Tags

Type your tag names separated by a space and hit enter

Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young.
Int J Spine Surg 2018; 12(3):399-407IJ

Abstract

Background

Surgical management of high-grade spondylolisthesis in the young is not only challenging but also controversial, from in-situ fusion to complete reduction. It is fraught with dangers such as neurological injury, pseudoarthrosis, and progressive deformity with subsequent global sagittal imbalance. We describe our experience of progressive reduction technique and restoration of lumbosacral alignment.

Methods

This study is a retrospective review of patients who underwent surgery between 1998 and 2012. The surgical technique involved positioning the hips in extension with traction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, and gradual reduction of the deformity and maintenance of reduction with interbody fusion. All patients were serially assessed at 1, 3, and 6 months and yearly thereafter with clinical, radiological, and Oswestry Disability Index and Visual Analogue Scale outcome measures.

Results

Twenty-seven patients with high-grade spondylolisthesis at L5-S1 (3 cases grade 3, 7 grade 4, 17 grade 5) with an average age of 13.9 years were reviewed. Mean follow-up was 120 months (range 24-192). All patients presented a solid fusion at the 6-month visit; mean slip percentage was reduced from 89% to 23%, with all cases reduced to grade 2 or less. The slip angle improved from 45° to 3° postoperatively, with improvement in sacral slope from 13° to 35°. Four spondyloptosis patients had concomitant scoliosis which corrected spontaneously after the surgery and did not need further intervention. All but one patient (96.2%) had good functional outcomes and returned to their full normal activities. One patient developed a deep infection necessitating implant removal, with eventual deformity progression leading to a poor outcome. Three patients (11.1%) suffered partial drop foot that resolved in full by 12 weeks.

Conclusion

Our technique demonstrated a significant reduction of high grade spondylolisthesis, with restoration of global sagittal balance via correction of the lumbosacral kyphosis. Though surgically demanding, it is safe and reproducible.

Level of Evidence

IV.

Authors+Show Affiliations

Apollo Hospitals, Chennai, India.Apollo Hospitals, Chennai, India.Apollo Hospitals, Chennai, India.SIMS Hospitals, Chennai, India.Apollo Hospitals, Chennai, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30276098

Citation

Sudarshan, Pramod K., et al. "Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young." International Journal of Spine Surgery, vol. 12, no. 3, 2018, pp. 399-407.
Sudarshan PK, Suthar HR, Varma VK, et al. Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young. Int J Spine Surg. 2018;12(3):399-407.
Sudarshan, P. K., Suthar, H. R., Varma, V. K., Krishnan, A., & Hegde, S. K. (2018). Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young. International Journal of Spine Surgery, 12(3), pp. 399-407. doi:10.14444/5047.
Sudarshan PK, et al. Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young. Int J Spine Surg. 2018;12(3):399-407. PubMed PMID: 30276098.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young. AU - Sudarshan,Pramod K, AU - Suthar,Hardik R, AU - Varma,Vamsi K, AU - Krishnan,Appaji, AU - Hegde,Sajan K, Y1 - 2018/08/15/ PY - 2018/10/3/entrez PY - 2018/10/3/pubmed PY - 2018/10/3/medline KW - high-grade spondylolisthesis KW - instrumentation KW - lumbosacral kyphosis KW - reduction KW - sagittal balance SP - 399 EP - 407 JF - International journal of spine surgery JO - Int J Spine Surg VL - 12 IS - 3 N2 - Background: Surgical management of high-grade spondylolisthesis in the young is not only challenging but also controversial, from in-situ fusion to complete reduction. It is fraught with dangers such as neurological injury, pseudoarthrosis, and progressive deformity with subsequent global sagittal imbalance. We describe our experience of progressive reduction technique and restoration of lumbosacral alignment. Methods: This study is a retrospective review of patients who underwent surgery between 1998 and 2012. The surgical technique involved positioning the hips in extension with traction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, and gradual reduction of the deformity and maintenance of reduction with interbody fusion. All patients were serially assessed at 1, 3, and 6 months and yearly thereafter with clinical, radiological, and Oswestry Disability Index and Visual Analogue Scale outcome measures. Results: Twenty-seven patients with high-grade spondylolisthesis at L5-S1 (3 cases grade 3, 7 grade 4, 17 grade 5) with an average age of 13.9 years were reviewed. Mean follow-up was 120 months (range 24-192). All patients presented a solid fusion at the 6-month visit; mean slip percentage was reduced from 89% to 23%, with all cases reduced to grade 2 or less. The slip angle improved from 45° to 3° postoperatively, with improvement in sacral slope from 13° to 35°. Four spondyloptosis patients had concomitant scoliosis which corrected spontaneously after the surgery and did not need further intervention. All but one patient (96.2%) had good functional outcomes and returned to their full normal activities. One patient developed a deep infection necessitating implant removal, with eventual deformity progression leading to a poor outcome. Three patients (11.1%) suffered partial drop foot that resolved in full by 12 weeks. Conclusion: Our technique demonstrated a significant reduction of high grade spondylolisthesis, with restoration of global sagittal balance via correction of the lumbosacral kyphosis. Though surgically demanding, it is safe and reproducible. Level of Evidence: IV. SN - 2211-4599 UR - https://www.unboundmedicine.com/medline/citation/30276098/Long-Term_Experience_With_Reduction_Technique_in_High-Grade_Spondylolisthesis_in_the_Young L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30276098/ DB - PRIME DP - Unbound Medicine ER -