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Lübbers T, Sandvoss G, Baalmann R, Wigt P. Surgical Treatment of Developmental Dysplastic Lumbosacral Spondylolisthesis: Additional Help from an Intervertebral Distraction, Correction, and Reduction Device. J Neurol Surg A Cent Eur Neurosurg 2024; 85:322-329. [PMID: 37168016 DOI: 10.1055/a-2091-6921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND In mid- to high-grade adult dysplastic spondylolisthesis, surgeons are faced with three underlying components: angular, translational, and collapse of the disk. In extremely narrow intervertebral spaces, it is difficult to distract and lift the vertebral bodies by the pedicle screw system alone. In this prospective case control study, we analyzed the efficacy of the latest prototypes (distraction, correction, and reduction [DCR] instrument) with intervertebral application in terms of distraction, correction of segmental kyphosis, and slip reduction. METHODS Twelve adult patients (5 male and 7 female patients) were enrolled in this study. The average age was 42 years (range: 17-67 years) and in all cases the maneuver was documented during the surgery. The amount of slip reduction, the lumbosacral angle according to the Spinal Deformity Study Group dysplastic angle (dys-SDGG), and the disk height were measured preoperatively, intraoperatively, 3 months after surgery, and during the latest follow-up (range: 3-44 months). The relative height of the lumbosacral disk was determined in relation to the disk height in L3/L4. RESULTS Slippage ranged from 17 to 67%. Overall, the average slippage was 45% preoperatively and 4.8% after the reduction maneuver. The average ratio of the disk height was 0.3 preoperatively, 1.0 intraoperatively, and 0.9 at the latest follow-up. Two patients showed significant kyphotic changes, and these patients had an 18- and 21-degree lordotic improvement. From those who had a lumbosacral kyphosis >20 degrees, only one patient did not show any lordotic improvement. All other patients had a significant lordotic improvement. In total, the lumbosacral angle changed from 15 to 23 degrees. CONCLUSION The application of an intervertebral distractor with a mobile thigh has a good clinical and radiologic outcome for mid- to high-grade adult dysplastic spondylolisthesis in terms of distraction, kyphosis correction, and reduction of underlying slippage. The described hardware failures and the complications were not related to the DCR device.
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Affiliation(s)
- Thomas Lübbers
- Department of Neurosurgery, Klinikum Leer gGmbH, Leer, Germany
| | - Gerd Sandvoss
- Department of Neurosurgery, Krankenhaus Ludmillenstift, Meppen, Niedersachsen, Germany
| | - Rainer Baalmann
- Department of Neurosurgery, MediClin Hedon Klinik, Lingen, Niedersachsen, Germany
| | - Peter Wigt
- Department of Orthopedic, Krankenhaus Ludmillenstift, Meppen, Niedersachsen, Germany
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Xie H, Ouyang Z, Zhang H. Radiographic Analysis of Pedicle Screw Retractor-Assisted Transforaminal Lumbar Interbody Fusion for Single-Segment Spondylolisthesis in Adults: A Retrospective Study and Technical Note. Orthop Surg 2022; 14:2219-2229. [PMID: 35979946 PMCID: PMC9483061 DOI: 10.1111/os.13441] [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: 08/19/2021] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives The objective of this study was to introduce a retractor that can be temporarily installed on unilateral pedicle screws to achieve distraction‐reduction and nerve root protection, and to analyze the efficacy and safety of retractor‐assisted transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods This was a retrospective study of 125 patients who underwent retractor‐assisted TLIF for single‐segment spondylolisthesis from November 2017 to February 2021. Based on morphology, patients were divided into degenerative (N = 66) and isthmic groups (N = 59). Differences in demographics and preoperative characteristics between the groups were analyzed using the independent samples t‐test and χ2 test. Changes in radiographic parameters (disc height, foramen height, spondylolisthesis degree, slippage length, and segmental lordosis) before and after surgery were compared using the paired samples t‐test. Logistic regression analysis was performed to analyze the relationship between facet joint angle (FJA) and degenerative lumbar spondylolisthesis (DLS). Results Unilateral screw retractor‐assisted TLIF significantly corrected spondylolisthesis and improved disc height and segmental lordosis (p < 0.05). There was no significant difference in foramen height between the two sides before and after operation (pre: 15.81 ± 3.58 mm vs 15.69 ± 3.68 mm, p = 0.599; post: 18.65 ± 2.31 mm vs 18.74 ± 2.26 mm, p = 0.516). The degree of spondylolisthesis in the DLS group before surgery was significantly lower than that in the isthmic spondylolisthesis group (17.70 ± 5.62% vs 25.18 ± 9.73%, p < 0.001), whereas a similar degree of correction could be achieved after surgery (5.91 ± 3.12% vs 7.16 ± 5.69%, p = 0.135). FJAs from L3/4 to L5/S1 were significantly smaller in patients with DLS than those in with isthmic spondylolisthesis (p < 0.05). Patients with facet sagittalization were more likely to have DLS (β: −0.101, odds ratio [OR]:0.904, 95% confidence interval [CI]: 0.874–0.934, p < 0.001), while the cut‐off FJA of L4/5 for predicting L4 spondylolisthesis was 53.19. Conclusions Pedicle screw retractor‐assisted TLIF is effective and safe in treating both degenerative and isthmic lumbar spondylolisthesis. The unilateral retractor has the capacity to maintain the disc height achieved by paddle distractors, which optimizes the nerve protection and distractor placement. Patients with an FJA on L4/5 <53.19 were more likely to have DLS.
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Affiliation(s)
- Hongwei Xie
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China
| | - Ziyu Ouyang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China
| | - Hua Zhang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China
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Tu KC, Shih CM, Chen KH, Pan CC, Jiang FC, Hsu CE, Wang YM, Lee CH. Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results. BMC Musculoskelet Disord 2021; 22:559. [PMID: 34144679 PMCID: PMC8214307 DOI: 10.1186/s12891-021-04439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/03/2021] [Indexed: 12/05/2022] Open
Abstract
Backgrounds Surgical reduction for high-grade spondylolisthesis is beneficial for restoring sagittal balance and improving the biomechanical environment for arthrodesis. Compared to posterior total laminectomy and long instrumentation, anterior lumbar inter-body fusion (ALIF) is less invasive and has the biomechanical advantage of restoring the original disk height and increasing lumbar lordosis, thus improving sagittal balance. However, the application of ALIF is still limited in treating low-grade spondylolisthesis. In this study, we developed a new technique termed anterior cantilever procedure to directly reduce the slippage of high-grade lumbosacral spondylolisthesis. The purpose of our study was to investigate the surgical outcomes of the anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation in high-grade spondylolisthesis. Methods All patients with high-grade spondylolisthesis who underwent anterior cantilever procedure followed by anterior lumbar inter-body fusion (ALIF) and posterior mono-segment instrumented fixation between November 2006 and July 2017 were enrolled in our study. The slip percentage, Dubousset’s lumbosacral angle, pelvic tilt, sacral slope, pelvic incidence, and sagittal alignment were measured pre-operatively and postoperatively at the last follow-up. Surgery time, blood loss, complications, and hospital stay were also collected and analysed. Results A total of 11 consecutive patients with high-grade spondylolisthesis patients were included and analysed. All of the high-grade spondylolisthesis in our series occurred at the L5-S1 level. The median age was 37 years, and the median follow-up duration was 36 months. The average slip reduction was 30% (60 to 30%, P < 0.01), and the average correction of Dubousset’s lumbosacral angle was 13.8° (84.1° to 97.9°, P < 0.01). The median intra-operative blood loss was 300 mL. All patients attained improved sagittal balance after the operation and achieved solid fusion within 9 months after surgery. No incidences of implant failure, permanent neurological deficit, or pseudarthrosis were recorded at the last follow-up. Conclusions Anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation is a valid procedure for treating high-grade spondylolisthesis. It achieved a high fusion rate, partially reduced slippage, and significantly improved lumbosacral angle, while minimizing common complications, such as pseudarthrosis, nerve traction injury, excessive soft tissue dissection, and blood loss in posterior reduction procedures. However, posterior instrumentation is still required to the structural stability in the ALIF procedure. Level of evidence IV
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Affiliation(s)
- Kao-Chang Tu
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Cheng-Min Shih
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,PhD Degree Program of Biomedical Science and Engineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan.,Department of Physical Therapy, Hungkuang University, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.,Department of Computer Science & Information Engineering, College of Computing and Informatics, Providence University, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Fuu-Cheng Jiang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan
| | - Yun-Ming Wang
- Institute of Molecular Medicine and Bioengineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan. .,Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan.
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