High-grade isthmic dysplastic spondylolisthesis: monosegmental surgical treatment.

STUDY

DESIGN

A prospective single arm cohort. OBJECTIVE.: To study the results of distraction reduction of high-grade isthmic dysplastic spondylolisthesis with posterior lumbar interbody fusion and posterior compression in a consecutive, prospectively collected series of adolescent patients.

SUMMARY OF BACKGROUND DATA: High-grade isthmic dysplastic spondylolisthesis has been associated with a high complication and failure rate regardless of the method of surgical treatment, including in situ fusion, cast correction and fusion, anterior fusion, posterior instrumented fusion, and combination procedures.

METHODS

A total of 18 adolescents with the diagnosis and a minimum 50% slip underwent the procedure of Gill decompression, temporary distraction with reduction of the deformity, complete lumbosacral discectomy, posterior lumbar interbody fusion with Harm's cage and autogenous iliac graft, and posterior monosegmental compression instrumentation with pedicular fixation.

RESULTS

Follow-up ranged from 2.3 to 5 years. Slip improved from 77% to 13% and slip angle from 35 degrees to 3.8 degrees initially and 4.3 degrees at final follow-up. One patient had loss of 16 degrees of slip angle but achieved arthrodesis. Sacral inclination improved from 28 degrees to 39 degrees . There were no neurologic or infectious complications. There were no overt instrumentation failures. Arthrodesis was achieved in every instance. Two patients had structural complications, neither of which underwent reoperation.

CONCLUSIONS

The index procedure provided near-anatomic correction of high-grade spondylolisthesis, which is maintained at a minimum 2-year follow-up without significant complications. There were two structural complications. Anterior column structural support and posterior compressive instrumentation help restore the necessary biomechanics to allow clinical fusion and success. This series has led the senior author to evolve his technique too ften include caudad fixation to the pelvis and/or cephalad fixation to L4.