Sagittal Balance Improvement in Surgical Treatment of Low- Grade Isthmic Lumbosacral Spondylolisthesis

Abstract

Background Data: The role of surgical correction of sagittal plane deformity in cases of lytic spondylolisthesis is essential. While evidence is emerging of the possible short- and long-term benefits of restoring spinal balance, some surgeonshave been concerned about the associated risks especially if instrumentation has to be used for reduction of the slipping.Purpose: To evaluate the Sagittal Balance improvement in surgical Treated Lowgrade Isthmic Lumbosacral Spondylolisthesis Study Design: Prospective clinical case study Patients and Methods: Twenty two patients with low-grades (<50%) of isthmic spondylolisthesis of lumbosacral junction (L5-S1) were managed by a surgical intervention aiming for correction of the deformity even with partial reduction of the slipping. Sagittal alignment at the lumbosacral junction was tried to be achieved by appropriate positioning of the patient during the surgery and by rod contouring. Posterior decompression of nerve structures by laminectomy in conjunction with posterior instrumented fusion from L5 to sacrum were also done. They were fourteen females and eight males with a mean age of 40.45 years. The mean follow up period was 20 months. Results: All patients achieved satisfactory results as regards the back pain, radicular pain and neurologic deficits. The mean preoperative estimated values of slip percentage, L1-S1 lordosis, sacral inclination angle and lumbosacral kyphosis were 30.2%, 48.8°, 46.04°, and 35°. The mean reconstructed values were 25%, 34.9°, 36.86°, and 28° postoperative. Pelvic version improved in patients with unbalanced spondylolisthesis as evidenced by decreased sacral slope [from 46.04 degrees to 36.86 degrees] (P<0.5). All patients could return to their normal activities of daily living.Conclusion: This study suggests that, the described technique can yield satisfactory clinical outcomes and substantial deformity correction using single posterior approach with proper patient position before surgery. (2013ESJ040)