1
|
Dionne A, Mac-Thiong JM, Parent S, Shen J, Joncas J, Barchi S, Labelle H. Clinical and radiological outcomes of gradual reduction and circumferential fusion of high-grade spondylolisthesis in adolescents: a prospective cohort study of 29 young patients. Spine Deform 2024:10.1007/s43390-024-00884-1. [PMID: 38698107 DOI: 10.1007/s43390-024-00884-1] [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: 12/07/2023] [Accepted: 04/13/2024] [Indexed: 05/05/2024]
Abstract
AIM The objective of this study was to evaluate the safety and efficacy of a novel technique of formal reduction and circumferential fusion for pediatric high-grade spondylolisthesis (HGS). PURPOSE The safety and efficacy of formal reduction for high-grade spondylolisthesis (HGS) has never been thoroughly examined. This study reports the outcomes of 29 children with HGS who underwent a procedure of gradual reduction and circumferential fusion. METHODS 29 children (13 males, 16 females) were recruited between 2006 and 2010. Radiographic measurements (including % of slip, lumbosacral angle-LSA, pelvic incidence-PI, pelvic tilt-PT, sacral slope-SS, and proximal femoral angle-PFA) and quality of life assessment (SRS-22 questionnaire) were prospectively obtained at baseline and at the last post-operative follow-up (> 2 years post-op). Radiological measurements were used to classify patients according to the Spine Deformity Study Group (SDSG) classification. RESULTS Mean baseline slip % was 69.9 ± 16.5%. There were 13 patients with a balanced pelvic (SDSG Type 4) and 16 with an unbalanced pelvis (SDSG Type 5 and 6). On average, a reduction of 45.5 ± 15.3% (range 20-86%) was achieved safely with no major complication. In particular, of the 29 patients, only 3 had a L5 radiculopathy postoperatively that was self-resolved at follow-up. From a radiological standpoint, we observed a mean improvement of LSA from 80.3 ± 17.9° to 91.7 ± 13.6°. We also observed a statistically significant improvement in global HRQOL, and in the function and body image domains. CONCLUSION This prospective study suggests that formal reduction of HGS followed by circumferential fusion is safe when using a standardized surgical technique based on gradual reduction. Performing this intervention could also help improve QOL in some patients.
Collapse
Affiliation(s)
- Antoine Dionne
- CHU Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
- Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Jean-Marc Mac-Thiong
- CHU Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
- Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Stefan Parent
- CHU Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
- Université de Montréal, Montréal, QC, Canada
| | - Jesse Shen
- Université de Montréal, Montréal, QC, Canada
- Centre Hospitalier Universitaire de l'Université de Montréal, Montréal, QC, Canada
| | - Julie Joncas
- CHU Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Soraya Barchi
- CHU Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Hubert Labelle
- CHU Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
- Université de Montréal, Montréal, QC, Canada.
| |
Collapse
|
2
|
Cetik RM, Latalski M, Yazici M. Management of low back pain accompanying sagittal plane pathologies in children: Spondylolysis/spondylolisthesis and Scheuermann's disease. J Child Orthop 2023; 17:535-547. [PMID: 38050599 PMCID: PMC10693848 DOI: 10.1177/18632521231215873] [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: 08/01/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Background Low back pain in childhood was underappreciated for a long time, but recent studies report higher prevalences, up to 70%. Two of the common causes are spondylolyis/spondylolisthesis and Scheuermann's disease. These disorders are relevant in a way they both cause significant back pain, and may disrupt the sagittal spinal balance. Purpose To present the current evidence on the diagnosis, natural history and treatment of these disorders with a special focus on sagittal spinal alignment. Methods This study is conducted as a literature review. Results and Conclusions Spondylolysis and low-grade spondylolisthesis have a benign course and are typically treated conservatively. When pars repair is indicated, pedicle screw-based techniques achieve more than 90% fusion with acceptable complication rates. High-grade spondylolisthesis, however, is frequently progressive. Surgical treatment involves fusion, which can be done in situ or after reduction. Reduction is useful for "unbalanced" patients to acquire sagittal spinopelvic balance, and it is important to distinguish these patients. Despite lowering the risk for pseudoarthrosis, reduction brings a risk for neurologic complications. With re-operation rates as high as 40%, these patients definitely require careful preoperative planning. Scheuermann's disease generally causes back pain in addition to cosmetic discomfort during adolescence. If the kyphosis is lower than 60°, symptoms typically resolve into adulthood with conservative measures only. However, it must be kept in mind that these patients may experience problems with physical performance and have a lower quality of life even when the problem seems to have "resolved". Severe kyphosis and intractable back pain are the most frequently referred surgical indications, and surgery typically involves fusion. Proper utilization of osteotomies and proper selection of the upper and lower fusion levels are of utmost importance to prevent complications in these patients.
Collapse
Affiliation(s)
- Riza Mert Cetik
- Department of Orthopedics and Traumatology, Pursaklar State Hospital, Ankara, Turkey
| | - Michał Latalski
- Children’s Orthopedics Department, Medical University of Lublin, Lublin, Poland
| | - Muharrem Yazici
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| |
Collapse
|