Treatment of severe spondylolisthesis in children by reduction and L4-S4 posterior segmental hyperextension fixation.

Twenty children with severe lumbosacral spondylolisthesis underwent reduction, posterolateral fusion, and posterior fixation with an L4 to S2, 3, and 4 sublaminar wired rectangular rod to lessen lumbosacral kyphosis, allow early ambulation, and maintain correction. All patients had a postural deformity, 10 had preoperative neurologic findings, and 8 had severe pain. The average percentage of slip improved from 76% preoperatively to 55% postoperatively, and the slip angle improved from 25 degrees to 5 degrees (p < 0.0001). All patients had solid fusion by 6 months and no progression at 43 month follow-up on the average. We conclude that this technique reliably provides partial reduction, solid fixation, and fusion for patients with severe spondylolisthesis while allowing early ambulation. As with any spondylolisthesis reduction technique, neurologic risk should limit this procedure to well-selected patients.