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A novel technique for stabilization of high-grade spondylolisthesis with transvertebral fusion without reduction.
J Clin Neurosci 2019; 60:170-175JC

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.

Authors+Show Affiliations

University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States. Electronic address: Chester.Donnally@jhsmiami.org.University of Miami Hospital, Department of Neurosurgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States.University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States.The University of Miami Leonard M. Miller School of Medicine, Department of Education, 1600 NW 10th Ave #1140, Miami, FL 33136, United States.University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States.University of Miami Hospital, Department of Neurosurgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States.University of Miami Hospital, Department of Orthopaedic Surgery, 1400 N.W. 12th Ave, Miami, FL 33136, United States.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30470650

Citation

Donnally, Chester J., et al. "A Novel Technique for Stabilization of High-grade Spondylolisthesis With Transvertebral Fusion Without Reduction." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 60, 2019, pp. 170-175.
Donnally CJ, Madhavan K, Butler AJ, et al. A novel technique for stabilization of high-grade spondylolisthesis with transvertebral fusion without reduction. J Clin Neurosci. 2019;60:170-175.
Donnally, C. J., Madhavan, K., Butler, A. J., Sheu, J. I., Massel, D. H., Green, B. A., & Gjolaj, J. P. (2019). A novel technique for stabilization of high-grade spondylolisthesis with transvertebral fusion without reduction. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 60, pp. 170-175. doi:10.1016/j.jocn.2018.11.001.
Donnally CJ, et al. A Novel Technique for Stabilization of High-grade Spondylolisthesis With Transvertebral Fusion Without Reduction. J Clin Neurosci. 2019;60:170-175. PubMed PMID: 30470650.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A novel technique for stabilization of high-grade spondylolisthesis with transvertebral fusion without reduction. AU - Donnally,Chester J,3rd AU - Madhavan,Karthik, AU - Butler,Alexander J, AU - Sheu,Jonathan I, AU - Massel,Dustin H, AU - Green,Barth A, AU - Gjolaj,Joseph P, Y1 - 2018/11/22/ PY - 2018/07/31/received PY - 2018/11/05/accepted PY - 2018/11/25/pubmed PY - 2019/2/28/medline PY - 2018/11/25/entrez KW - High-grade spondylolisthesis KW - L5 spondylectomy KW - Novel technique KW - Spino-pelvic balance KW - Spondyloptosis SP - 170 EP - 175 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 60 N2 - 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. SN - 1532-2653 UR - https://www.unboundmedicine.com/medline/citation/30470650/A_novel_technique_for_stabilization_of_high-grade_spondylolisthesis_with_transvertebral_fusion_without_reduction L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(18)31182-2 DB - PRIME DP - Unbound Medicine ER -