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Takeda K, Suzuki S, Ozaki M, Takahashi Y, Tsuji O, Nagoshi N, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Influence of slippage reduction and correction of lumbosacral kyphosis by single-level posterior lumbar interbody fusion on spinal alignment in patients with dysplastic spondylolisthesis. Spine Deform 2024:10.1007/s43390-024-00917-9. [PMID: 38926256 DOI: 10.1007/s43390-024-00917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To investigate the influence of slippage reduction and correction of lumbosacral kyphosis by L5-S1 single-level posterior lumbar interbody fusion (PLIF) on spinal alignment and clinical outcomes including postoperative complications in patients with dysplastic spondylolisthesis (DS). METHODS Twenty consecutive patients with symptomatic and severe DS who underwent L5-S1 single-level PLIF with a minimum of 2 years of follow-up after surgery were included. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low back and leg pain obtained on preoperative and postoperative examinations. Postoperative instrumentation failure and L5 radiculopathy were also evaluated. The preoperative and postoperative spinopelvic parameters were measured. RESULTS The JOA score significantly improved from 21.5 ± 4.8 (preoperative) to 27.0 ± 2.5 (postoperative), with a mean recovery rate of 75.0% ± 30.4%. The VAS score for low back pain significantly improved from 44.5 ± 30.1 (preoperative) to 11.5 ± 15.9 (postoperative), and that for leg pain significantly improved from 31.0 ± 33.2 (preoperative) to 5.0 ± 10.2 (postoperative). The slip percentage (% slip) significantly improved from 59.6% ± 13.5% (preoperative) to 25.2% ± 15.0% (postoperative). The lumbosacral angle (LSA) significantly improved from 12.3° ± 9.5° (preoperative) to 1.0° ± 4.9° (postoperative). L5-S1 PLIF led to significant improvement of lumbar lordosis (from 52.0° ± 15.9° to 59.7° ± 8.0°) and pelvic incidence - lumbar lordosis mismatch (from 23.9° ± 20.6° to 13.3° ± 10.0°). Correction of lumbosacral kyphosis had a significant positive correlation with postoperative pelvic tilt (PT) (r = 0.50, P = 0.02), while postoperative % slip did not have a significant correlation with postoperative PT. CONCLUSIONS L5-S1 PLIF for DS provided good clinical outcomes. Correction of lumbosacral kyphosis had a positive impact on regaining ideal spinopelvic balance and may be beneficial in the setting of treating DS. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 1608582, Japan.
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Klawson B, Buchowski JM, Punyarat P, Singleton Q, Feger M, Theologis AA. Comparative Analysis of Three Posterior-Only Surgical Techniques for Isthmic L5-S1 Spondylolisthesis. J Am Acad Orthop Surg 2024; 32:456-463. [PMID: 38412458 DOI: 10.5435/jaaos-d-23-00369] [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: 04/17/2023] [Accepted: 09/10/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE To compare adults with isthmic L5-S1 spondylolisthesis who were treated with three different surgical techniques: PS-only, TS, and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion (TLIF/PLIF). METHODS This is a retrospective analysis of adults with L5-S1 isthmic spondylolisthesis (grade ≥2) who underwent primary all-posterior operations with pedicle screws. Patients were excluded if they had <1 year follow-up, anterior approaches, and trans-sacral fibular grafts. Patient demographics and surgical, radiographic, and clinical data were compared between groups based on the method of anterior column support: none (PS-only), TS, and TLIF/PLIF. RESULTS Sixty patients met inclusion criteria (male patients 21, female patients 39, average age 47 ± 15 years, PS-only 16; TS 20; TLIF/PLIF 24). TS patients more commonly had high-grade slips and markedly greater slip percentage, lumbosacral kyphosis, and pelvic incidence. The three groups were similar for smoking status, visual analog scores/Oswestry Disability Index scores (VAS/ODI), surgical data, and average follow-up (40.1 ± 31.2 months). All groups had similarly notable improvements in Meyerding grade and lumbosacral angle. Slip reduction percentage was similar between groups. While there was a markedly higher overall complication rate for PS-only constructs, all groups had similarly notable improvements in ODI and VAS back scores. CONCLUSIONS All-posterior techniques for L5-S1 isthmic spondylolisthesis resulted in excellent improvement in preoperative symptoms and HRQoL scores and similar radiographic alignment. Trans-sacral screws were more commonly used for high-grade slips. The use of anterior column support resulted in fewer overall complications than posterior-only instrumentation.
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Affiliation(s)
- Ben Klawson
- From the Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO ( Klawson, Buchowski, Singleton, and Feger), Department of Surgery, Faculty of Medicine, Division of Neurosurgery, Thammasat University, Thailand (Punyarat), and the Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, CA (Theologis)
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Kong C, Wang D, Wang W, Wang Y, Lu S. Fusion with and without lever reduction in degenerative lumbar spondylolisthesis: a retrospective study. J Orthop Surg Res 2024; 19:17. [PMID: 38167006 PMCID: PMC10763449 DOI: 10.1186/s13018-023-04507-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The reduction of slipped vertebra is often performed during surgery for degenerative lumbar spondylolisthesis (DLS). This approach, while potentially improving clinical and radiological outcomes, also carries a risk of increased complications due to the reduction process. To address this, we introduced an innovative lever reduction technique for DLS treatment. This study aims to investigate the clinical efficacy, radiological outcomes, and complications of fusion with or without lever reduction. METHODS We conducted a retrospective review of prospectively collected data from a registry of patients who underwent lumbar fusion surgery for DLS, with a follow-up of at least 24 months. Self-reported measures included visual analog scale (VAS) for back or leg pain, Oswestry Disability Index (ODI), and the achievement of minimal clinically important difference (MCID). Radiological assessments encompassed spondylolisthesis percentage (SP), focal lordosis (FL), and lumbar lordosis (LL). Complications were categorized using the modified Clavien-Dindo classification (MCDC) scheme. Patients were assigned to the reduction group (RG) and non-reduction group (NRG) based on the application of the lever reduction technique. Clinical and radiological outcomes at baseline, immediately after surgery, and at the last follow-up were compared. RESULTS A total of 281 patients were analyzed (123 NRG, 158 RG). Baseline patient demographics, comorbidities, and surgical characteristics were similarly distributed between groups except for operating time (NRG 129.25 min, RG 138.04 min, P = .009). Both groups exhibited significant clinical improvement after surgery (all, P = .000), with no substantial difference between groups (VAS, ODI, or the ability to reach MCID). Patients in RG showed statistically lower SP and higher FL during follow-up (all, P = .000). LL was comparable at different time points within each group or at the same time point between the two groups (all, P > .050). The overall complication rate (NRG 38.2%, RG 27.2%, P = .050) or specific complication rates per MCDC were similar between groups (all, P > .050). Patients in RG were predisposed to a lower risk of adjacent segment degeneration (ASDeg) (NRG 9.8%, RG 6.3%, P = .035). CONCLUSIONS There were no significant differences in postoperative measures such as VAS scores for back and leg pain, ODI, the ability to reach MCID, overall complication rate, or specific complication rates per MCDC between surgical approaches. However, fusion with lever reduction demonstrated a notable advantage in restoring segmental spinal sagittal alignment and reducing the occurrence of ASDeg compared to in situ fusion.
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Affiliation(s)
- Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Yu Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.
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Ramirez Velandia F, Gomez Cristancho DC, Urrego Nieto A, Marquez I, Restrepo Martinez A, Becerra Ospina JE, Pérez Rodriguez JC. Minimally Invasive Surgery for Managing Grade IV and V Spondylolisthesis. Asian J Neurosurg 2023; 18:437-443. [PMID: 38152513 PMCID: PMC10749848 DOI: 10.1055/s-0043-1771317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Surgical treatment of high-grade spondylolisthesis is controversial and aims at restoring the spinopelvic sagittal balance through complete or partial reduction of the listhesis. Nerve decompression and interbody fusion are necessary for patients presenting with neurological deficit, severe pain, lower limb asymmetry, or deformities. We present the case and the results of a patient with high-grade spondylolisthesis, in whom minimally invasive management was performed. A narrative review in this topic is also provided. We performed a literature review of high-grade spondylolisthesis to compare our technique to current surgical alternatives. We included articles from PubMed, Embase, Scopus, Ovid, and Science Direct published between 1963 and 2022 that were written in English, German, and Spanish. The terms used were the following: "high grade spondylolisthesis," "spondyloptosis," "surgical management," "interbody fusion," and "arthrodesis." In all, 485 articles were displayed, from which we filtered 112 by title and abstract. At the end, 75 references were selected for the review. Different interbody fusion techniques can be used to correct the lumbosacral kyphosis and restore the spinopelvic parameters. A complete reduction of the listhesis is not always required. The surgical procedure carried out in our patient corresponds to the first known case of minimally invasive circumferential arthrodesis with iliac screws and sacral fixation in a high-grade dysplastic spondylolisthesis. This approach guarantees the correction of the lumbosacral kyphosis and a complete reduction of the listhesis. Further studies are required to determine whether the results of this case can be extrapolated to other patients with high-grade spondylolisthesis.
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Affiliation(s)
- Felipe Ramirez Velandia
- Neurology and Neurosurgery Research Group, Pontificia Universidad Javeriana, Bogotá́ D.C., Colombia
| | - David Camilo Gomez Cristancho
- Department of Neurologic Surgery, Universidad Nacional de Colombia, Neurosurgery Research Group, NeuroAxis SAS, Bogota D.C., Colombia
| | - Andres Urrego Nieto
- Department of Neurologic Surgery, Universidad Nacional de Colombia, Neurosurgery Research Group, NeuroAxis SAS, Bogota D.C., Colombia
| | - Isabel Marquez
- Neurology and Neurosurgery Research Group, Pontificia Universidad Javeriana, Bogotá́ D.C., Colombia
| | | | - Jaime Eduardo Becerra Ospina
- Department of Neurologic Sugery, Pontificia Universidad Javeriana, Neurosurgery Research Group, NeuroAxis SAS, Bogota D.C., Colombia
| | - Juan Carlos Pérez Rodriguez
- Department of Neurologic Sugery, Pontificia Universidad Javeriana, Neurosurgery Research Group, NeuroAxis SAS, Bogota D.C., Colombia
- Department of Spinal Deformity Surgery, Instituto Nacional de Traumatología e Ortopedia Jamil Haddad, Río de Janeiro, Brazil
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Zhang Y, Song J, Lu Y, Yi M, Lin W, Yao M, Luo Z, Zhang G, Ding L. Modified unilateral iliac screw fixation with partial reduction in the treatment of high-grade spondylolisthesis at L5/S1 in adult patients: introduction of key technique, report of clinical outcomes and analysis of spinopelvic parameters. BMC Musculoskelet Disord 2023; 24:451. [PMID: 37268898 DOI: 10.1186/s12891-023-06552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Management of high-grade spondylolisthesis (HGS) remains challenging. Spinopelvic fixation such as iliac screw (IS) was developed to deal with HGS. However concerns regarding constructs prominence and increased infection-related revision surgery have complicated it's use. We aim to introduce the modified iliac screw (IS) technique in treating high-grade L5/S1 spondylolisthesis and it's clinical and radiological outcomes. METHODS Patients with L5/S1 HGS who underwent modified IS fixation were enrolled. Pre- and postsurgical upright full spine radiographs were obtained to analyze sagittal imbalance, spinopelvic parameters, pelvic incidence-lumbar lordosis mismatch (PI-LL), slip percentage, slip angle (SA), and lumbosacral angle (LSA). Visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated pre- and postoperatively for clinical outcomes assessment. Estimated blood loss, operating time, perioperative complications and revision surgery were documented. RESULTS From Jan 2018 to March 2020, 32 patients (15 males) with mean age of 58.66 ± 7.77 years were included. The mean follow-up period was 49 months. The mean operation duration was 171.67 ± 36.66 min. At the last follow-up: (1) the VAS and ODI score were significantly improved (p < 0.05), (2) PI increased by an average of 4.3°, the slip percent, SA and LSA were significantly improved (p < 0.05), (3) four patients (16.7%) with global sagittal imbalance recovered a good sagittal alignment, PI-LL within ± 10° was observed in all patients. One patient experienced wound infection. One patient underwent a revision surgery due to pseudoarthrosis at L5/S1. CONCLUSION The modified IS technique is safe and effective in treating L5/S1 HGS. Sparing use of offset connector could reduce hardware prominence, leading to lower wound infection rate and less revision surgery. The long-term clinical affection of increased PI value is unknown.
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Affiliation(s)
- Yao Zhang
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Jipeng Song
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Yuzheng Lu
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Meng Yi
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Wancheng Lin
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Mingtao Yao
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Zhengning Luo
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Genai Zhang
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Lixiang Ding
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China.
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Alves A, Langlais T, Odent T, Pham AD, Pouliquen JC, Glorion C. High-grade L5-S1 spondylolisthesis with lumbosacral kyphosis: Long-term results of non-instrumented circumferential arthrodesis in children, adolescents. Orthop Traumatol Surg Res 2022; 108:103093. [PMID: 34601157 DOI: 10.1016/j.otsr.2021.103093] [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: 10/01/2017] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The choice of surgical technique for high-grade spondylolisthesis (HGS) associated with lumbosacral kyphosis remains controversial. Are non-instrumented techniques still relevant, what with the multiplicity and modernity of patient-specific instrumentation? HYPOTHESIS Our hypothesis was that a non-instrumented circumferential arthrodesis performed after a period of gradual reduction of HGS, associated with lumbosacral kyphosis, provided satisfactory long-term functional and radiographic results in children and adolescents while minimizing the risk of complications. MATERIALS AND METHODS Thirty-one L5-S1 HGS associated with a lumbosacral kyphosis operated by non-instrumented circumferential arthrodesis after a period of traction and suspension were included in our study. The first stage of this technique consisted of a gradual reduction using traction followed by immobilization in the corrected position. The second stage involved a posterior, followed by an anterior, surgical procedure and a spica cast immobilization for 4 months. The mean age at surgery was 13.9±2.3 years (6-18) and the mean follow-up was 10.3±4.5 years (2.1-17.8). RESULTS The overall complication rate was 26% (n=8/31): 13% neurologic complications, 10% bone fusion defects and 3% skin complications. The reoperation rate was 13% (n=4/31). The mean ODI (/50) was 3±4.6 (0-22) and the SRS-30 126.7±15 (72-143). The Taillard index decreased by 25% (p<.001) and remained stable throughout the follow-up period (p=.65). The lumbosacral angle was corrected by 13.5% (p=.03) and the correction was maintained throughout the follow-up period (p=.71). At the last follow-up, the lumbosacral angle was significantly correlated with a low ODI score and a high SRS-30 score (p<.05). CONCLUSION Even though this technique achieved a smaller reduction of the lumbosacral angle, it reduced by at least a factor of three the incidence of neurologic complications and resulted in satisfactory functional outcomes when compared to instrumented and intraoperative correction series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alexandra Alves
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.
| | - Tristan Langlais
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital des enfants Purpan, Université de Toulouse, Place du docteur Baylac, 31000 Toulouse, France
| | - Thierry Odent
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Anne-Dominique Pham
- Département de Biostatistiques et Recherche Clinique, Université Caen-Normandie, avenue de la Côte de Nacre, 14033 Caen cedex 9, France
| | - Jean-Claude Pouliquen
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Christophe Glorion
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
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Srinivasan ES, Than KD. Commentary: Sacral Pedicle Subtraction Osteotomy for Treatment of High-Grade Spondylolisthesis: A Technical Note and Review of the Literature. Oper Neurosurg (Hagerstown) 2022; 23:e91-e92. [PMID: 35838457 DOI: 10.1227/ons.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ethan S Srinivasan
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Yeung CM, Schoenfeld AJ, Lightsey HM, Kang JD, Makhni MC. Trends and Complications in Spinopelvic Fixation for Deformity for Spinal Surgeons in Early Independent Practice. Clin Spine Surg 2022; 35:E162-E166. [PMID: 33783368 DOI: 10.1097/bsd.0000000000001163] [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: 08/12/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective case series study. OBJECTIVE Evaluate trends and complications following posterior spinal instrumented fusion for deformity with/without pelvic fixation using the American Board of Orthopaedic Surgery Part II Oral Examination Candidate Case List data from 2008 to 2017. SUMMARY OF BACKGROUND DATA Complication rates for cases with pelvic fixation are widely reported in spine deformity literature but are typically derived from practices of senior surgeons. As surgical experience and clinical volume are shown to decrease complication rates, spine surgeons newly in practice may have higher risks of such events. MATERIALS AND METHODS Surgical cases submitted by candidates taking the American Board of Orthopaedic Surgery Part II Oral Examination between 2008 and 2017 with a self-designated sub-specialty of spine surgery were retrospectively reviewed. Mortality, readmission/reoperation data, and complications as reported by candidates were tracked over time. Bivariate testing and multivariable Poisson analyses, respectively, were used to assess complication rates and time-related trends. RESULTS A total of 37,539 cases were submitted between 2008 and 2017. Four hundred sixty-one cases (1.2%) were for deformity; of these, 60 cases included pelvic fixation (13% of deformity cases). For all deformity cases, we noted medical, surgical, and overall complication rates to be 17%, 22.3%, and 31.5%. Multivariable analyses demonstrated no difference in surgical/overall complication rates between spinopelvic and nonspinopelvic instrumented groups, but showed a consistently low number of cases using spinopelvic fixation over time. CONCLUSIONS Newly practicing spinal surgeons consistently performed low numbers of deformity cases with relatively high complication rates which remained stable over time.
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Affiliation(s)
- Caleb M Yeung
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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High-grade high-dysplastic lumbosacral spondylolisthesis in children treated with complete reduction and single-level circumferential fusion: A prospective case series. BRAIN AND SPINE 2022; 2:100871. [PMID: 36248175 PMCID: PMC9560694 DOI: 10.1016/j.bas.2022.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 10/26/2022]
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Jamshidi AM, Soldozy S, Levi AD. Efficacy of Reverse and Modified Bohlman Technique for Lumbar Spondylolisthesis: A Systematic Review of the Literature. World Neurosurg 2021; 162:36-41. [PMID: 34871805 DOI: 10.1016/j.wneu.2021.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE High grade lumbar spondylolisthesis (HGLS) remains a challenging surgical entity, and there is no current consensus regarding optimal surgical approach. The purpose of this study was to systematically review the literature for studies utilizing the Reverse or Modified Bohlman technique for the treatment of HGLS to assess its safety and efficacy. METHODS The authors perform a literature search of PubMed/MEDLINE electronic databases from their inception according to the PRISMA guidelines. RESULTS A total of 8 studies were included. The studies comprised a total of 43 patients, with mean age of 41.4 ± 19.8 (9-83) years. The mean follow-up was 38.2 ± 41.7 (3-137) months. Most patients (81.4%) were classified as having grade III or higher spondylolisthesis. The most common presenting symptom was back pain (93%), followed by radiculopathy in roughly half of patients (41.9%). Majority of patients (93%) experienced complete resolution of symptoms as well as successful fusion (90.7%) on follow-up. Complications included cage/graft failure (7%), nerve injury (7%), wound infection (7%), pseudoarthrosis (2.3%), epidural hematoma (2.3%), and deep vein thrombosis (2.3%). Revision surgery was required in 4 (9.3%) patients. Slip percentage (60.2% versus 43.2%, p<0.0001) and slip angle (17.1° versus 6.4°, p<0.001) both decreased significantly following surgery. CONCLUSIONS Our data demonstrate Reverse and Modified Bohlman techniques appear to be effective in both improving slip angle/percentage and relieving symptoms with low risk of complications. These findings are limited by the small sample size of patients. The authors recommend larger series before formal recommendations can be made.
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Affiliation(s)
- Aria M Jamshidi
- University of Miami MILLER School of Medicine, Department of Neurological Surgery Lois Pope Life Center 1095 NW 14 (th) Terrace (D4-6), Miami, FL 33136
| | - Sauson Soldozy
- University of Miami MILLER School of Medicine, Department of Neurological Surgery Lois Pope Life Center 1095 NW 14 (th) Terrace (D4-6), Miami, FL 33136
| | - Alan D Levi
- University of Miami MILLER School of Medicine, Department of Neurological Surgery, 1095 Northwest 14th Terrace, Suite (D4-6), Miami, FL 33136
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Delgado-Fernández J, Frade-Porto N, Blasco G, González-Tarno P, Gil-Simoes R, Rivas PP, de Sola RG. Long term outcome and fusion rate of transdiscal fixation for L5-S1 high grade spondylolisthesis. Clin Neurol Neurosurg 2021; 208:106898. [PMID: 34478988 DOI: 10.1016/j.clineuro.2021.106898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High grade spondylolisthesis (HGS) is a quite rare entity and many techniques are available to address this condition. In 1994 Abdu et al. proposed a transdiscal fixation approach that achieved a good clinical outcome. We analyse outcome and fusion achieved in patients treated by transdiscal fixation after 1-year follow-up. METHODS We reviewed patients operated through transdiscal fixation since 2014 with a follow-up of at least 1 year, and compared preoperative and postoperative clinical measures (ODI, VAS and EQ-5D) and postoperative complications. Also, we analyzed the degree of fusion on CT scan with Lenke and Birdwell criteria. RESULTS Twelve patients were included in the study with a mean follow-up of 49.4 months (range 12.8-84.1 months). Three cases presented a Meyerding grade IV spondylolisthesis and 9 cases grade III. At 1-year follow-up mean postoperative ODI, VAS and EQ5D scores improved (ODI 13.2 (range 0-30) vs 49.83 (range 15-71.1); p = .005). Equally this improvement was seen in the last follow-up (ODI 9.28 (range 0-35) vs 49.83 (range 15-71.1); p = .005). CT scan showed fusion grade A in 5 patients (41.6%), another 5 as grade B (41.6%) in Lenke classification. According to the Birdwell criteria 4 patients were classified as grade I (33.3%), 7 patients grade II (58.3%). None showed complications postoperatively or radiolucency in follow-up. CONCLUSIONS Transdiscal fixation shows a good clinical outcome that is maintained throughout a long time period and provides a reliable and suitable fusion.
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Affiliation(s)
| | - Natalia Frade-Porto
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Guillermo Blasco
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Patricia González-Tarno
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Paloma Pulido Rivas
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Rafael García de Sola
- Department of Neurosurgery, Innovation in Neurosurgery, Universidad Autonoma de Madrid, Hospital del Rosario, Madrid, Spain
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Kerr HL, Gee A, Fernandes RJR, Kanawati AJ, Jin W, Gurr KR, Bailey CS, Zdero R, Rasoulinejad P. Biomechanical comparison of 3 types of transdiscal fixation implants for fixing high-grade L5/S1 spine spondylolisthesis. Spine J 2021; 21:1587-1593. [PMID: 33933707 DOI: 10.1016/j.spinee.2021.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There are several options for the stabilization of high-grade lumbosacral spondylolisthesis including transdiscal screws, the Bohlman technique (transdiscal fibular strut) and the modified Bohlman technique (transdiscal titanium mesh cage). The choice of an optimum construct remains controversial; therefore, we endeavoured to study and compare the biomechanical performance of these 3 techniques. PURPOSE The aim of this study was to compare 3 types of transdiscal fixation biomechanically in an in vitro porcine lumbar-sacral spine model. STUDY DESIGN/SETTING Porcine cadaveric biomechanical study. METHODS 18 complete lumbar-sacral porcine spines were split into 3 repair groups, transdiscal screws (TS), Bohlman technique, and a modified Bohlman technique (MBT). Range of motion (L3 - S1) was measured in an intact and repaired state for flexion, extension, left/right lateral bending, and left/right torsion. To recreate a high-grade lumbosacral spondylolisthesis a bilateral L5/S1 facetectomy, removing the intervertebral disc completely, and the L5 body was displaced 50%-60% over the sacral promontory. Results were analyzed and compared to intact baseline measurements. Standard quasi-static moments (5 Nm) were applied in all modes. RESULTS All range of motion (ROM) were in reference to intact baseline values. TS had the lowest ROM in all modes (p=.006-.495). Statistical difference was found only in extension for TS vs. BT (p=.011) and TS vs. MBT (p=.014). No bone or implant failures occurred. CONCLUSION TS provided the lowest ROM in all modes of loading compared to Bohlman technique and MBT. Our study indicates that TS results in the most biomechanically stable construct. CLINICAL SIGNIFICANCE Knowledge of the biomechanical attributes of various constructs could aid physicians in choosing a surgical construct for their patients.
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Affiliation(s)
- Hui-Ling Kerr
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada; Dept. of Trauma and Orthopaedics, Gloucestershire Hospitals NHS Foundation Trust, GL53 7AN, Gloucestershire, UK
| | - Aaron Gee
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada.
| | - Renan J R Fernandes
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada
| | - Andrew J Kanawati
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada; Westmead Hospital, Sydney, New South Wales, NSW 2145, Australia
| | - Winston Jin
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada
| | - Kevin R Gurr
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada
| | - Christopher S Bailey
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada
| | - Radovan Zdero
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada; Dept. of Mechanical and Materials Engineering, Western University, London, N6A 3K7, Canada
| | - Parham Rasoulinejad
- London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada
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13
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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: 9] [Impact Index Per Article: 3.0] [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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14
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Elnokaly MA, Adawi MM, Nabeel AM. Pedicular lumbosacral spine fusion for adult/adolescent lumbar developmental high-grade spondylolisthesis. Surg Neurol Int 2020; 11:416. [PMID: 33365179 PMCID: PMC7749966 DOI: 10.25259/sni_676_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/18/2020] [Indexed: 11/04/2022] Open
Abstract
Background Few series report on the management of high-grade spondylolisthesis (HGS) in adolescents and young adults. This review highlights a series of six consecutive cases with developmental (dysplastic) HGS successfully managed with L3 or L4 to S1 transpedicular screw placement, rather than in situ/noninstrumented lumbosacral fusion. Methods The six patients with HGS, according to the Meyerding Grading, presented with low back pain and bilateral sciatica (2016-2020). Patients averaged 19.8 years of age and underwent posterior transpedicular L3 or L4-S1 screw fusions. They were all monitored for at least 6 postoperative months. Results None of the six patients developed any major perioperative/postoperative complications; only one patient had severe postoperative back pain that slowly improved over 3 months. All the patients were clinically improved postoperatively, uniformly demonstrated fusion on postoperative CT studies, and considered the operation worthwhile. Conclusion Posterior transpedicular screw fixation of the lumbosacral spine is an efficient and safe technique for the treatment of L3 or L4 to L5-S1 HGS. It is a suitable instrumented technique for managing adult/adolescent HGS and offers an alternative to the more typically performed in situ/noninstrumented L4-S1 procedures.
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Affiliation(s)
| | - Mohammed M Adawi
- Department of Neurosurgery, Faculty of Medicine, Benha University, Benha, Al Qalubia, Egypt
| | - Ahmed M Nabeel
- Department of Neurosurgery, Faculty of Medicine, Benha University, Benha, Al Qalubia, Egypt
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15
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Surgical treatment of high-grade spondylolisthesis: Technique and results. J Orthop 2020; 22:383-389. [PMID: 32952331 DOI: 10.1016/j.jor.2020.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Surgical management of high-grade spondylolisthesis is not only challenging but also controversial, from in situ fusion to complete reduction. We report our results of a safe three-stage spinal procedure in a single surgical session with seven patients diagnosed high-grade spondylolisthesis. Hypothesis Posterior fixation combined with interbody fusion is effective on reduction, ossification and clinical outcomes in high-grade spondylolisthesis. Patients and methods This study is a retrospective review of patients who underwent surgery between 2016 and 2018. The surgical method involved specific installation for deformity reduction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, gradual reduction of the deformity, and sometimes maintenance of the reduction with interbody fusion. Patients were checked out at 2, 6 and 12 months and yearly after the procedure. Clinical, radiological, Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI) outcomes measures were collected. Results Seven patients with high-grade spondylolisthesis at L5-S1 (2 patients grade II, 4 patients grade IV and 1 patient grade V), with a median age of 37 years [17; 72] were included. Median follow-up was 24 months [12; 25 months]. All patients have a fused joint at 6 months except one. Median lumbosacral angle (LSA) improved from 76°[59; 85] to 94°[76; 104]. Meyerding grade of 2 cases was stable after surgery, 3 cases with loss of two ranks and 2 cases with loss of one rank. The radiological parameters showed statistically significant difference (p = 0.036) postoperatively. There was not deep infection. Medians VAS and ODI showed improved pain and disability scores. Conclusion This procedure allows correct reduction rate of high-grade spondylolisthesis with good clinic-radiologic outcomes. Though surgically demanding, it was safe and reproducible. Level of evidence IV, retrospective.
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16
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Kunze KN, Lilly DT, Khan JM, Louie PK, Ferguson J, Basques BA, Nolte MT, Dewald CJ. High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management. Int J Spine Surg 2020; 14:327-340. [PMID: 32699755 DOI: 10.14444/7044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Information regarding the treatment of high-grade spondylolisthesis (HGS) in adults has been previously described; however, previous descriptions of the evaluation and surgical management of HGS do not represent more recent and now established approaches. The purpose of the current review is to discuss current concepts in the evaluation and management of patients with HGS. Methods Literature review. Results HGS is diagnosed in up to 11.3% of adults with spondylolisthesis and typically presents as nonspecific lower back pain. Regarding evaluation, a thorough history and physical examination should be performed, which may help predict the presence of HGS. Diagnostic imaging, and specifically the use of spino-pelvic parameters, are now commonly implicated in guiding treatment course and prognosis. When surgical intervention is indicated, surgical approaches include in situ fusion variations, reduction and partial reduction with fusion, and vertebrectomy. Although the majority of studies suggest improvements with these approaches, the literature is limited by a low level of evidence with regards to the superiority of one technique when compared with others. Conclusions HGS is a unique cause of low back pain in adults that carries considerable morbidity, but rarely presents with neurologic symptoms. Although the definitions, classifications, and methods of diagnosis of this spinal deformity have been established and accepted, the ideal surgical management of this deformity remains highly debated. Fusion in situ techniques are often technically easier to perform and provide lower risk of neurologic complications, whereas reduction and fusion techniques offer greater restoration of global spino-pelvic balance. Preoperative spino-pelvic parameters may have utility in assisting in procedural selection; however, future, higher-quality and longer-term studies are warranted to determine the optimal surgical intervention among the widely available techniques currently used, and to better define the indications for these interventions.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Daniel T Lilly
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jannat M Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip K Louie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph Ferguson
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Christopher J Dewald
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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18
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Reduction versus In Situ Fusion for Adult High-Grade Spondylolisthesis: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:512-520.e2. [PMID: 32179186 DOI: 10.1016/j.wneu.2020.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical management of high-grade spondylolisthesis is controversial. Both reduction and in situ fusion are available options, but it remains unclear which approach provides better outcomes. We conducted a systematic review and meta-analysis of studies reporting outcomes following reduction or in situ fusion for adult high-grade spondylolisthesis. METHODS PubMed, Embase, Web of Science, and Cochrane databases were last searched on June 24, 2019. We identified 1236 studies after excluding duplicates. After screening, 15 studies were included in the meta-analysis. Random-effects models were used to pool effect estimates. RESULTS A total of 188 patients were analyzed. Compared with reduction, in situ fusion had a higher mean estimated blood loss (584 mL vs. 451 mL) and a clinically higher incidence of neurologic (48% vs. 15%), pseudarthrosis (13% vs. 8%), and infectious (20% vs. 10%) complications; however, these differences were not statistically significant. Reduction was associated with a clinically higher incidence of overall complications (32% vs. 25%) and dural tears (22% vs. 7%). Reduction provided better pain relief (mean difference [MD] = 5.24 vs. 4.77) and greater change in pelvic tilt (MD = 5.33 vs. 2.60); however, these differences were not statistically significant. Patients who underwent reduction had significantly greater decline in Oswestry Disability Index scores (MD = 55.7 vs. 11.5; Pinteraction < 0.01) and greater change in slip angle (MD = 25.0 vs. 11.4; Pinteraction = 0.01). CONCLUSIONS In management of adult high-grade spondylolisthesis, both approaches appeared to be safe and effective. Reduction appeared to offer better disability relief and spinopelvic parameter correction than in situ fusion.
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19
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Kong C, Wang W, Li X, Sun X, Ding J, Lu S. A new lever reduction technique for the surgical treatment of elderly patients with lumbar degenerative Spondylolisthesis. BMC Musculoskelet Disord 2020; 21:11. [PMID: 31910845 PMCID: PMC6947985 DOI: 10.1186/s12891-019-3028-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proper reduction method for Lumbar degenerative spondylolisthesis (LDS) is still controversial. The aim of this study was to determine the safety and effectiveness of lever reduction combined with traditional elevating-pull reduction technique for the treatment of elderly patients with LDS. METHODS From May 2015 to December 2017, 142 elderly patients (≥65 years) diagnosed with LDS were enrolled in this study with a mean follow-up of 25.42 ± 8.31 months. All patients were operated using lever reduction combined with traditional elevating-pull reduction technique. Patient age, sex, body mass index, bone mineral density, preoperative comorbidities, surgical duration, blood loss, and surgical complications were collected form patient charts. Clinical data as visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36) were collected preoperatively, 1 month postoperatively, and at the final follow-up. Radiographic evaluation included slip percentage, slip angle (SA), lumbar lordosis (LL), and fusion status. RESULTS The clinical parameters of VASback, VASleg, ODI, and SF-36 had significantly improved at both follow-ups after surgery. A significant improvement was indicated for slippage reduction at both follow-ups, showing no significant correction loss after surgery. SA significantly increased after surgery and was well maintained at the final follow-up. LL was not affected by the surgery. At the final follow-up, complete fusion was obtained in 121 patients (85.2%) and partial fusion in 21 (14.8%). Revision surgery was performed for one patient. Screw loosening was observed in 3 (2.11%) cases. No nerve root injury or adjacent segment disease was observed. CONCLUSIONS This new lever reduction combined with traditional elevating-pull reduction technique for the surgical treatment of elderly patients with LDS is both safe and effective. Satisfactory correction and fusion rates were achieved with acceptable correction loss and reduction-related complications.
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Affiliation(s)
- Chao Kong
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Wei Wang
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiangyu Li
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiangyao Sun
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Junzhe Ding
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Pham MH, Buchanan IA, Lewis CS, Fredrickson V, Kammen A, Bakhsheshian J, Acosta FL. Use of a Reverse Bohlman Technique for Low-Grade Spondylolisthesis. Int J Spine Surg 2019; 13:486-491. [PMID: 31745450 DOI: 10.14444/6065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Treatment of spondylolisthesis can be difficult with regard to patients with high sacral slopes that may prohibit placement of interbody grafts for fusions across that segment. Here, we describe placement of a reverse Bohlman technique from an anterior approach to obtain fusion across a low-grade spondylolisthesis with a high sacral slope to obtain anterior fusion. Methods A chart review was conducted on this single patient regarding his clinical course and outcome. Results A 54-year-old male presented with low-back pain associated with bilateral leg pain dating back several years. Plain films demonstrated a Grade II isthmic spondylolisthesis at L5-S1 with spinopelvic measurements of 73° sacral slope, 82° lumbar lordosis, 12° pelvic tilt, and 94° pelvic incidence. Magnetic resonance imaging showed bilateral L5 pars defects with diffuse degenerative disease from L4 through S1 and significant ligamentous and facet hypertrophy. He underwent an L4-5 anterior lumbar interbody fusion and an L5-S1 reverse Bohlman placement of a transvertebral transsacral titanium mesh cage. This was supplemented with a posterior decompression and instrumentation from L4-ilium. He had resolution of his radiculopathy and has maintained a good clinical outcome at 3 years follow up. Conclusions We present here a patient with low-grade spondylolisthesis and a steep sacral slope who underwent a successful reverse Bohlman approach with long-term follow up. This report highlights the potential utility of this method as a viable alternative for patients with low-grade spondylolisthesis. Level of Evidence IV. Clinical Relevance Technical description of surgical technique.
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Affiliation(s)
- Martin H Pham
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ian A Buchanan
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Courtney S Lewis
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vance Fredrickson
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Alexandra Kammen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Frank L Acosta
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Jamshidi A, Levi AD. Reverse Bohlman technique for treatment of high-grade spondylolisthesis in an adult population. J Clin Neurosci 2019; 69:230-236. [PMID: 31439487 DOI: 10.1016/j.jocn.2019.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND/AIMS Surgical techniques for treatment of high-grade spondylolisthesis (HGS) remain controversial. This study aims to evaluate both radiographic and clinical outcomes in patients with HGS treated with the "modified Bohlman" and Reverse Bohlman technique. METHODS Review of consecutive HGS patients undergoing modified Bohlman and Reverse Bohlman at a single center from 2006 to 2018. Clinical, surgical, and radiographic data were collected. RESULTS Six patients identified in the modified Bohlman treatment arm: and eight patients in the Reverse Bohlman group. Twelve (12) patients presented with high grade congenital spondylolisthesis at L5-S1; one patient presented with dissolution of the L5 vertebral body secondary to uncontrolled osteomyelitis that developed after a previous failed fusion; and one patient presented with iatrogenic L5-S1 spondylolisthesis after a previous L3-S1 fusion. One patient had medially placement pedicle screw and associated radiculopathy. All follow-up post = operative scans demonstrated solid fusion. Postoperatively, anterolisthesis improved from 18.3% to 10.1% (p = .0586) and the slip angle improved from 60.43° of kyphosis to 48.71° (p = .0139). No spondylolisthesis translational reduction maneuvers were attempted intraoperatively except for positioning on a sacral cushion to increase lordotic angle. Lumbar lordosis improved from 65.29 to 63.86 postoperatively. Four of our fourteen patients had long-term median follow-up of 28 months (range = 19-48 months) slip angle, percentage, and lumbar lordosis all improved from the patient's pre-operative measurements. The improvement in slip angle was nearly statistically significant with a p-value of 0.065. CONCLUSIONS Reverse Bohlman technique for high grade spondylolisthesis is a viable option when seeking to address adjacent level instability or slip.
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Affiliation(s)
- Aria Jamshidi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan D Levi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
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Expectations for Postoperative Improvement in Health-Related Quality of Life in Young Patients With Lumbosacral Spondylolisthesis: A Prospective Cohort Study. Spine (Phila Pa 1976) 2019; 44:E181-E186. [PMID: 30005048 DOI: 10.1097/brs.0000000000002788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective multicenter study of the changes in Scoliosis Research Society Outcome Questionaire 22 (SRS-22) scores for 78 patients younger than 25 years old surgically treated for lumbosacral spondylolisthesis OBJECTIVE.: Report the change of health-related quality of life (HRQOL) in patients younger than 25 years after surgical treatment of lumbosacral spondylolisthesis. SUMMARY OF BACKGROUND DATA There is a paucity of data with regard to the influence of surgical treatment on the HRQOL of patients with lumbosacral spondylolisthesis. Large prospective studies are needed to clearly define the benefits of surgery in the young patient population. METHODS A prospective multicenter cohort of 78 patients younger than 25 years (14.8 ± 2.9, range: 7.9-23.6 yr) undergoing posterior fusion for lumbosacral spondylolisthesis were enrolled. There were 17 patients with low-grade (<50%) and 61 with high-grade (≥50%) slips. SRS-22 scores calculated before surgery and after 2 years of follow-up were compared for all patients using two-tailed paired t tests. Subanalyses for low- and high-grade patients were done using two-tailed Wilcoxon signed ranked and paired t tests, respectively. The level of significance was set at 0.05. RESULTS HRQOL was significantly improved 2 years after surgery for all domains and for the total score of the SRS-22 questionnaire. The individual total score was improved in 66 patients (85%), and 52 patients (67%) improved by at least 0.5 point. All domains and the total score of the SRS-22 questionnaire were significantly improved for high-grade patients, whereas only pain, function, and total score were improved for low-grade patients. CONCLUSION This is the largest study comparing the HRQOL before and after surgery in young patients with low- and high-grade lumbosacral spondylolisthesis. HRQOL significantly improves after surgery for the majority of patients, especially for high-grade patients. This study helps clinicians to better counsel patients with regard to the benefits of surgery for lumbosacral spondylolisthesis. LEVEL OF EVIDENCE 2.
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Sharma M, Aljuboori Z, Clouse JW, Rodgers R, Altstadt T. Sacro-iliac joint fusion system for high-grade Spondylolisthesis using "Reverse Bohlman technique": a technical report and overview of the literature. World Neurosurg 2019; 124:331-339. [PMID: 30684713 DOI: 10.1016/j.wneu.2019.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND High-grade Spondylolisthesis (HGS) is a complex clinical problem that poses significant challenges to the treating physician. There is a contentious debate regarding the most optimal surgical approach in these patients. A variety of trans-sacral and transvertebral techniques have been described in the literature. CASE ILLUSTRATION In this report, we present two cases of 35-year-old and 26-year-old Caucasian females who presented with low back pain and radicular symptoms. CT and MRI scan revealed progressive HGS (Grade III), which was not relieved with conservative measures. They underwent transsacral fixation using Reverse Bohlman technique (RBT) at L5-S1, L4-5 Anterior lumbar interbody fusion (ALIF) combined with postero-lateral fusion (PLF). At 9 and 10 months follow up, patients reported minimal back pain with no radicular symptoms and imaging showed satisfactory fusion in both patients. CONCLUSION This is the first report to demonstrate the utility of SI joint fusion cage (using RBT) in patients with HGS with successful clinical outcome. This technique is safe, feasible, and effective in carefully selected patients.
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Affiliation(s)
- Mayur Sharma
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Zaid Aljuboori
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jared William Clouse
- Department of Neurological Surgery, Indianapolis University School of Medicine, Indianapolis, IN
| | - Richard Rodgers
- Department of Neurological Surgery, Indianapolis University School of Medicine, Indianapolis, IN
| | - Thomas Altstadt
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
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Krause KL, DeDeaux C, Jung E, Than KD. Two-level reverse Bohlman transsoseous approach for treatment of symptomatic pseudarthrosis. Br J Neurosurg 2018; 33:84-87. [PMID: 30522354 DOI: 10.1080/02688697.2018.1525481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surgical treatment for high-grade spondylolisthesis with high sacral slope remains controversial and no definitive gold standard procedure has been identified. The Bohlman technique, in which a fibular strut is reamed posteriorly across the L5-S1 disc space in an oblique, inferior to superior trajectory, has been increasingly utilized. Recently, a Reverse Bohlman technique has been described, in which a graft is reamed anteriorly across a single disc space in a superior to inferior trajectory. Case Report A 55 year-old male with complete lumbarization of S1 (referred to as L6) and previous L5-L6-S1 posterior instrumented fusion presented, with progressively worsening low back pain and lower extremity radicular pain. After failing conservative management, he underwent a 2-level Reverse Bohlman approach to place a titanium mesh interbody graft (cage) anteriorly from L5 to S1, crossing the L5-6 and L6-S1 disc spaces. Here we describe for the first time a Reverse Bohlman technique spanning two disc spaces in a patient with a transitional lumbosacral anomaly and high sacral slope. At 6 months post-operative follow up, the patient reported near complete resolution of symptoms.
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Affiliation(s)
- Katie L Krause
- a Department of Neurological Surgery , Oregon Health & Science University , Portland , OR , USA
| | - Caitlin DeDeaux
- a Department of Neurological Surgery , Oregon Health & Science University , Portland , OR , USA
| | - Enjae Jung
- a Department of Neurological Surgery , Oregon Health & Science University , Portland , OR , USA
| | - Khoi D Than
- a Department of Neurological Surgery , Oregon Health & Science University , Portland , OR , USA
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Donnally CJ, Madhavan K, Butler AJ, Sheu JI, Massel DH, Green BA, Gjolaj JP. A novel technique for stabilization of high-grade spondylolisthesis with transvertebral fusion without reduction. J Clin Neurosci 2018; 60:170-175. [PMID: 30470650 DOI: 10.1016/j.jocn.2018.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022]
Abstract
Surgical treatment of high-grade spondylolisthesis and spondyloptosis is recommended in symptomatic patients, yet there exists much debate regarding the optimal surgical approach and the need for reduction. Similar to the Bohlman technique in that fixation is achieved across two vertebral endplates, we discuss a novel technique with the advantage of using bilateral threaded pedicle screws of large diameter and length instead of a single fibula allograft. Patients underwent posterior instrumented fusion without spondylolisthesis reduction using a novel technique placing pedicle screws with a transvertebral trajectory through the two end plates involved in the spondylolisthesis. Following screw placement, patients underwent decompression ± discectomy. Screws were connected to adjacent pedicle screws either in the upper adjacent vertebrae (i.e. L5) or the more rostral adjacent vertebrae (i.e. L4) if spinal alignment or instability necessitate including additional levels of fixation. Three patients were reviewed with ages of 67, 62, 58 years, operative times of 377-790 min, estimated blood loss 400-1050 cc, and follow-up times of 478-1082 days. There were no CSF leaks, intragenic neurologic deficits post-operatively, implant failures, revisions, or other systemic events. Two patients achieve radiographic fusion assessed by CT. At the time of final follow up, all patients were satisfied and essentially pain free. This one-stage technique offers the ability to manage local malalignment with a technique that inherently minimizes risk. The minimal complications and favorable outcomes make this technique an effective, efficient and safe procedure. Additional studies will focus on long term outcomes and should include larger patient samples.
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Affiliation(s)
- Chester J Donnally
- University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States.
| | - Karthik Madhavan
- University of Miami Hospital, Department of Neurosurgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States
| | - Alexander J Butler
- University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States
| | - Jonathan I Sheu
- The University of Miami Leonard M. Miller School of Medicine, Department of Education, 1600 NW 10th Ave #1140, Miami, FL 33136, United States
| | - Dustin H Massel
- University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States
| | - Barth A Green
- University of Miami Hospital, Department of Neurosurgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States
| | - Joseph P Gjolaj
- University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States
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Abstract
Fixation at the lumbosacral junction continues to be a challenge for spine surgeons despite advances in spinal instrumentation techniques. The poor bone quality of the sacrum, the complex regional anatomy, and the tremendous biomechanical forces at the lumbosacral junction contribute to the high rates of instrumentation-related complications. Although many spinopelvic fixation techniques have been reported, only a few are still widely used because of the high complication rates associated with previous techniques. Spinopelvic fixation has numerous indications. Long-segment lumbar and thoracolumbar fusions to the sacrum are the most common scenarios in which instrumentation is extended to the pelvis. Surgeons performing complex spinal reconstruction should be familiar with the available techniques, including their potential risks and complications.
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Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee. Spine Deform 2017; 5:284-302. [PMID: 28882346 DOI: 10.1016/j.jspd.2017.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/12/2017] [Accepted: 03/19/2017] [Indexed: 11/23/2022]
Abstract
STUDY DESIGN Structured literature review. OBJECTIVES The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis to identify what is known and what research remains essential to further understanding. SUMMARY OF BACKGROUND DATA Pediatric lumbar spondylolisthesis is common, yet no formal synthesis of the published literature regarding treatment has been previously performed. METHODS A comprehensive literature search was performed. From 6600 initial citations with abstract, 663 articles underwent full-text review. The best available evidence regarding surgical and medical/interventional treatment was provided by 51 studies. None of the studies were graded Level I or II evidence. Eighteen of the studies were Level III, representing the current best available evidence. Thirty-three of the studies were Level IV. RESULTS Although studies suggest a benign course for "low grade" (<50% slip) isthmic spondylolisthesis, extensive literature suggests that a substantial number of patients present for treatment with pain and activity limitations. Pain resolution and return to activity is common with both medical/interventional and operative treatment. The role of medical/interventional bracing is not well established. Uninstrumented posterolateral fusion has been reported to produce good clinical results, but concerns regarding nonunion exist. Risk of slip progression is a specific concern in the "high grade" or dysplastic type. Although medical/interventional observation has been reported to be reasonable in a small series of asymptomatic high-grade slip patients, surgical treatment is commonly recommended to prevent progression. There is Level III evidence that instrumentation and reduction lowers the risk of nonunion, and that circumferential fusion is superior to posterior-only or anterior-only fusion. There is Level III evidence that patients with a higher slip angle are more likely to fail medical/interventional treatment of high-grade spondylolisthesis. CONCLUSIONS The current "best available" evidence to guide the treatment of pediatric spondylolisthesis is presented. LEVEL OF EVIDENCE Level III; review of Level III studies.
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Wu AM, Harris JA, Hao JC, Jenkins SM, Chi YL, Bucklen BS. Biomechanical properties of posterior transpedicular-transdiscal oblique lumbar screw fixation with novel trapezoidal lateral interbody spacer: an in vitro human cadaveric model. 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 2017; 26:2873-2882. [PMID: 28386725 DOI: 10.1007/s00586-017-5050-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate biomechanical properties of posterior transpedicular-transdiscal (TPTD) oblique lumbar screw fixation whereby the screw traverses the inferior pedicle across the posterior disc space into the super-adjacent body and lateral trapezoidal interbody spacer. METHODS Eight fresh-frozen osteoligamentous human cadaveric spines (L1-S1) were tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR), with pure bending moment set at 7.5 Nm. Surgical constructs included (1) intact spine; (2) bilateral pedicle screw (BPS) fixation at L3-L4; (3) TPTD screw fixation at L3-L4; (4) lateral L3-L4 discectomy; (5) TPTD screw fixation with lateral interbody spacer (TPTD+S); and (6) BPS fixation with lateral interbody spacer (BPS+S). Peak range of motion (ROM) at L3-L4 was normalized to intact for statistical analysis. RESULTS In FE and LB, all posterior fixation with or without interbody spacers significantly reduced motion compared with intact and discectomy. BPS and BPS+S provided increased fixation in all planes of motion; significantly reducing FE and LB motion relative to TPTD (p = 0.005, p = 0.002 and p = 0.020, p = 0.004, respectively). In AR, only BPS significantly reduced normalized ROM to intact (p = 0.034); BPS+S provided greater fixation compared with TPTD+S (p = 0.005). CONCLUSIONS Investigators found less stiffness with TPTD screw fixation than with BPS regardless of immediate stabilization with lateral discectomy and spacer. Clinical use should be decided by required biomechanical performance, difficulty of installation, and extent of paraspinal tissue disruption.
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Affiliation(s)
- Ai-Min Wu
- Department of Spinal Surgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA.
| | - John C Hao
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bosson 718, Philadelphia, PA, 19104, USA
| | - Sean M Jenkins
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bosson 718, Philadelphia, PA, 19104, USA
| | - Yong-Long Chi
- Department of Spinal Surgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA
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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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Historical Perspective: Henry H. Bohlman (1937-2010): The Father of Contemporary Spine Surgery. Spine (Phila Pa 1976) 2016; 41:1628-1629. [PMID: 27172280 DOI: 10.1097/brs.0000000000001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The incredible career of Henry H. Bohlman, MD, spanned over four decades at University Hospitals Case Medical Center. He was an innovator and pioneer, designing several techniques for the management of several spinal pathologies while advocating the anterior approach to the spine. Dr. Bohlman's legacy is preserved in his fellows who have become leaders in spine surgery throughout the world.
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Macagno AE, Hasan S, Jalai CM, Worley N, de Moura AB, Spivak J, Bendo JA, Passias PG. "Reverse Bohlman" technique for the treatment of high grade spondylolisthesis in an adult population. J Orthop 2016; 13:1-9. [PMID: 26955227 DOI: 10.1016/j.jor.2015.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/25/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/AIMS Surgical techniques for effective high-grade spondylolisthesis (HGS) remain controversial. This study aims to evaluate radiographic/clinical outcomes in HGS patients treated using modified "Reverse Bohlman" (RB) technique. METHODS Review of consecutive HGS patients undergoing RB at a single university-center from 2006 to 2013. Clinical, surgical, radiographic parameters collected. RESULTS Six patients identified: five with L5-S1 HGS with L4-L5 instability and one had an L4-5 isthmic spondylolisthesis and grade 1 L5-S1 isthmic spondylolisthesis. Two interbody graft failures and one L5-S1 pseudoarthrosis. Postoperative improvement of anterolisthesis (62.3% vs. 49.6%, p = 0.003), slip angle (10 vs. 5°, p = 0.005), and lumbar lordosis (49 vs. 57.5°, p = 0.049). CONCLUSIONS RB technique for HGS recommended when addressing adjacent level instability/slip.
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Affiliation(s)
- Angel E Macagno
- NY Spine Institute/NYU Medical Center Hospital for Joint Diseases, New York, NY, United States
| | - Saqib Hasan
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Cyrus M Jalai
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Nancy Worley
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Alexandre B de Moura
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Jeffrey Spivak
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - John A Bendo
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Peter G Passias
- NY Spine Institute/NYU Medical Center Hospital for Joint Diseases, New York, NY, United States
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Schoenleber SJ, Shufflebarger HL, Shah SA. The Assessment and Treatment of High-Grade Lumbosacral Spondylolisthesis and Spondyloptosis in Children and Young Adults. JBJS Rev 2015; 3:01874474-201512000-00003. [PMID: 27490997 DOI: 10.2106/jbjs.rvw.o.00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Scott J Schoenleber
- Department of Orthopaedic Surgery, Nemours/A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
| | - Harry L Shufflebarger
- Division of Pediatric Spine Surgery, Department of Orthopaedics, Nicklaus Children's Hospital/Miami Children's Health System, 3100 S.W. 62nd Avenue, Miami, FL 33155
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours/A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
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Omidi-Kashani F, Hootkani A, Jarahi L, Rezvan M, Moayedpour A. Radiologic and clinical outcomes of surgery in high grade spondylolisthesis treated with temporary distraction rod. Clin Orthop Surg 2015; 7:85-90. [PMID: 25729523 PMCID: PMC4329538 DOI: 10.4055/cios.2015.7.1.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/18/2014] [Indexed: 11/14/2022] Open
Abstract
Background Surgical techniques used in the treatment of patients with high grade lumbar spondylolisthesis (> 50% slippage) are usually associated with a great deal of controversies. We aim to evaluate the surgical outcomes of high grade spondylolisthesis treated with an intraoperative temporary distraction rod. Methods We retrospectively studied 21 patients (14 females and 7 males), aged 50.4 ± 9.2 years, who had high grade lumbar spondylolisthesis that was treated with intraoperative temporary distraction rods, neural decompression, pedicular screw fixation, and posterolateral fusion involving one more intact upper vertebra. The mean follow-up period was 39.2 months. Radiologic and clinical outcomes were measured by slip angle, slip percentage, correction rate, Oswestry Disability Index (ODI), visual analogue scale (VAS), patient's satisfaction rate in the pre- and postoperative period. Data were analyzed by SPSS ver. 11.5. Results Analysis of the preoperative visits and final follow-up visits indicated that surgery could improve ODI, lumbar VAS, and leg VAS from 60.5% to 8.2%, from 6.7 to 2.2, and from 6.9 to 1.3, respectively. Slip angle and slip percentage were also changed from -8° to -15° and from 59.2% to 21.4%, respectively. Mean correction rate at the final follow-up visit was 64.1%. Loss of correction was insignificant and a neurologic complication occurred in one patient due to misplacement of one screw. Excellent and good levels of satisfaction were observed in 90.5% of the patients. Conclusions In the surgical treatment of refractory high grade spondylolisthesis, the use of a temporary distraction rod to reduce the slipped vertebra in combination with neural decompression, posterolateral fusion, and longer instrumentation is associated with satisfactory clinical and radiologic outcomes.
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Affiliation(s)
- Farzad Omidi-Kashani
- Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Hootkani
- Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Addiction Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Manizheh Rezvan
- Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Moayedpour
- Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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