Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis

Abstract

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.