Accepted: 05/26/2017] [Indexed: 11/08/2022] Open
Abstract
Study Design Retrospective case series. Purpose To correlate functional outcomes with spinopelvic parameters in patients with high-grade spondylolisthesis (HGS) treated with instrumented in-situ surgery or reduction and fusion. Overview of Literature Satisfactory functional outcomes are reported with reduction and in-situ fusion strategies in HGS. However, reasons for this are unclear. We hypothesize that following lumbosacral fusion, the L5 becomes part of the sacrum, which improves spinopelvic parameters, resulting in equivalent functional outcomes in both surgical methods. Methods Twenty-six patients undergoing HGS (reduction group A, 13; in-situ group B, 13) were clinically evaluated using the Oswestry Disability Index (ODI), short form-12 (SF-12), and Visual Analogue Scale (VAS) scores. Spinopelvic parameters, including pelvic incidence, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), lumbosacral kyphosis (LSK) angle, and sacrofemoral distance (SFD) were measured preoperatively from S1 and postoperatively from L5 as the new sacrum at 1 year follow-up. Sagittal alignment was assessed using the sagittal vertical axis. Results Both groups were comparable in terms of age, sex, severity of slip, and preoperative spinopelvic parameters (p>0.05). Postoperative VAS, SF-12, and ODI scores significantly improved in both groups (p<0.05). Compared with preoperative values, the mean postoperative PT, SFD, and LSK significantly changed in both groups. In reduction group, PT changed from 26.98° to 10.78°, SFD from 61.24 to 33.56 mm, and LSK from 74.76° to 109.61° (p<0.05). In in-situ fusion group PT changed from 26.78° to 11.08°, SFD from 62.9 to 36.99 mm, and LSK from 67.23° to 113.38° (p<0.05 for all). In both groups, SS and LL did not change significantly (p>0.05). Conclusions After fusion, the L5 becomes the new sacrum and influences spinopelvic parameters to change favorably. This possibly explains why reduction and in-situ fusion achieve equivalent functional outcomes in HGS.
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Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:3. [PMID: 29435499 PMCID: PMC5795289 DOI: 10.1186/s13013-017-0145-8] [Citation(s) in RCA: 412] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). METHODS Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. RESULTS The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. CONCLUSION The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.
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Affiliation(s)
- Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia Viale Europa 11, Brescia, Italy
- IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Angelo Gabriele Aulisa
- U.O.C. of Orthopedics and Traumatology, Children’s Hospital Bambino Gesù, Institute of Scientific Research, 00165 Rome, Italy
| | - Dariusz Czaprowski
- Center of Body Posture, Olsztyn, Poland
- Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland
| | - Sanja Schreiber
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Department of Surgery, Edmonton, Canada
| | | | - Helmut Diers
- Department of Orthopedics and Trauma Surgery, University Medical Center, Mainz, Germany
| | - Theodoros B. Grivas
- Department of Orthopaedics and Traumatology, “Tzaneio” General Hospital of Piraeus, Piraeus, Greece
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | - Andrea Lebel
- Scoliosis Physiotherapy & Posture Centre, 231 McLeod Street, Ottawa, Ontario K2P0Z8 Canada
| | - Cindy Marti
- Schroth-Barcelona Institute, LLC, Spinal Dynamics of Wisconsin, SC., Barcelona, Spain
| | - Toru Maruyama
- Saitama Prefectural Rehabilitation Center, Saitama, Japan
| | - Joe O’Brien
- National Scoliosis Foundation, Stoughton, MA USA
| | - Nigel Price
- Section of Spine Surgery, Children’s Mercy Hospitals and Clinics, UMKC Orthopedics, Kansas City, MO USA
| | - Eric Parent
- Department of Physical Therapy, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Manuel Rigo
- Salvá SLP (E. Salvá Institute), Vía Augusta 185, 08021 Barcelona, Spain
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Luke Stikeleather
- National Scoliosis Center, 3023 Hamaker Court, Suite LL-50, Fairfax, VA 22124 USA
| | - James Wynne
- Boston Orthotics & Prosthetics, Boston, MA USA
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
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Vernese LF, Chu SK. Spondylolysis: Assessment and Treatment in Youth Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rindler RS, Miller BA, Eshraghi SR, Pradilla G, Refai D, Rodts G, Ahmad FU. Efficacy of Transsacral Instrumentation for High-Grade Spondylolisthesis at L5-S1: A Systematic Review of the Literature. World Neurosurg 2016; 95:623.e11-623.e19. [DOI: 10.1016/j.wneu.2016.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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ALIF- und PLIF-Interposition bei low-grade isthmischen Spondylolisthesen L5/S1. DER ORTHOPADE 2016; 45:760-9. [DOI: 10.1007/s00132-016-3311-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shrinuvasan S, Chidambaram R. Evaluation of low back pain with low field open magnetic resonance imaging scanner in rural hospital of Southern India. J Neurosci Rural Pract 2016; 7:368-73. [PMID: 27365953 PMCID: PMC4898104 DOI: 10.4103/0976-3147.181455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Low back pain (LBP) is the most common symptom which is associated with limitation of normal activities and work-related disability. Imaging techniques are often essential in making the correct diagnosis for prompt management. Plain Radiography though remain a first imaging modality, magnetic resonance imaging (MRI) due to its inherent softtissue contrast resolution and lack of ionizing radiation remains invaluable modality in the evaluation of LBP. Aim: To find the common causes of LBP in different age groups and the role of MRI in detecting the spectrum of various pathological findings. Materials and Methods: This is a prospective study done in the Department of Radiodiagnosis during a period of 2 years from July 2013 to July 2015. The study population includes all the cases referred to our department with complaints of LBP. Patients with ferromagnetic metallic implants and uncooperative cases were excluded. HITACHI 0.4 Tesla open MRI machine was used for imaging. Results and Conclusion: This study involved a total of 235 cases. There were 121 males and 114 females. The age of the patient ranged from 21 to 68 years with an average of 41.3 years. Back pain was commonly observed in the third to fifth decade. The common causes for back pain are disc herniations (disc bulge – 35.3%, disc protrusion – 39.6%, disc extrusion – 7.2%) accounting to 82.1%, followed by normal study (10.2%), vertebral collapse (traumatic – 2.1%, osteoporotic – 1.7%), infections (2.1%), and neoplasm (1.7%). MRI provides valuable information regarding the underlying causes of LBP, especially in disc and marrow pathology.
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Affiliation(s)
- Sadhanandham Shrinuvasan
- Department of Radiology, Sri Lakshmi Narayana Institute of Medical Sciences (Affiliated to Bharath University), Puducherry, India
| | - Ranganathan Chidambaram
- Department of Radiology, Sri Lakshmi Narayana Institute of Medical Sciences (Affiliated to Bharath University), Puducherry, India
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Grødahl LHJ, Fawcett L, Nazareth M, Smith R, Spencer S, Heneghan N, Rushton A. Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review. ACTA ACUST UNITED AC 2016; 24:7-17. [PMID: 27317501 DOI: 10.1016/j.math.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND In adolescent athletes, low back pain has a 1-year prevalence of 57% and causes include spondylolysis and spondylolisthesis. An accurate diagnosis enables healing, prevention of progression and return to sport. OBJECTIVE To evaluate the diagnostic utility of patient history and physical examination data to identify spondylolysis and/or spondylolisthesis in athletes. DESIGN Systematic review was undertaken according to published guidelines, and reported in line with PRISMA. METHOD Key databases were searched up to 13/11/15. INCLUSION CRITERIA athletic population with LBP, patient history and/or physical examination accuracy data for spondylolysis and/or spondylolisthesis, any study design including raw data. Two reviewers independently assessed risk of bias (ROB) using QUADAS-2. A data extraction sheet was pre-designed. Pooling of data and investigation for heterogeneity enabled a qualitative synthesis of data across studies. RESULTS Of the eight included studies, two were assessed as low ROB, one of which also had no concerns regarding applicability. Age (<20 years) demonstrated 81% sensitivity and 44% specificity and gender (male) 73% sensitivity and 57% specificity for spondylolysis. Difficulty falling asleep, waking up because of pain, pain worse with sitting and walking all have sensitivity >75% for spondylolisthesis. Step-deformity palpation demonstrated 60-88% sensitivity and 87-100% specificity for spondylolisthesis. The one-legged hyperextension test was not supported for spondylolysis (sensitivity 50-73%, specificity 0-87%). CONCLUSION No recommendations can be made utilising patient history data. Based on one low ROB study, step deformity palpation may be useful in diagnosing spondylolisthesis. No physical tests demonstrated diagnostic utility for spondylolysis. Further research is required.
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Affiliation(s)
- Linn Helen J Grødahl
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Louise Fawcett
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Madeleine Nazareth
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Richard Smith
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Simon Spencer
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Nicola Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Xue X, Wei X, Li L. Surgical Versus Nonsurgical Treatment for High-Grade Spondylolisthesis in Children and Adolescents: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e3070. [PMID: 26986134 PMCID: PMC4839915 DOI: 10.1097/md.0000000000003070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/12/2016] [Accepted: 02/22/2016] [Indexed: 11/25/2022] Open
Abstract
The optimal management of high-grade spondylolisthesis in children and adolescent is controversial. There is a paucity of literature regarding operatively or nonoperative management in this setting. To assessment of the current state of evidence regarding high-grade spondylolisthesis treatment with the goal of obtaining outcome comparisons in these patients managed either operatively or nonoperatively. We performed a systematic literature search up to November 2014, using Medline, Embase, and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines) and Cochrane Back Review Group editorial board. We used the Newcastle-Ottawa quality assessment scale (NOS-scale) to assess the quality. Five observational studies were considered eligible for analysis based on the evaluation of 1596 identified papers. The mean overall difference in the Scoliosis Research Society questionnaire 22 between the surgical and nonsurgical groups was not statistically significant (95% CI: -0.17 to 0.21, P = 0.84). The pooled mean difference in progression of slip between the surgical and nonsurgical groups was no significant difference (OR: 0.47, 95% CI: 0.12-1.81, P = 0.27, I = 0%). Because of the preponderance of uncontrolled case series, low-quality evidence indicates that the quality of life and progression of slips was no significant difference between surgery and nonoperation group. Nonoperative patients had no radiologic progression of their slip during the follow-up period.
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Affiliation(s)
- Xuhong Xue
- From the Department of Orthopedics (XXH, WXC), The Second Hospital, Shanxi Medical University, Taiyuan; and The First People's Hospital of Jinzhong (LL), Shanxi Medical University, Jinzhong, Shanxi, P.R. China
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Tsirikos AI, Sud A, McGurk SM. Radiographic and functional outcome of posterolateral lumbosacral fusion for low grade isthmic spondylolisthesis in children and adolescents. Bone Joint J 2016; 98-B:88-96. [DOI: 10.1302/0301-620x.98b1.35672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We reviewed 34 consecutive patients (18 female-16 male) with isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis who underwent in situ posterolateral arthodesis between the L5 transverse processes and the sacral ala with the use of iliac crest autograft. Ten patients had an associated scoliosis which required surgical correction at a later stage only in two patients with idiopathic curves unrelated to the spondylolisthesis. Methods No patient underwent spinal decompression or instrumentation placement. Mean surgical time was 1.5 hours (1 to 1.8) and intra-operative blood loss 200 ml (150 to 340). There was one wound infection treated with antibiotics but no other complication. Radiological assessment included standing posteroanterior and lateral, Ferguson and lateral flexion/extension views, as well as CT scans. Results A solid posterolateral fusion was confirmed in all patients at mean latest follow-up of 4.7 years (3.4 to 9.8) beyond skeletal maturity into early adult life. Fusion of the isthmic lesion was documented in nine patients bilaterally and eight patients unilaterally. The poor fusion rate across the spondylolysis has not affected the excellent functional results of the procedure, which in our series depended on achieving a stable lumbosacral junction. Conclusion Quality of life assessment demonstrated significant improvement in all functional scores and high patient satisfaction with 28 patients returning to previous sports activities at an elite competitive level. Take home message: Posterolateral arthrodesis in situ with autologous iliac crest bone without instrumentation has achieved a solid fusion between the L5 transverse processes and the sacral ala in patients with grade I to II isthmic lumbosacral spondylolisthesis and this has produced excellent clinical outcomes and high patient satisfaction. Cite this article: Bone Joint J 2016;98-B:88–96.
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Affiliation(s)
- A. I. Tsirikos
- Royal Hospital For Sick Children, Sciennes
Road, Edinburgh, EH9 1LF, UK
| | - A. Sud
- Royal Hospital For Sick Children, Sciennes
Road, Edinburgh, EH9 1LF, UK
| | - S. M. McGurk
- Royal Hospital For Sick Children, Sciennes
Road, Edinburgh, EH9 1LF, UK
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Toueg CW, Mac-Thiong JM, Grimard G, Poitras B, Parent S, Labelle H. Spondylolisthesis, Sacro-Pelvic Morphology, and Orientation in Young Gymnasts. ACTA ACUST UNITED AC 2015; 28:E358-64. [DOI: 10.1097/bsd.0b013e3182956d62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE Despite the predominant use of standing flexion-extension radiography for quantifying instability in isthmic and degenerative spondylolisthesis, other functional radio-graphic techniques have been presented in the literature. CONCLUSION The current evidence reported in the literature is insufficient to influence how the results of these other functional radiographic techniques should affect clinical management; however, it does raise doubts regarding the accuracy and reliability of standing flexion-extension radiography in this setting. Based on the currently available evidence and until randomized studies are performed to assess the efficacy of functional radiographic techniques in directing clinical decision making, positioning schemes other than traditional standing flexion-extension may be considered as options in the evaluation of patients with symptomatic isthmic and degenerative spondylolisthesis in which standard flexion-extension radiographs fail to show pathologic instability.
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Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children. J Pediatr Orthop 2015; 34:483-9. [PMID: 24590330 DOI: 10.1097/bpo.0000000000000133] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal management of high-grade spondylolisthesis in the growing child is controversial. Some authors have advocated for surgery in all cases regardless of symptoms. Surgical intervention results in a >10% risk of complications with increased risk of neurological injury associated with slip reduction maneuvers. There is a paucity of literature regarding nonoperative management in this setting. This study sought to obtain outcome measures in pediatric patients with high-grade spondylolisthesis managed either operatively or nonoperatively. METHODS Database review was performed to identify patients with a high-grade (Meyerding grade III to V) spondylolisthesis managed either operatively or nonoperatively. Retrospective radiographic and chart review was performed. Patients were then contacted by phone to obtain current quality-of-life measurements using the Scoliosis Research Society (SRS)-30 questionnaire. RESULTS Fifty-three patients were identified for inclusion in the study and 49 were contacted for 92% follow-up. Twenty-four patients were treated with operative intervention, and 25 patients were initially treated nonoperatively, but 10 went on to require surgical intervention. Mean age at presentation was 12.6 years (range, 8 to 17 y) and mean age at follow-up was 20.1 years (range, 10 to 29 y). There were no outcome differences between the groups. A more kyphotic slip angle was associated with worse SRS-30 outcome scores across all groups. In the nonoperative group, the slip angle was significantly larger in patients who failed conservative treatment (34 ± 17 degrees) than in those who remained nonsurgical at final follow-up (20 ± 14 degrees). Slip angle in the operative group was 27 ± 14 degrees. In surgical patients, an older age at surgery was associated with better SRS-30 outcome scores. CONCLUSIONS Nonoperative management or "watchful waiting" of the minimally symptomatic or asymptomatic child with a high-grade spondylolisthesis is safe and does not lead to significant problems. Operative intervention for the symptomatic patient achieves similar long-term results compared with patients whose minimal symptoms do not warrant surgery. Delayed surgical intervention does not result in worse outcomes. Regardless of treatment modality, patients with a more kyphotic slip angle tend to have a poorer prognosis. LEVEL OF EVIDENCE Level III.
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Liu ZD, Li XF, Qian L, Wu LM, Lao LF, Wang HT. Lever reduction using polyaxial screw and rod fixation system for the treatment of degenerative lumbar spondylolisthesis with spinal stenosis: technique and clinical outcome. J Orthop Surg Res 2015; 10:29. [PMID: 25890019 PMCID: PMC4355151 DOI: 10.1186/s13018-015-0168-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background The management for degenerative lumbar spondylolisthesis with spinal stenosis remains controversial. Reduction of lumbar spondylolisthesis has been performed via numerous techniques. Most of them need extra reduction assembly. Methods In this retrospective analysis, 27 patients of degenerative lumbar spondylolisthesis with spinal stenosis underwent reduction using polyaxial screw and rod constructs and posterolateral fusion. The average age at the time of surgery was 53 ± 3.23 years. The outcome measures consisted of a radiographic assessment of deformity and fusion rate and a clinical assessment of perioperative improvement in low back pain and function. Preoperative and postoperative radiographic evaluation included the percent slip, slip angle, and the lumbar lordosis between L1 and the sacrum measured using the Cobb method. Before surgery and at the final follow-up, the Oswestry Disability Index (ODI) and the visual pain analog scale (VPAS) between 0 (no pain) and 10 (maximal pain) were quantified. Results The average follow-up period more than 5 years was available. The mean operative time was 90.19 ± 14.51 min, and the mean blood loss during surgery was 152.59 ± 45.71 ml. The mean length of incision was 4.83 ± 0.63 cm. The average percent slippage and the mean slip angle were, respectively, 19.8 ± 4.49% and 9.69 ± 3.79° before surgery, 5.09 ± 3.40% and 6.39 ± 3.16° after surgery, and 5.67 ± 3.92% and 7.21 ± 3.05° at the last follow-up. The average lumbar lordosis was 36.88 ± 2.64° before surgery, 41.96 ± 1.64° after surgery, and 40.27 ± 1.19° at the final follow-up. No neurologic deficit occurred. Solid fusion was achieved for all cases. Compared with the outcome preoperation, the data improved from 6.56 ± 1.40 to 2.48 ± 1.16 for VPAS pain scores and from 32.22 ± 3.57 to 10.93 ± 4.93 for the ODI at the final follow-up. Conclusions Lever slip reduction maneuver techniques using polyaxial screw and rod fixation system was simple and practicable. The treatment outcomes showed satisfactory radiographic characteristics and clinical results. The length of the incision was relatively small with a low intraoperative blood loss and short operation time.
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Affiliation(s)
- Zu-De Liu
- Department of Orthopaedic Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xin-Feng Li
- Department of Orthopaedic Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lie Qian
- Department of Orthopaedic Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Li-Feng Lao
- Department of Orthopaedic Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Han-Tao Wang
- Department of Orthopaedic Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Lumbar spondylolysis and spondylolytic spondylolisthesis: who should be have surgery? An algorithmic approach. Asian Spine J 2014; 8:856-63. [PMID: 25558333 PMCID: PMC4278996 DOI: 10.4184/asj.2014.8.6.856] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 07/27/2014] [Accepted: 08/03/2014] [Indexed: 11/29/2022] Open
Abstract
Lumbar spondylolysis and spondylolisthesis are common spinal disorders that most of the times are incidental findings or respond favorably to conservative treatment. In a small percentage of the patients, surgical intervention becomes necessary. Because too much attention has been paid to novel surgical techniques and new modern spinal implants, some of fundamental concepts have been forgotten. Identifying that small but important number of patients with lumbar spondylolysis or spondylolisthesis who would really benefit from lumbar surgery is one of those forgotten concepts. In this paper, we have developed an algorithmic approach to determine who is a good candidate for surgery due to lumbar spondylolysis or spondylolisthesis.
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Mizuno K, Mikami Y, Nagae M, Tonomura H, Ikeda T, Fujiwara H, Kubo T. Instrumented reduction and monosegmental fusion for Meyerding Grade IV developmental spondylolisthesis: a report of 3 cases. Medicine (Baltimore) 2014; 93:e244. [PMID: 25546662 PMCID: PMC4602615 DOI: 10.1097/md.0000000000000244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
There are numerous reports of treatment methods for spondylolisthesis with a Meyerding Grade of more than III. In high dysplastic spondylosthesis, surgical treatment was selected because there is considered to be a high possibility of low back pain and lower limb neurological symptoms worsening if slippage progresses. Monosegmental lumbar interbody fusion (L5-S1) with a pedicle screw system (PPS) was used to treat three cases of Meyerding Grade IV developmental spondylolisthesis. Patients gave written informed consent. The spondylolisthesis was reduced to Meyerding Grade I and sagittal balance improved in all three cases. In two cases with severe spinal instability, there were no postoperative neurological complications and the course was favorable. However, in one case with little spinal mobility due to vertebral body dysplasia, despite performing sufficient decompression of the nerve root at L5 and slow reduction to avoid placing excessive tension on the nerve root, a transient neurological disorder was observed. A PPS was used to increase the reduction strength and favorable reduction was possible. However, in the case with a long clinical course and the case with poor spinal mobility, since the mobility and plasticity of the nerve root itself may have been reduced, it was considered that reduction should be performed carefully using intraoperative neurological monitoring.
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Affiliation(s)
- Kentaro Mizuno
- From the Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine (KM, YM, MN, HT, TI, HF, TK)
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Mora-de Sambricio A, Garrido-Stratenwerth E. Spondylolysis and spondylolisthesis in children and adolescents. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Changes in spino-pelvic alignment after surgical treatment of high-grade isthmic spondylolisthesis by a posterior approach: a report of 41 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23 Suppl 6:714-9. [DOI: 10.1007/s00586-014-3552-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/25/2022]
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40
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[Spondylolysis and spondylolisthesis in children and adolescents]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:395-406. [PMID: 25224623 DOI: 10.1016/j.recot.2014.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/11/2014] [Accepted: 05/13/2014] [Indexed: 11/24/2022] Open
Abstract
Low back pain is a common cause of lost playing time in young athletes, and spondylolysis is its most common identifiable cause. Despite technological advances in radiology, which can lead to an early diagnosis with better prognosis, progression to spondylolisthesis is sometimes asymptomatic and may not be detected until late stages. There are wide variations, suggesting lack of consensus as regards the objective of treatment, which consists of clinical, radiological, biomechanical or functional improvement. There is also a lack of agreement regarding the ideal conservative treatment, surgical indications and need of slip reduction, and most of the established recommendations are not evidence based. We present a review of literature, which summarizes the current knowledge of spondylolysis and spondylolisthesis in children and adolescents.
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Lengert R, Charles YP, Walter A, Schuller S, Godet J, Steib JP. Posterior surgery in high-grade spondylolisthesis. Orthop Traumatol Surg Res 2014; 100:481-4. [PMID: 25002197 DOI: 10.1016/j.otsr.2014.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/06/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION High-grade L5-S1 spondylolisthesis alters sagittal spinopelvic balance, which can cause low back pain and progressive neurologic disorder. The present study assessed spondylolisthesis reduction and maintenance over time with L4-S1 versus L5-S1 fusion using a lever-arm system and posterior fusion combined with lumbosacral graft. MATERIALS AND METHODS Forty patients were operated on for symptomatic high-grade spondylolisthesis, 34 of whom had full pre- and post-operative radiological analysis, with a mean follow-up of 5.4years. There were 9 L5-S1 and 25 L4-S1 instrumentations. Analysis of spinopelvic and slipping parameters and the evolution of segmental lordosis compared results between L5-S1 and L4-S1 instrumentation. RESULTS Mean Taillard spondylolisthesis index decreased from 64% to 37% (P=0.0001). Overall sagittal spinopelvic balance was not significantly changed. Overall L1-S1 and segmental L4-L5 lordosis were not affected by instrumentation. Mean L5-S1 segmental lordosis increased from 11° to 18°. There was loss of reduction from 19° to 14° with L5-S1 instrumentation, in contrast to maintained reduction with L4-S1 instrumentation (P=0.006). CONCLUSION The lever-arm system provided anterior-posterior reduction of spondylolisthesis and corrected slippage. Postoperative change in overall sagittal spinopelvic balance was slight and constant. Posterior L4-S1 fusion provided better long-term control of L5-S1 lordosis reduction than the shorter L5-S1 fusion. Retrospective study of level IV.
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Affiliation(s)
- R Lengert
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - Y P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - A Walter
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - S Schuller
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - J Godet
- Département de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - J-P Steib
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Radiological evidence of spontaneous spinal arthrodesis in patients with lower lumbar spondylolisthesis. Spine (Phila Pa 1976) 2014; 39:656-63. [PMID: 24430714 DOI: 10.1097/brs.0000000000000212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a consecutive series of patients with radiological evidence of spondylolisthesis. OBJECTIVE To establish the incidence and characteristics of spontaneous spinal arthrodesis in the setting of lower lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA Spontaneous spinal arthrodesis of lumbar spondylolisthesis is a finding that is not discussed in the literature outside of isolated case reports. Identifying spontaneous spinal arthrodesis may impact the surgical plan, as patients with existing fusion may not require instrumentation and might require more work to reduce their spondylolisthesis. METHODS We reviewed a consecutive series of 1490 lumbar spine computed tomography scans from the year 2010 for radiological evidence of spondylolisthesis at either L4-L5 or L5-S1. Patients were excluded if they had undergone previous lumbar surgery. Scans were assessed for the presence of spontaneous fusion based on the following criteria: (1) a solid bridging anterior or posterior vertebral body osteophyte, (2) contiguous bone formation from one vertebral body to another, or (3) contiguous bone across the facet joints bilaterally. Patients were characterized by demographic variables, radiological characteristics including type of spondylolisthesis, and presenting symptomology. Differences between patients in the fused and nonfused cohorts were compared with univariate analysis. RESULTS A total of 86 separate instances of spondylolisthesis were identified, of which 18 (20.9%) had radiological evidence of spontaneous fusion. The most common site of fusion was in the bilateral facets, followed by directly in the intervertebral disc space, and bridging osteophytes adjoining the vertebral bodies. There were significant differences between patients in the fused and nonfused cohorts in terms of average age (fused: 74.3 ± 10.7 yr vs. nonfused: 63.3 ± 18.6 yr, P = 0.019), sex (fused: 88.9% female vs. nonfused: 57.4% female, P = 0.013), and rate of pars defects (fused: 11.1% vs. nonfused: 35.3%, P = 0.047). CONCLUSION In this study, 20.9% of patients with lumbar spondylolisthesis have radiological signs of spontaneous fusion. Further work is needed to better characterize the natural history and clinical-radiological correlation of spontaneous fusion in spondylolisthesis. LEVEL OF EVIDENCE 4.
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Bouyer B, Bachy M, Courvoisier A, Dromzee E, Mary P, Vialle R. High-grade lumbosacral spondylolisthesis reduction and fusion in children using transsacral rod fixation. Childs Nerv Syst 2014; 30:505-13. [PMID: 23955179 DOI: 10.1007/s00381-013-2260-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/05/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE There is no consensus on how to treat surgically high-dysplastic developmental spondylolisthesis in children and adolescents. Although reducing spinal deformity seems mandatory, the issue of surgical reduction versus in situ fusion remains controversial. METHODS The files of 12 consecutive patients surgically treated for a grade 3 or 4 spondylolisthesis were reviewed. The treatment consisted in L4 to sacrum reduction and fusion by posterior approach. The reduction of lumbopelvic imbalance was made intraoperatively using a trans-sacral rod fixation technique. RESULTS Mean preoperative L5 anterior slippage was 72.3 % (60 to 95 %). The mean preoperative lumbosacral tilt angle was 70.5° (43 to 92°). Mean final lumbosacral tilt angle was 102° (91 to 114°). Mean final L5 anterior slippage was 19 % (7 to 63 %). Neurological complications (radicular L5 or S1 deficits) were noted in five patients. At final follow-up L4 to S1 fusion was achieved in all patients. No patient had persistent deficit or radicular pain. CONCLUSIONS The fusion rate in our series proved to be optimal. Thanks to the trans-sacral rod fixation, lumbosacral kyphosis correction was very good. The intrasacral positioning of the screws reduces the risk of implant prominence especially in such pediatric patients. We stress the importance to avoid complete slip reduction in such patients to minimize stretching on L5 and S1 roots. No additional immobilization is needed due to solid posterior instrumentation. Doing such procedure only by posterior approach avoids anterior approach-related complications.
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Affiliation(s)
- Benjamin Bouyer
- Université Pierre et Marie Curie Paris6, Department of Pediatric Orthopedics, Armand Trousseau Hospital, 26 avenue du Dr Arnold Netter, Cedex 12, 75571, Paris, France
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Tebet MA. Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis. Rev Bras Ortop 2014; 49:3-12. [PMID: 26229765 PMCID: PMC4511775 DOI: 10.1016/j.rboe.2014.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/09/2013] [Indexed: 11/28/2022] Open
Abstract
Treatment of spondylolysis and spondylolisthesis remains a challenge for orthopaedic surgeons, neurosurgeons and paediatrics. In spondylolisthesis, it has been clearly demonstrated over the past decade that spino-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagittal balance of spine. This article presents the SDSG (Spinal Deformity Study Group) classification of lumbosacral spondylolisthesis. The proper treatment of spondylolisthesis is dependent on recognizing the type of slip, sacro-pelvic balance and overall sagittal balance and its natural history. Although a number of clinical radiographic features have been identified as risk factors, their role as primary causative factors or secondary adaptative changes is not clear. The conservative treatment of adult isthmic spondylolisthesis results in good outcome in the majority of cases. Of those patients who fail conservative treatment, success with surgery is quite good, with significant improvement in neurologic function in those patients with deficits, as well as improvement in patients with back pain.
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Affiliation(s)
- Marcos Antonio Tebet
- Discipline of Orthopaedics and Traumatology, Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil
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Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V. Evidence-based surgical management of spondylolisthesis: reduction or arthrodesis in situ. J Bone Joint Surg Am 2014; 96:53-8. [PMID: 24382725 DOI: 10.2106/jbjs.l.01012] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The role of reduction in the operative management of spondylolisthesis is controversial because of its potential complications, including neurologic deficits, prolonged operative time, and loss of reduction. The aim of this systematic review was to compare arthrodesis in situ and arthrodesis after reduction techniques with respect to clinical and radiographic outcomes and safety. METHODS We performed a comprehensive search of the PubMed, Ovid MEDLINE, Cochrane, CINAHL, Google Scholar, and Embase databases with use of the keyword "spondylolisthesis" in combination with "surgery," "reduction," "in situ," "low back pain," "high-grade," "lumbar spine," "lumbar instability," and "fusion." RESULTS Eight eligible studies, containing reports of 165 procedures involving reduction followed by arthrodesis and 101 procedures involving arthrodesis in situ without reduction, were identified and included. The procedure involving reduction was associated with a significantly greater decrease in the percentage of slippage (p < 0.002) and slip angle (p < 0.003) compared with arthrodesis in situ. Pseudarthrosis was significantly more frequent in the arthrodesis in situ group compared with the reduction group (17.8% compared with 5.5%, p = 0.004). Neurologic deficits were not significantly more prevalent in the reduction group compared with the arthrodesis in situ group (7.8% compared with 8.9%, p = 0.8). CONCLUSIONS On the basis on this review, the reduction of high-grade spondylolisthesis potentially improves overall spine biomechanics by correcting the local kyphotic deformity and reducing vertebral slippage. Reduction was not associated with a greater risk of developing neurologic deficits compared with arthrodesis in situ. Both procedures were associated with good clinical outcomes.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Giovanni Romeo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, England
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
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Conceitos atuais sobre equilíbrio sagital e classificação da espondilólise e espondilolistese. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hardwick D, Tierney D, Fein C, Reinmann S, Donaldson M. Outcomes of strengthening approaches in the treatment of low-grade spondylolisthesis. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Collaer JW, McKeough DM, Boissonnault WG. Lumbar Isthmic Spondylolisthesis Detection with Palpation: Interrater Reliability and Concurrent Criterion-Related Validity. J Man Manip Ther 2013. [DOI: 10.1179/106698106790820917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Wang Z, Mac-Thiong JM, Parent S, Petit Y, Labelle H. The relevance of sacral and sacro-pelvic morphology in developmental lumbosacral spondylolisthesis: are they equally important? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:157-62. [PMID: 23712627 DOI: 10.1007/s00586-013-2832-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/27/2012] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Retrospective study of the importance of sacral and sacro-pelvic morphology in developmental L5-S1 spondylolisthesis. OBJECTIVES To determine and compare the importance of sacral and sacro-pelvic morphology in developmental L5-S1 spondylolisthesis. Recent studies have shown abnormalities in sacral and sacro-pelvic morphology in spondylolisthesis. However, it is still unclear if sacral and sacro-pelvic morphology are correlated and if they are equally important in the progression of spondylolisthesis. METHODS Lateral radiographs of 120 controls and 131 subjects with developmental L5-S1 spondylolisthesis were analyzed. Sacral table angle (STA) and pelvic incidence (PI) were compared using Student t tests. The relationship between STA and PI was assessed separately in the control and spondylolisthesis groups using Pearson's coefficients. The proportion of subjects with high PI but average STA was compared to the proportion of subjects with low STA but average PI using χ (2) tests. RESULTS STA was significantly lower and PI was significantly higher in the spondylolisthesis group. STA was statistically related to PI in both control (r = -0.43) and spondylolisthesis (r = -0.57) groups. In the spondylolisthesis group, STA (r = -0.45) and PI (r = 0.35) were significantly related to slip percentage. STA remained statistically related to slip when controlling for PI. A significantly greater proportion of subjects in the spondylolisthesis group had average STA and high PI, rather than average PI and low STA. CONCLUSION The significant relationship between PI and STA validates that geometrically sacral morphology depends on sacro-pelvic morphology. This study failed to demonstrate a clear predominant role of either STA or PI in the presence of spondylolisthesis.
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Affiliation(s)
- Zhi Wang
- Department of Surgery, University of Montreal, Montreal, Canada,
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Kasliwal MK, Smith JS, Kanter A, Chen CJ, Mummaneni PV, Hart RA, Shaffrey CI. Management of high-grade spondylolisthesis. Neurosurg Clin N Am 2013; 24:275-91. [PMID: 23561564 DOI: 10.1016/j.nec.2012.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Management of high-grade spondylolisthesis (HGS) remains challenging and is associated with significant controversies. The best surgical procedure remains debatable. Although the need for instrumentation is generally agreed upon, significant controversies still surround the role of reduction and anterior column support in the surgical management of HGS. Complications with operative management of HGS can be significant and often dictate the selection of surgical approach. This review highlights the pathophysiology, classification, clinical presentation, and management controversies of HGS, in light of recent advances in our understanding of the importance of sagittal spinopelvic alignment and technologic advancements.
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Affiliation(s)
- Manish K Kasliwal
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA
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