Abstract
IntroductionTraditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis.Case presentationThree patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50)-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA) was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL). Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up.ConclusionsPercutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management of lumbosacral spondylolisthesis.
Highlights
Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications
Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management of lumbosacral spondylolisthesis
The patients were selected on the basis of imaging evidence of low-grade spondylolisthesis and axial pain with concomitant lumbar radiculopathy [6]
Summary
Patients with intractable low back pain or radiculopathy (or both) resulting from lumbar or lumbosacral spondylolisthesis benefit from surgical intervention [1,2]. The patients were selected on the basis of imaging evidence of low-grade spondylolisthesis and axial pain with concomitant lumbar radiculopathy [6]. The first case was of a 46-year-old Caucasian man who presented with a four-year history of axial low back pain and radiculopathy that was described as 7 out of 10 on average and as 10 out of 10 at its worst on an 11point Likert scale, of mechanical type (exacerbated by standing or walking for extended periods of time and improved by lying down), and refractory to extensive conservative treatment. Successful fusion, defined as no motion at the treated segment on flexion/extension radiographs and evidence of bone growth between the adjacent vertebral bodies on reconstructed computed tomography images, was demonstrated at one-year follow-up (Figure 6). Wide indirect neuroforaminal decompression and solid fixation constructs were achieved with successful fusion at one-year follow-up
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