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Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis
Michael Ruf1, Hannjörg Koch, Robert P Melcher
1Department of Orthopaedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Germany. michael.ruf@kkl.srh.de
Study Design:
A retrospective review of the clinical and radiographic outcomes of reduction by temporary instrumentation of L4 and monosegmental fusion of L5/S1 in patients with high-grade developmental spondylolisthesis.
Objective:
To assess the efficacy of this technique in the reduction of local deformity and correction of overall sagittal profile.
Summary Of Background Data:
In situ fusions as well as partial reduction with fusion L4-S1 via various approaches have been described previously. To date and to our knowledge, there have been no reports describing complete reduction and monosegmental fusion for high-grade developmental spondylolisthesis.
Methods:
A total of 27 consecutive patients with severe developmental spondylolisthesis of L5/S1 were treated with operative reduction via temporary instrumentation of L4 and monosegmental fusion of L5/S1. The clinical and radiographic outcomes were retrospectively reviewed for each case at a minimum of 2 years (mean follow-up of 45 months; range 24-80). Mean age at surgery was 16.7 years (range 9-29).
Results:
At most recent follow-up, 23 patients were pain free. There were 4 patients who had moderate pain. All radiographic parameters improved. Mean slippage improved from 74.0% before surgery to 11.0% after surgery and 10.0% at latest follow-up. Slip angle improved from 36.6 degrees before surgery to 8.1 degrees after surgery and 7.6 degrees at latest follow-up. Sacral inclination improved from 34.6 degrees before surgery to 43.4 degrees after surgery and 47.2 degrees at latest follow-up. The overall sagittal profile improved dramatically. There was 1 superficial infection, 6 patients had L5 root symptoms (5 of these resolved, 1 patient had a persistent sensory deficit). Four patients had decompensation at L4/5 (2 reoperations).
Conclusions:
Reduction of L5/S1 with temporary instrumentation of L4 and monosegmental fusion of L5/S1 is an effective technique for the treatment of high-grade developmental spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal profile can be achieved. Fusion of the primarily healthy segment L4/5 can be avoided.