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Viroli G, Ruffilli A, Ialuna M, Barile F, Manzetti M, Traversari M, Vita F, Faldini C. Restoration of Spinopelvic Alignment After Reduction of High-grade Spondylolisthesis: Myth or Reality? A Systematic Review of the literature and Meta-analysis. Clin Spine Surg 2024:01933606-990000000-00284. [PMID: 38531831 DOI: 10.1097/bsd.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Systematic review and meta-analysis of literature. OBJECTIVE The aim of the presented study is to assess whether the reduction of high-grade spondylolisthesis (HGS) through the correction of lumbosacral kyphosis leads to a decrease in the sagittal spinopelvic compensatory mechanisms. SUMMARY OF BACKGROUND DATA HGS is as an anterior translation of a vertebra, >50%. It is also characterized by a kyphotic deformity of the affected level. This combination of translation and kyphosis leads to compensatory mechanisms on the sagittal plane [pelvic retroversion, increased lumbar lordosis (LL), reduction in thoracic kyphosis (TK)]. METHODS A systematic search of electronic databases was conducted. Inclusion criteria were diagnosis of HGS (Meyerding >II, Slip% >50%), partial or complete reduction surgery (with a significant decrease in Slip%), and report of spinopelvic parameters (pelvic incidence, pelvic tilt, or sacral slope). Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between preoperative and postoperative spinopelvic alignment measures. P<0.05 was considered significant. RESULTS Eighteen studies were included. PT showed a statistically significant decrease of -2.1217 (95% CI: -3.4803 to -0.7630), while SS showed a significant increase of 4.8349 (95% CI: 2.7462-6.9236). Conversely, both LL and TK showed nonsignificant changes, -4.7043 (95% CI: -10.4535 to 1.0449) and 6.3881 (95% CI: -0.8344 to 13.6106), respectively. VAS significantly decreased by -3.1950 (95% CI: -4.9462 to -1.4439). CONCLUSIONS The meta-analysis showed mild, yet statistically significant, decrease of PT and an increase in SS after HGS reduction. Conversely, nonstatically significant decrease in LL and an increase in TK occurred. The clinical significance of these results remains questionable. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Giovanni Viroli
- Department of Biomedical and Neuromotor Science, IRCCS Istituto Ortopedico Rizzoli, DIBINEM, 1st Orthopaedic and Traumatologic Clinic, University of Bologna, Bologna, Italy
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Mac-Thiong JM, Hresko MT, Alzakri A, Parent S, Sucato DJ, Lenke LG, Marks M, Goulet J, Labelle H. A Surgical Treatment Algorithm for Restoring Pelvic Balance and Health-related Quality of Life in High-grade Lumbosacral Spondylolisthesis: Prospective Multicenter Cohort of 61 Young Patients. Clin Spine Surg 2023; 36:E442-E452. [PMID: 37482639 DOI: 10.1097/bsd.0000000000001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
STUDY DESIGN Retrospective multicenter cohort-study. OBJECTIVE We propose an evidence-based surgical algorithm for achieving normal pelvic balance while optimizing health-related quality of life (HRQoL) in high-grade spondylolisthesis. SUMMARY OF BACKGROUND DATA The principles of surgical treatment for young patients with high-grade L5-S1 spondylolisthesis remain unclear. There is a growing body of evidence supporting the central role of pelvic balance in the postural control and biomechanics of subjects with high-grade spondylolisthesis. METHODS This retrospective study assessed a multicenter cohort of 61 patients with high-grade L5-S1 spondylolisthesis. Classification and regression tree analysis was used to identify objective criteria associated with pelvic balance and HRQoL after surgery. RESULTS The most important predictor of a postoperative balanced pelvis was a postoperative L5 incidence ≤63.5 degrees. With postoperative L5 incidence ≤63.5 degrees,a residual slip percentage 9% and performing an L5-S1 posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) increased the likelihood of achieving a balanced pelvis postoperatively. When L5 incidence was 63.5 degrees,a balanced pelvis was most likely achieved with fusion limited to L5 proximally, residual slip percentage ≤40%, and residual lumbosacral angle 98 degrees. Predictors of postoperative HRQoL were the preoperative HRQoL score, L5 incidence and slip percentage. CONCLUSIONS A surgical algorithm is proposed to achieve normal pelvic balance, while optimizing HRQoL. The first step during surgery is to assess L5 incidence and if L5 incidence is <65 degrees, the next step depends on the pelvic balance. With a preoperative balanced pelvis, it is important not to reduce completely the slip percentage by leaving a slip percentage ≥10%. When the preoperative pelvis is unbalanced, a TLIF/PLIF at L5-S1 is recommended to facilitate correcting the angular deformity at L5-S1. If L5 incidence is ≥65 degrees,a TLIF/PLIF at L5-S1 should be performed to correct the angular deformity at L5-S1, and fusion should ideally end at L5 proximally, in addition to performing gradual reduction of the slip percentage. If fusion up to L4 is required, a lumbosacral angle ≥100 degrees is key.
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Affiliation(s)
- Jean-Marc Mac-Thiong
- University of Montreal
- CHU Sainte-Justine
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
| | | | - Abdulmajeed Alzakri
- University of Montreal
- CHU Sainte-Justine
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
- Department of Orthopaedic, College of Medecine
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Stefan Parent
- University of Montreal
- CHU Sainte-Justine
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
| | | | | | | | - Julien Goulet
- University of Montreal
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
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Patel BK, Bapat MR, Gujral A. Clinical and Radiological Outcomes after Reducing Adult Lytic High-Grade Spondylolisthesis Using a Hybrid Technique: Combination of Percutaneous Pedicle Screws with Midline Microscopic Transforaminal Decompression. Asian Spine J 2023; 17:1004-1012. [PMID: 37946335 PMCID: PMC10764137 DOI: 10.31616/asj.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 11/12/2023] Open
Abstract
STUDY DESIGN Retrospective study. PURPOSE To analyze the results and effectiveness of percutaneous screws (PS) with midline microscopic transforaminal decompression (MTFD) technique in reducing adult stiff lytic high-grade spondylolisthesis (HGSL) and compare it with the conventional technique. OVERVIEW OF LITERATURE Pedicle screw cannulation and segmental kyphosis negotiation are surgical challenges in HGSL. Open reduction is the preferred approach. PS have the advantage of optimized trajectory and minimized soft tissue exposure. The role of minimally invasive surgery in HGSL remains unknown. We propose a hybrid technique combining PS with MTFD for lytic HGSL. METHODS This study included 25 patients with adult lytic HGSL (Meyerding grade III and IV) operated using a hybrid technique from 2012 to 2015. Data were compared with retrospective data on conventional open reduction (n=23) operated from 2000 to 2015. The minimum follow-up was 5 years. Clinical outcomes were assessed using the Visual Analog Scale (VAS) score and modified Oswestry Disability Index (m-ODI). The spinopelvic and perioperative parameters were recorded. The inter-body fusion and adjacent segment degeneration (ASD) were assessed on radiographs at the final follow-up. RESULTS The average age in the MTFD and open groups was 45.84±12.70 years (nine males and 16 females) and 49.26±13.33 years (eight males and 15 females), respectively. Further, 22 and three patients in the MTFD group and 19 and four in the open group had grade III and IV listhesis, respectively. The MTFD group demonstrated less operative time, blood loss, and hospital stays than the open group. Significant improvements were observed in VAS and m-ODI in subsequent follow-ups in both groups. The MTFD group fared better at 3 months but outcomes were comparable at the final follow-up. Both techniques were equally effective in restoring spinopelvic parameters. The incidence of ASD is comparable. CONCLUSIONS The technique was proven effective in reducing HGSL. The long-term clinical and radiological outcomes were favorable and comparable with the conventional approach.
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Affiliation(s)
- Bharat K. Patel
- Department of Spine Surgery, Nanavati Max Super Speciality Hospital, Mumbai,
India
| | - Mihir R. Bapat
- Minimally Invasive Spine Surgery Unit, Nanavati Max Super Speciality Hospital, Mumbai,
India
| | - Amandeep Gujral
- Department of Spine Surgery, Nanavati Max Super Speciality Hospital, Mumbai,
India
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Faldini C, Barile F, Ialuna M, Manzetti M, Viroli G, Vita F, Traversari M, Rinaldi A, Cerasoli T, Paolucci A, D’Antonio G, Ruffilli A. High-grade dysplastic spondylolisthesis: surgical technique and case series. Musculoskelet Surg 2023; 107:323-331. [PMID: 36183053 PMCID: PMC10432321 DOI: 10.1007/s12306-022-00763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/22/2022] [Indexed: 10/07/2022]
Abstract
PURPOSE The aim of the present study is to evaluate the results of our all posterior-one stage surgical technique for the reduction and fusion of high-grade high-dysplastic spondylolisthesis. METHODS Patients over 11 years old with high-grade spondylolisthesis treated by reduction and circumferential fusion with a posterior-only approach were reviewed. Data about operative time, blood loss, length of stay, intra- and postoperative complications were collected. Meyerding grade (M), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), lumbosacral angle (LSA), slip angle (SLIP), lumbar index (LI) and severity index were measured on preoperative and last follow-up. Sagittal vertical axis (SVA) was used to assess sagittal balance. RESULTS Of the 14 included patients, L5-S1 arthrodesis was performed in 12 cases, and L4-S1 was performed in 2 cases. Average surgical time was 275 ± 65 min; average blood loss was 635 ± 375 mL. Average length of stay of was 3.9 ± 1.5 days. The SLIP angle improves from 33.8° ± 7.3° to 6.4° ± 2.5°, (p = 0.002); the lumbosacral angle improves from 68.8° ± 18.6° to 100.7° ± 13.2°, (p = 0.01); and the SVA decreased from 49.4 ± 22.1 mm to 34.4 ± 8.6 mm (p = 0.02). No significant changes were observed in PI, PT and SS. Thoracic kyphosis (TK) and lumbar lordosis (LL) did not change significantly. At last follow-up, no patient had surgical site infection or mechanical complications; no pseudoarthrosis was observed. No revision surgery was performed. CONCLUSION Although technically demanding, reduction and fusion with one stage all posterior approach prove to be a safe and effective.
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Affiliation(s)
- C. Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - F. Barile
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Ialuna
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - G. Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - F. Vita
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Rinaldi
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - T. Cerasoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Paolucci
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - G. D’Antonio
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
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Yang J, Peng Z, Kong Q, Wu H, Wang Y, Li W, Guo C, Wu Y. Stretch on the L5 nerve root in high-grade spondylolisthesis reduction. J Neurosurg Spine 2022; 37:232-240. [PMID: 35148501 DOI: 10.3171/2021.12.spine211237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/16/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE L5 nerve root (L5-NR) injury after surgery for high-grade spondylolisthesis (HGS) was considered a nerve stretch associated with reduction. Currently, however, no study has directly measured the stretch on the L5-NR during HGS reduction procedures. METHODS CT data of 4 patients with mild lumbar degeneration (control group [CG]) and 4 patients with HGS (spondylolisthesis group [SG]) were used for 3D printing to develop L5 vertebrae and sacrum models. These models were mounted on a self-designed reduction apparatus, which performed vertical translation (disc heights of 0, 5, and 10 mm), anterior-posterior translation (reduction, 0%-100%), and slip-angle correction (0° to -30°). The L5-NR was simulated by using a rabbit sciatic nerve. The cephalic side of the nerve was fixed at the upper base of the L5 pedicle, while the caudal side was connected to a high-precision sensor and an indicator to measure the tension (stretch) on the nerve during the reduction procedures in real time. RESULTS The SG had shorter L5-NRs than the CG. At a 0-mm disc height, the peak tension on the L5-NR changed from 0 N (reduction 0%) to 1.81 ± 0.54 N (reduction 100%) in the SG and to 1.78 ± 0.71 N in the CG. At a 10-mm disc height, the tension changed from 1.50 ± 0.67 N to 4.97 ± 1.04 N in the SG and from 0.92 ± 0.45 N to 3.26 ± 0.88 N in the CG. In both the CG and SG, at the same disc height, all values from the complete reduction process were statistically significant. Furthermore, at the same degree of reduction, the comparisons between different disc heights were almost all statistically significant. Intergroup comparisons showed that an increased disc height would cause more tension on the L5-NR in the SG than in the CG. At a 10-mm disc height, all results between the groups demonstrated statistical significance. The slip-angle correction produced a slight increase in the tension on the L5-NR in both groups. CONCLUSIONS Increased disc height and reduction significantly increased the tension on the L5-NR, which demonstrated a nonlinear curve. The slip-angle correction from 0° to -30° slightly increased the tension on the L5-NR. Under the same degree of reduction and restored disc height, the SG had more tension on the L5-NR than the CG.
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Affiliation(s)
- Jin Yang
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
- 2Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Zhiyu Peng
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
| | - Qingquan Kong
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
| | - Hao Wu
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
| | - Yu Wang
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
| | - Weilong Li
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
| | - Chuan Guo
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
| | - Ye Wu
- 1Department of Orthopedics Surgery, West China Hospital, Sichuan University; and
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Guo X, Guo Z, Li W, Chen Z, Zeng Y, Zhong W, Li Z. Scoliosis in dysplastic spondylolisthesis: a clinical survey of 50 young patients. BMC Musculoskelet Disord 2022; 23:335. [PMID: 35395763 PMCID: PMC8991581 DOI: 10.1186/s12891-022-05297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Dysplastic spondylolisthesis is a rare spinal deformity that occurs mainly in young patients. Although its sagittal parameters had been well stated, coronal abnormalities in these patients were poorly studied. The purposes of this study were: (1) to investigate the prevalence of scoliosis in dysplastic spondylolisthesis;(2) to assess scoliosis resolution or persistence after surgery; and (3) to propose a modified classification of scoliosis associated with dysplastic spondylolisthesis. Methods Fifty patients (average age 14.9 ± 5.6 years) diagnosed with dysplastic spondylolisthesis who underwent surgical treatment were followed up and their data were analyzed. Standing posteroanterior and lateral full spine radiographs were used to measure the coronal and sagittal parameters. Patients with scoliosis, which was defined as a coronal Cobb angle greater than 10°, were divided into three groups according to their curve characteristics: “independent” scoliosis (IS) group, spasm scoliosis (SS) group, and olisthetic scoliosis (OS) group. SS and OS were spondylolisthesis-induced scoliosis. The radiographic parameters and patient-reported outcomes were collected before and after surgery and compared between groups. Results The average slip percentage was 62.8% ± 23.1% and the average follow-up time was 51.5 ± 36.4 months (range 3–168 months). Twenty-eight of the 50 (56%) dysplastic spondylolisthesis patients showed scoliosis, of which 8 were IS (24.7° ± 15.2°), 11 were SS (13.9° ± 3.0°), and 9 were OS (12.9° ± 1.9°). By the last follow-up, no scoliosis resolution was observed in the IS group whereas all SS patients were relieved. Of the nine patients with OS, four (44.4%) had scoliosis resolution after surgery. Conclusion Distinguishing different types of scoliosis in dysplastic spondylolisthesis patients may help surgeons to plan treatment and understand prognosis. For patients with significant scoliosis, whether “independent” or spondylolisthesis-induced, treatment of spondylolisthesis should be performed first and scoliosis should be observed for a period of time and treated according to the corresponding principles.
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Affiliation(s)
- Xinhu Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Yan Zeng
- Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Woquan Zhong
- Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Zihe Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
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Koller H, Mühlenkamp K, Hitzl W, Koller J, Ferraris L, Hostettler IC, Hempfing A. Surgical outcomes with anatomic reduction of high-grade spondylolisthesis revisited: an analysis of 101 patients. J Neurosurg Spine 2022; 36:215-225. [PMID: 34534956 DOI: 10.3171/2021.3.spine202091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The ideal strategy for high-grade L5-S1 isthmic spondylolisthesis (HGS) remains controversial. Critical questions include the impact of reduction on clinical outcomes, rate of pseudarthrosis, and postoperative foot drop. The scope of this study was to delineate predictors of radiographic and clinical outcome factors after surgery for HGS and to identify risk factors of foot drop. METHODS This was a single-center analysis of patients who were admitted for HGS, defined as grade III or greater L5 translation according to the Meyerding (MD) classification. Complete postoperative reduction was defined as MD grade I or less and L5 slip < 20%. Forty-six patients completed health-related quality-of-life questionnaires (Oswestry Disability Index, Physical Component Summary of SF-36, and visual analog scale) and ≥ 2 years' follow-up (average 105 months). A 540° approach was used in 61 patients, a 360° approach was used in 40, and L5 corpectomy was used in 17. Radiographic analysis included measures of global spinopelvic balance (e.g., pelvic incidence [PI], lumbar lordosis) and measurement of lumbosacral kyphosis angle (LSA), L4 slope (L4S), L5 slip (%), and postoperative increase of L5-S1 height. RESULTS The authors included 101 patients with > 1 year of clinical and radiographic follow-up. The mean age was 26 years. Average preoperative MD grade was 3.8 and average L5 slip was 81%; complete reduction was achieved in 55 and 42 patients, respectively, according to these criteria. At follow-up, LSA correlated with all clinical outcomes (r ≥ 0.4, p < 0.05). Forty patients experienced a major complication. Risk was increased in patients with greater preoperative deformity (i.e., LSA) (p = 0.04) and those who underwent L5 corpectomy (p < 0.01) and correlated with greater deformity correction. Thirty-one patients needed revision surgery, including 17 for pseudarthrosis. Patients who needed revision surgery had greater preoperative deformity (i.e., MD grade and L5 slip) (p < 0.01), greater PI (p = 0.02), and greater postoperative L4S (p < 0.01) and were older (p = 0.02), and these patients more often underwent L5 corpectomy (p < 0.01). Complete reduction was associated with lower likelihood of pseudarthrosis (p = 0.08) and resulted in better lumbar lordosis correction (p = 0.03). Thirty patients had foot drop, and these patients had greater MD grade and L5 slip (p < 0.01) and greater preoperative LSA (p < 0.01). These patients with foot drop more often required L5 corpectomy (p < 0.01). Change in preoperative L4S (p = 0.02), LSA (p < 0.01), and L5-S1 height (p = 0.02) were significantly different between patients with foot drop and those without foot drop. A significant risk model was established that included L4S change and PI as independent variables and foot drop as a dependent variable (82% negative predictive value and 71% positive predictive value, p < 0.01). CONCLUSIONS Multivariable analysis identified factors associated with foot drop, major complications, and need for revision surgery, including degree of deformity (MD grade and L5 slip) and correction of LSA. Functional outcome correlated with LSA correction.
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Affiliation(s)
- Heiko Koller
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- 2Paracelsus Medical University Salzburg, Salzburg, Austria
- 3Research Office (biostatistics), Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Wolfang Hitzl
- 5Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria
- 6Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria; and
| | - Juliane Koller
- 7Department for Orthopedic Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Luis Ferraris
- 4Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany
| | - Isabel C Hostettler
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Axel Hempfing
- 4Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany
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High-grade high-dysplastic lumbosacral spondylolisthesis in children treated with complete reduction and single-level circumferential fusion: A prospective case series. BRAIN AND SPINE 2022; 2:100871. [PMID: 36248175 PMCID: PMC9560694 DOI: 10.1016/j.bas.2022.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 10/26/2022]
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Tanaka M, Sonawane S, Fujiwara Y, Uotani K, Yamauchi T, Omori T, Hashizume K. Surgical treatment for spondyloptosis: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Pinter ZW, Kolz JM, Elder BD, Sebastian AS. Is Reduction and Fusion Required for High-grade Spondylolisthesis? Clin Spine Surg 2021; 34:237-240. [PMID: 32554987 DOI: 10.1097/bsd.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022]
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Gonçalves Barsotti CE, Aguiar Lira RC, Andrade RM, Torini AP, Ribeiro AP. L5 Radiculopathy After Formal Reduction of High-Grade SDSG Type 5 and 6 L5-S1 Isthmic Spondylolisthesis with 2-Year Follow-Up. Int J Spine Surg 2021; 15:645-653. [PMID: 34281952 DOI: 10.14444/8085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Surgery is the main treatment for patients with high-grade L5-S1 isthmic spondylolisthesis, which can result in neurologic complications, but little is known about its clinical course. The present study evaluated the presence of L5 radiculopathy in high-grade L5-S1 spondylolisthesis in adults in pre- and postoperative periods and after a 2-year follow-up. METHODS A series of 16 patients who underwent reduction and instrumented fusion for high-grade 5 and 6 spondylolisthesis between 2018 and 2019 were retrospectively evaluated in the pre- and postoperative periods as well as after 6 weeks, 3 months, 6 months, and 1 and 2 years of follow-up. Clinical and surgical data on possible neurological complications of L5 radiculopathy were prospectively collected. RESULTS The age was 20.1 ± 12.0 years, and preoperative L5-S1 slip was 89.0%. Five patients presented motor deficit in the preoperative period. In the immediate postoperative period, 9 patients (56%) experienced motor deficits or worsening of the preoperative condition. At the 6-week follow-up, only 1 patient showed resolution of the motor deficit. Three patients presented healed motor deficits after 3 months, and 1 patient demonstrated a healed L5 motor radiculopathy after 6 months. At the 1-year follow-up, only 1 patient exhibited an L5 radiculopathy motor deficit, and at the 2-year follow-up, none of the patients exhibited an L5 radiculopathy motor deficit. CONCLUSION L5 radiculopathy was frequent in the preoperative period and increased after reduction and instrumented fusion of high-grade L5-S1 spondylolisthesis in the postoperative period and in the 6-week follow-up. Three and 6 months after the surgery, there were consecutive motor improvements. After 2 years of follow-up, no patients showed neurological deficit of L5 radiculopathy. LEVEL OF EVIDENCE 2. CLINICAL RELEVANCE This is the first study reporting a reduction in complications of L5 neurological motor deficit over a 2-year follow-up in high-grade L5-S1 spondylolisthesis in young adults.
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Affiliation(s)
- Carlos Eduardo Gonçalves Barsotti
- Member of the Spine Group, Institute of Medical Assistance to the State Public Hospital Servant (IMASPS), São Paulo, Brazil.,Clinical Rehabilitation Center in Scoliosis, Campinas, São Paulo, Brazil
| | - Réjelos Charles Aguiar Lira
- Member of the Spine Group, Institute of Medical Assistance to the State Public Hospital Servant (IMASPS), São Paulo, Brazil
| | | | - Alexandre Penna Torini
- Member of the Spine Group, Institute of Medical Assistance to the State Public Hospital Servant (IMASPS), São Paulo, Brazil.,Post-Graduate Program in Health Science, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil
| | - Ana Paula Ribeiro
- Post-Graduate Program in Health Science, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil.,University of Sao Paulo, School of Medicine, São Paulo, Brazil
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Tu KC, Shih CM, Chen KH, Pan CC, Jiang FC, Hsu CE, Wang YM, Lee CH. Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results. BMC Musculoskelet Disord 2021; 22:559. [PMID: 34144679 PMCID: PMC8214307 DOI: 10.1186/s12891-021-04439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/03/2021] [Indexed: 12/05/2022] Open
Abstract
Backgrounds Surgical reduction for high-grade spondylolisthesis is beneficial for restoring sagittal balance and improving the biomechanical environment for arthrodesis. Compared to posterior total laminectomy and long instrumentation, anterior lumbar inter-body fusion (ALIF) is less invasive and has the biomechanical advantage of restoring the original disk height and increasing lumbar lordosis, thus improving sagittal balance. However, the application of ALIF is still limited in treating low-grade spondylolisthesis. In this study, we developed a new technique termed anterior cantilever procedure to directly reduce the slippage of high-grade lumbosacral spondylolisthesis. The purpose of our study was to investigate the surgical outcomes of the anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation in high-grade spondylolisthesis. Methods All patients with high-grade spondylolisthesis who underwent anterior cantilever procedure followed by anterior lumbar inter-body fusion (ALIF) and posterior mono-segment instrumented fixation between November 2006 and July 2017 were enrolled in our study. The slip percentage, Dubousset’s lumbosacral angle, pelvic tilt, sacral slope, pelvic incidence, and sagittal alignment were measured pre-operatively and postoperatively at the last follow-up. Surgery time, blood loss, complications, and hospital stay were also collected and analysed. Results A total of 11 consecutive patients with high-grade spondylolisthesis patients were included and analysed. All of the high-grade spondylolisthesis in our series occurred at the L5-S1 level. The median age was 37 years, and the median follow-up duration was 36 months. The average slip reduction was 30% (60 to 30%, P < 0.01), and the average correction of Dubousset’s lumbosacral angle was 13.8° (84.1° to 97.9°, P < 0.01). The median intra-operative blood loss was 300 mL. All patients attained improved sagittal balance after the operation and achieved solid fusion within 9 months after surgery. No incidences of implant failure, permanent neurological deficit, or pseudarthrosis were recorded at the last follow-up. Conclusions Anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation is a valid procedure for treating high-grade spondylolisthesis. It achieved a high fusion rate, partially reduced slippage, and significantly improved lumbosacral angle, while minimizing common complications, such as pseudarthrosis, nerve traction injury, excessive soft tissue dissection, and blood loss in posterior reduction procedures. However, posterior instrumentation is still required to the structural stability in the ALIF procedure. Level of evidence IV
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Affiliation(s)
- Kao-Chang Tu
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Cheng-Min Shih
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,PhD Degree Program of Biomedical Science and Engineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan.,Department of Physical Therapy, Hungkuang University, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.,Department of Computer Science & Information Engineering, College of Computing and Informatics, Providence University, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Fuu-Cheng Jiang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan
| | - Yun-Ming Wang
- Institute of Molecular Medicine and Bioengineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan. .,Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan.
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Clinical appearance and reliability in visual assessment after in situ fusion for high-grade isthmic spondylolisthesis. Spine Deform 2021; 9:155-160. [PMID: 32965628 DOI: 10.1007/s43390-020-00208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The current literature on clinical appearance after surgery for high-grade spondylolisthesis is inconclusive. The few long-term comparative studies on surgical reduction versus in situ fusion report contradictory findings concerning appearance-related issues. The purpose of the current study was to evaluate and quantify clinical appearance three decades after in situ fusion for high-grade isthmic spondylolisthesis. METHODS The Scoliosis Research Society (SRS)-22r questionnaire, digital photographs and standing lateral radiographs were used to evaluate clinical appearance for 22 patients three decades after in situ fusion for high-grade spondylolisthesis. The appearance was assessed by two spine surgeons, by the patient themselves, and by quantification of cosmesis relevant radiographic variables including pelvic parameters and sagittal balance. RESULTS The surgeon inter- and intraobserver reliability of the photographic evaluation of the trunk deformity was at most moderate (Cohen's kappa 0.5). Correlation analysis revealed at most medium correlation between radiographic outcome and self-rated (SRS-22r) self-image (Spearman's rank correlation coefficient 0.3). The agreement between patient and surgeon-rated trunk appearance was poor (Cohen's kappa 0.2). CONCLUSIONS Photographic evaluation of the trunk deformity in high-grade spondylolisthesis is unreliable. There were only weak correlations between patient self-assessed trunk appearance and radiographic parameters. The results reflect the pronounced subjectivity of cosmesis, and that the trunk deformity in high-grade spondylolisthesis is not easily observed. LEVEL OF EVIDENCE IV.
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Outcomes of Minimally Invasive versus Open Surgery for Intermediate to High-grade Spondylolisthesis: A 10-Year Retrospective, Multicenter Experience. Spine (Phila Pa 1976) 2020; 45:1451-1458. [PMID: 32453240 DOI: 10.1097/brs.0000000000003573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The primary objective of our study was to evaluate the surgical outcomes and complications of minimally invasive surgery (MIS) versus open surgery in the management of intermediate to high grade spondylolisthesis, and secondarily to compare the outcomes following MIS in-situ fusion versus MIS reduction and open in-situ fusion versus open reduction subgroups. SUMMARY OF BACKGROUND DATA High-grade spondylolisthesis is a relatively rare spine pathology with unknown prevalence. The optimal management and long-term prognosis of high-grade spondylolisthesis remain controversial. METHODS A multicenter, retrospective cohort study of adult patients who were surgically treated for grade II or higher lumbar or lumbosacral spondylolisthesis from January 2008 until February 2019, was conducted. RESULTS A total of 57 patients were included in this study. Forty cases were treated with open surgery and 17 with MIS. Specifically, seven patients underwent MIS in-situ fusion, 11 patients open in-situ fusion, an additional 10 patients underwent MIS reduction, and 29 had open reduction. Patients who underwent open surgery had significantly better pain relief at short-term follow-up with no statistically significant difference in the rate of complications (25% vs. 35.2%, P = 0.44), as compared with MIS. The most common complications were related to instrumentation (17.7%), followed by neurological complications (14.5%), wound infection/dehiscence (6.5%), and post laminectomy syndrome (1.6%). The average follow-up time was 9.1 ± 6.2 months. In a subgroup comparison, the complication rate in the open in-situ fusion (36.3%) versus open reduction (20.6%) subgroup was non-significant (P = 0.42). However, complication rate in the MIS reduction group (55%) was significantly higher than MIS in-situ fusion (P = 0.03). CONCLUSION MIS reduction is associated with a higher rate of complications in the management of grade II or higher lumbar or lumbosacral spondylolisthesis. The management of this complex pathology may be better addressed via traditional open surgery. LEVEL OF EVIDENCE 3.
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Zhou QS, Sun X, Chen X, Xu L, Qian BP, Zhu ZZ, Wang B, Qiu Y. How does sagittal spinopelvic alignment of lumbar multisegmental spondylolysis differ from monosegmental spondylolysis? J Neurosurg Spine 2020; 33:211-218. [PMID: 32302981 DOI: 10.3171/2020.2.spine191415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate sagittal alignment and compensatory mechanisms in patients with monosegmental spondylolysis (mono_lysis) and multisegmental spondylolysis (multi_lysis). METHODS A total of 453 adult patients treated for symptomatic low-grade spondylolytic spondylolisthesis were retrospectively studied at a single center. Patients were divided into 2 subgroups, the mono_lysis group and the multi_lysis group, based on the number of spondylolysis segments. A total of 158 asymptomatic healthy volunteers were enrolled in this study as the control group. Radiographic parameters measured on standing sagittal radiographs and the ratios of L4-S1 segmental lordosis (SL) to lumbar lordosis (L4-S1 SL/LL) and pelvic tilt to pelvic incidence (PT/PI) were compared between all experimental groups. RESULTS There were 51 patients (11.3%) with a diagnosis of multi_lysis in the spondylolysis group. When compared with the control group, the spondylolysis group exhibited larger PI (p < 0.001), PT (p < 0.001), LL (p < 0.001), and L4-S1 SL (p = 0.025) and a smaller L4-S1 SL/LL ratio (p < 0.001). When analyzing the specific spondylolysis subgroups, there were no significant differences in PI, but the multi_lysis group had a higher L5 incidence (p = 0.004), PT (p = 0.018), and PT/PI ratio (p = 0.039). The multi_lysis group also had a smaller L4-S1 SL/LL ratio (p = 0.012) and greater sagittal vertical axis (p < 0.001). CONCLUSIONS A high-PI spinopelvic pattern was involved in the development of spondylolytic spondylolisthesis, and a larger L5 incidence might be associated with the occurrence of consecutive multi_lysis. Unlike patients with mono_lysis, individuals with multi_lysis were characterized by an anterior trunk, insufficiency of L4-S1 SL, and pelvic retroversion.
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Affiliation(s)
| | - Xu Sun
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Xi Chen
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Liang Xu
- 2Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Ze-Zhang Zhu
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Bin Wang
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Yong Qiu
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
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Reduction versus In Situ Fusion for Adult High-Grade Spondylolisthesis: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:512-520.e2. [PMID: 32179186 DOI: 10.1016/j.wneu.2020.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical management of high-grade spondylolisthesis is controversial. Both reduction and in situ fusion are available options, but it remains unclear which approach provides better outcomes. We conducted a systematic review and meta-analysis of studies reporting outcomes following reduction or in situ fusion for adult high-grade spondylolisthesis. METHODS PubMed, Embase, Web of Science, and Cochrane databases were last searched on June 24, 2019. We identified 1236 studies after excluding duplicates. After screening, 15 studies were included in the meta-analysis. Random-effects models were used to pool effect estimates. RESULTS A total of 188 patients were analyzed. Compared with reduction, in situ fusion had a higher mean estimated blood loss (584 mL vs. 451 mL) and a clinically higher incidence of neurologic (48% vs. 15%), pseudarthrosis (13% vs. 8%), and infectious (20% vs. 10%) complications; however, these differences were not statistically significant. Reduction was associated with a clinically higher incidence of overall complications (32% vs. 25%) and dural tears (22% vs. 7%). Reduction provided better pain relief (mean difference [MD] = 5.24 vs. 4.77) and greater change in pelvic tilt (MD = 5.33 vs. 2.60); however, these differences were not statistically significant. Patients who underwent reduction had significantly greater decline in Oswestry Disability Index scores (MD = 55.7 vs. 11.5; Pinteraction < 0.01) and greater change in slip angle (MD = 25.0 vs. 11.4; Pinteraction = 0.01). CONCLUSIONS In management of adult high-grade spondylolisthesis, both approaches appeared to be safe and effective. Reduction appeared to offer better disability relief and spinopelvic parameter correction than in situ fusion.
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