Review Article On Recent Trends in Surgical Techniques for High-grade Spondylolisthesis

Abstract

Introduction: High-grade spondylolisthesis is defined as cases with more than 50% displacement and spondylolisthesis with Meyerding grade III and higher. The surgical management of high-grade spondylolisthesis is highly controversial. Many surgical methods have been reported like posterior in situ fusion, instrumented posterior fusion with or without reduction, combined anterior and posterior procedures, spondylectomy with reduction of L4 to the sacrum (for spondyloptosis), posterior interbody fusion with trans-sacral fixation. Minimally invasive transforaminal lumbar interbody fusion for high-grade spondylolisthesis has also been recently mentioned in literature. This study aimed to review the recent literature which has described the surgical outcomes associated with various surgical techniques used for high-grade spondylolisthesis Materials and Methods: Recent articles were searched on search engines such as PubMed, Google Scholar with the use of Keywords like ‘High-grade Spondylolisthesis’, ‘Surgical Techniques’ ‘complications’. Discussion: The surgical management of high-grade spondylolisthesis is an area of significant controversies. The literature is replete with regards to need for reduction, need for decompression, levels of fusion, the nature of instrumentation, surgical approaches including open, minimally invasive, and “mini-open” procedures, as well as various techniques for reduction of the slip and fusion strategy. The three basic options of high-grade spondylolisthesis include in-situ fusion, partial reduction and fusion, and complete reduction. Conclusion: Various techniques have been described for high-grade spondylolisthesis. Spine Deformity Study Group (SDSG) classification gives guidelines about balanced and unbalanced pelvis and advising reduction and fusion in case of unbalanced pelvis for correction of biomechanical and global sagittal alignment. Each of the surgical techniques has their own advantages and disadvantages. Although individual authors’ experience, skill levels, anatomic reduction with fusion techniques has yielded highly encouraging results. Keywords: High-grade spondylolisthesis, Surgical techniques, In situ fusion, Reduction and fusion, Complications