Staged salvage reconstruction of grade-IV and V spondylolisthesis

Sixteen patients who had Grade-IV or V spondylolisthesis underwent a staged reconstruction for the salvage of a failed result of previous procedures. The indications for operation were incapacitating pain, radicular pain, pseudoclaudication, or the inability to stand upright. All patients had shown progression of the deformity after the previous surgery. At an average length of follow-up of fifty-two months, all patients had resumed normal activities and were free of the pain and symptoms of spinal stenosis. The complications included delayed union in six patients and a traumatic pseudarthrosis in one patient. In all of these patients a solid fusion was obtained after additional surgery. In five patients, neuropathy of the fifth lumbar-nerve root developed after surgery; it resolved in three patients. From this work, it is concluded that staged reconstructive surgery is feasible in patients who have Grade-IV or V spondylolisthesis with incapacitating pain and deformity that interfere with normal function. The benefits outweighed the risks in this very select group of patients.