High-grade high-dysplastic lumbosacral spondylolisthesis in children treated with complete reduction and single-level circumferential fusion: A prospective case series

Abstract

IntroductionSurgical treatment of high-grade developmental spondylolisthesis remains controversial with paucity of data reporting complete reduction of the deformity, especially in pediatric patients. Research questionTo assess efficacy and safety of complete reduction and circumferential L5-S1 fusion in children with high-grade high-dysplastic spondylolisthesis. Emphasis was placed on fusion rates, correction of lumbosacral deformity and long-term clinical outcomes by means of patient-reported outcome measures (PROMs). Material and methodsConsecutive series of 18 pediatric patients referred to surgery over an 11-years period. Several radiographic variables and PROMs were collected pre- and post-surgery with minimum follow-up of 2-years. ResultsThe mean age of cohort was 12.9 years with a mean follow-up of 7.8 years. Postoperatively, the mean slip was reduced from 64.4±9.8% to 4.5±5.9% with no loss of correction during follow-up. PROMs significantly improved following the index procedure (p<0.0001). Lumbo-pelvic parameters improved after surgery, including SS, but not PT. Development of adjacent level spondylolisthesis was noted in eight subjects (44%), two of these patients required additional surgery. Posterolateral and anterior fusion was obtained in 100% and 78% of cases, respectively. One patient developed a transient right-sided L5 nerve paresis after surgery that gradually resolved within one year post-surgery. Preoperatively, we recorded three patients with L5 nerve root motor deficit, which resolved completely in two cases and in one patient remained unchanged. Discussion and conclusionComplete reduction can safely be accomplished without an increased risk of nerve root injury. Coupled with single-level circumferential fusion, it provides high fusion rates with satisfactory spino-pelvic alignment.