In situ posterolateral and fibular interbody fusion in high grade spondylolysthesis

High-grade spondylolysthesis and spondyloptosis management have various options. There were no large series reported to support any particular treatment modality. The aim of surgery is to get solid bony fusion to get relief of instability and its symptoms as well as relief of neurological symptoms. There are many treatment options which are associated with technical difficulties and high incidence of complications and failures. In situ transsacral fibular graft with posterolateral fusion along with posterior decompression is a good surgical option. It offers anterior and posterolateral fusion for instability pain and relief of neurological symptoms in most of the patients. It is technically simple, with no major surgery-related complications.

The cases of high-grade spondylolysthesis operated since 2008 with one year minimal follow up were included in this study. Six cases were operated during this period. All were females in their second and third decade of life. All of them had transsacral fibular grafting with posterolateral fusion and decompression. One of the cases had additional anterior procedure with sacral widening with bone graft. The clinical status and bony fusion has been assessed at the end of one year after surgery and also for assessing final outcome.

All the patients had solid bony fusion with no progression of slip and are pain free and relived of neurological symptoms. conclusions: In situ transsacral fibular graft with posterolateral fusion and posterior decompression is technically simple surgical option with minimal risks and reliable outcome.