Reduction Of Spondylolisthesis Research Articles

Effectiveness in indirect decompression using mis tlif in single level lumbo-sacral spondylolisthesis

Minimally invasive surgery - transforaminal lumbar interbody fusion (MIS TLIF) was considered as a promising treatment in lumbo-sacral spondylolisthesis, especially using intraoperative neuromonitoring will provide safer and faster recovery with less complications. The objective of this study was to confirmed the safety of the innovative MIS TLIF in releasing nerves without exposure. From 2022 to March 2024, 20 single-level lumbo-sacral spondylolisthesis was performed for indirect decompression using MIS TLIF with intraoperation neuromonitoring. During perioperative and follow-up, demographic data, operation time, blood loss, VAS, ODI, modified MacNab criteria, radiographic evaluation and complications were collected and analyzed. 20 patients were followed up for more than 12 months. Mean age: 52.1 and mean follow-up 15.2 months. VAS back pain: 7.4 preoperatively and 0.8 at the final. VAS of leg pain was 7.1 preoperatively and 0.9 at the final. ODI was 52.4% preoperatively and 15.6% at the final. MIS-TLIF was associated with reduction of spondylolisthesis, increase in disc height (+6 mm), foraminal height (+3,1 mm), and segmental lordosis (+4.8°). Patients with hypolordosis (<40°) significant increases +6.1° and overall lordosis +7.6°. Pelvic parameters were not significantly changed. According to the modified MacNab criteria: 75% excellent, 20% good and 51% fair. There was no complication perioperatively. Indirect decompression using MIS TLIF seems to be a safe, effective, and feasible technique in managing single level lumbo-sacral spondylolisthesis.

Buck technique supplemented by temporary intersegmental pedicle screw fixation to repair lumbar spondylolysis in youth

BackgroundLumbar spondylolysis is a bone defect in the pars interarticularis of the lumbar vertebral, which is a common cause of low back pain in youth. Although non-surgical treatment is a mainstream option, surgery is necessary for patients with persistent symptoms. Buck technique is widely used as a classical direct repair technique, but it cannot achieve reduction of low-grade spondylolisthesis and reconstruction of lumbosacral sagittal balance. We have described a novel surgical procedure based on Buck technique with temporary intersegmental pedicle screw fixation, and report a series of clinical outcomes in 5 patients to provide a reference for the clinical treatment of young lumbar spondylolysis.MethodsFive young patients with symptomatic lumbar spondylolysis with a mean age of 19.20 ± 5.41 years underwent surgical treatment after an average of 7.60 ± 1.52 months of failure to respond to conservative treatment, using a new surgical procedure based on Buck technique combined with temporary intersegmental pedicle screw fixation.ResultsFive patients were successfully operated without serious complications such as nerve and vascular injury. The average operation time was 109.00 ± 7.42 min, the interpretative average blood loss was 148.00 ± 31.14 ml, and the average fusion time was 11.20 ± 1.64 months. All patients were followed up for 2 years after surgery, and the visual analogue score (VAS) of low back pain and Oswestry disability index (ODI) scores were significantly improved compared with those before surgery, and the Henderson’s evaluation were rated excellent or good. After the removal of the internal fixation, it was observed that temporary intersegmental fixation could repair the isthmus, reduce lumbar spondylolisthesis, and reconstruct the sagittal balance of the lumbosacral vertebrae while preserving lumbar motion and preventing intervertebral disc degeneration. Postoperative MRI indicated the Pfirrmann classification of the affected discs: 1 case from grade III to grade II, 3 cases from grade II to grade I, and 1 case remained grade II.ConclusionsBuck technique supplemented by temporary intersegmental pedicle screw fixation is a highly applicable and effective method for the treatment of adolescent lumbar spondylolysis. The isthmic fusion is accurate, and temporary intersegmental fixation can effectively prevent disc degeneration and reconstruct the sagittal balance of lumbosacral vertebra.

Anatomical Reduction of Spondylolisthesis Through Lateral Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation: An Intraoperative Technical Note

Surgical management of lumbar spondylolisthesis requires neural decompression, stabilization, and alignment restoration. Minimally invasive spine approaches offer a wide variety of advantages for spondylolisthesis management. This intraoperative note describes the treatment of L4-L5 lumbar spondylolisthesis with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw fixation (PSF). The surgical technique for treating L4-L5 lumbar spondylolisthesis using a minimally invasive approach with LLIF and percutaneous PSF is described. This operative technique is illustrated with figures, and an intraoperative case example of its application is described. LLIF with percutaneous PSF can be a safe, effective, and reliable option for treating lumbar spondylolisthesis when applied with appropriate surgical technique in a selected patient population. This technique is a valuable addition to the range of available spine surgical options. LLIF with percutaneous PSF can be an effective technique for treating lumbar L4-L5 spondylolisthesis.

Clinical and radiological outcomes of gradual reduction and circumferential fusion of high-grade spondylolisthesis in adolescents: a prospective cohort study of 29 young patients.

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). 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. 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 (> 2years post-op). Radiological measurements were used to classify patients according to the Spine Deformity Study Group (SDSG) classification. 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. 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.

Radiographic and surgery-related predictive factors for increased segmental lumbar lordosis following lumbar fusion surgery in patients with degenerative lumbar spondylolisthesis.

This study aimed to evaluate preoperative (pre-op) radiographic characteristics and specific surgical interventions in patients with degenerative lumbar spondylolisthesis (DLS) who underwent lumbar fusion surgery (LFS), with a focus on analyzing predictors of postoperative restoration of segmental lumbar lordosis (SLL). A retrospective review at a single center identified consecutive single-level DLS patients who underwent LFS between 2016 and 2022. Radiographic measures included disc angle (DA), SLL, lumbar lordosis (LL), anterior/posterior disc height (ADH/PDH), spondylolisthesis percentage (SP), intervertebral disc degeneration, and paraspinal muscle quality. Surgery-related measures included cage position, screw insertion depth, spondylolisthesis reduction rate, and disc height restoration rate. A change in SLL ≥ 4° indicated increased segmental lumbar lordosis (ISLL), and unincreased segmental lumbar lordosis (UISLL) < 4°. Propensity score matching was employed for a 1:1 match between ISLL and UISLL patients based on age, gender, body mass index, smoking status, and osteoporosis condition. A total of 192 patients with an average follow-up of 20.9months were enrolled. Compared to UISLL patients, ISLL patients had significantly lower pre-op DA (6.78° vs. 11.84°), SLL (10.73° vs. 18.24°), LL (42.59° vs. 45.75°), and ADH (10.09mm vs. 12.21mm) (all, P < 0.05). ISLL patients were predisposed to more severe intervertebral disc degeneration (P = 0.047) and higher SP (21.30% vs. 19.39%, P = 0.019). The cage was positioned more anteriorly in ISLL patients (67.00% vs. 60.08%, P = 0.000), with more extensive reduction of spondylolisthesis (- 73.70% vs. - 56.16%, P = 0.000) and higher restoration of ADH (33.34% vs. 8.11%, P = 0.000). Multivariate regression showed that lower pre-op SLL (OR 0.750, P = 0.000), more anterior cage position (OR 1.269, P = 0.000), and a greater spondylolisthesis reduction rate (OR 0.965, P = 0.000) significantly impacted SLL restoration. Pre-op SLL, cage position, and spondylolisthesis reduction rate were identified as significant predictors of SLL restoration after LFS for DLS. Surgeons are advised to meticulously select patients based on pre-op SLL and strive to position the cage more anteriorly while minimizing spondylolisthesis to maximize SLL restoration.

1247 Bridging the Gap: ALIF Outshines TLIF in Radiographic Reduction of L5-S1 Spondylolisthesis

INTRODUCTION: Both the ALIF and TLIF are established surgical approaches for treating Grade 1 or 2 L5-S1 spondylolisthesis. Additionally, each procedure poses different complication profiles. There is a rising debate regarding ALIF versus TLIF regarding multiple outcomes including reduction of spondylolisthesis, thus, we aimed to compare our rates of radiographic reduction. METHODS: We conducted a retrospective review of isolated L5-S1 TLIF or ALIF surgeries at our tertiary care center from 2012-2022. These cases were reviewed for demographics, follow-up, preoperative parameters, surgical characteristics, postoperative parameters, radiographic outcomes, reduction rates and complications encountered. The inclusion criteria were minimum age of 18 years and a grade 1 or 2 spondylolisthesis at L5-S1 treated with ALIF or TLIF. We excluded patients with previous instrumentation, trauma, infection, and no spondylolisthesis. RESULTS: Of the 156 patients screened, 98 patients were specifically treated for this condition. The ALIF group (n = 40) had a higher rate of complete reduction of spondylolisthesis (90%) compared to the TLIF group (n = 58) (62.1%, p = 0.008). The TLIF group had a higher rate of partial reduction (84%, n = 21) compared to the ALIF group (16%, n = 4). Gender distribution differed significantly between the groups, with the ALIF group comprising 30% males and 70% females, while the TLIF group included 62.1% males and 37.9% females (p = 0.004). Baseline radiographic measures revealed a significant difference in Sagittal Vertical Axis (SVA), with the ALIF group exhibiting a lower average SVA (1.1 ± 3.3) compared to the TLIF group (4.3 ± 2.5, p = 0.005). CONCLUSIONS: Although further research is required, when discussing options with patients regarding surgical approaches for Grade 1-2 spondylolisthesis, ALIF demonstrates higher radiographic reduction rates than TLIF at L5-S1.

474 Comparing the Reciprocal Changes of Single Level Transforaminal Interbody Fusions Versus Lateral Interbody Fusions: A Radiographic Analysis for Sagittal Alignment and Spinopelvic Parameters

INTRODUCTION: Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are two techniques that are widely used to treat single-level pathology at L4-5. To date, no studies have compared the two techniques in terms of their ability to address disc space pathology, such as loss of height and spondylolisthesis, and achieve spinopelvic alignment goals. METHODS: After IRB approval, this study retrospectively reviewed the records of 203 patients who underwent single-level L4-L5 TLIFs and single-level L4-L5 LLIFs between 2017 to 2022. Preoperative and postoperative scoliosis films were collected and analyzed using an automated calibrated radiographic tool to measure pre-postoperative SA and SPs. Two blinded readers measured the pre-postoperative variables. Independent Sample T-tests were used to analyze the radiographic outcomes between the two groups. RESULTS: This study evaluated the results of 203 single-level TLIFs and LLIFs (109 L4-L5 TLIFs, and 94 L4-L5 LLIFs). Among the surgeries analyzed, 90 were MIS TLIFs, 19 open TLIFs, 16 standalone LLIs, and 78 LLIFs with posterior instrumentation. Postoperative scoliosis films were taken at a median of 0.28 (± 0.4) months. The analysis focused on comparing the reciprocal changes between both procedures. Significant statistical differences was found for ΔGTilt (p = 0.036), ΔLPA (p = 0.12), ΔADH (p = 0.03), ΔPDH (p = 0.04), ΔFH (p = 0.001), and ΔS% (p = 0.01) in the LLIF group, among all the variables included in the analysis. CONCLUSIONS: L4-5 LLIF and TLIF resulted in statistically similar amounts of lordosis restoration and reciprocal change at proximal and distal lumbar levels. LLIF was found to be superior in restoration of anterior disc height, posterior disc height, and foraminal height compared to TLIF. LLIF was also superior in percentage reduction of spondylolisthesis.

Restoration of Spinopelvic Alignment After Reduction of High-grade Spondylolisthesis: Myth or Reality? A Systematic Review of the literature and Meta-analysis.

Systematic review and meta-analysis of literature. The aim of the presented study is to assess whether the reduction of high-grade spondylolisthesis (HGS) through the correction of lumbosacral kyphosis leads to a decrease in the sagittal spinopelvic compensatory mechanisms. HGS is as an anterior translation of a vertebra, >50%. It is also characterized by a kyphotic deformity of the affected level. This combination of translation and kyphosis leads to compensatory mechanisms on the sagittal plane [pelvic retroversion, increased lumbar lordosis (LL), reduction in thoracic kyphosis (TK)]. A systematic search of electronic databases was conducted. Inclusion criteria were diagnosis of HGS (Meyerding >II, Slip% >50%), partial or complete reduction surgery (with a significant decrease in Slip%), and report of spinopelvic parameters (pelvic incidence, pelvic tilt, or sacral slope). Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between preoperative and postoperative spinopelvic alignment measures. P<0.05 was considered significant. Eighteen studies were included. PT showed a statistically significant decrease of -2.1217 (95% CI: -3.4803 to -0.7630), while SS showed a significant increase of 4.8349 (95% CI: 2.7462-6.9236). Conversely, both LL and TK showed nonsignificant changes, -4.7043 (95% CI: -10.4535 to 1.0449) and 6.3881 (95% CI: -0.8344 to 13.6106), respectively. VAS significantly decreased by -3.1950 (95% CI: -4.9462 to -1.4439). The meta-analysis showed mild, yet statistically significant, decrease of PT and an increase in SS after HGS reduction. Conversely, nonstatically significant decrease in LL and an increase in TK occurred. The clinical significance of these results remains questionable. Level IV.

Clinical, Radiographic and Fusion Comparison of Oblique Lumbar Interbody Fusion (OLIF) stand-alone and OLIF with posterior pedicle screw fixation in patients with degenerative spondylolisthesis

PurposeTo compare the outcomes and characteristics of oblique lumbar interbody fusion stand-alone (OLIF-SA) and OLIF with posterior pedicle screw fixation (OLIF-PPS) in the treatment of Grade I or Grade II degenerative lumbar spondylolisthesis.Patients and methodsBetween January 2019 and May 2022, 139 patients with degenerative spondylolisthesis were treated with OLIF-SA (n = 85) or OLIF-PPS (n = 54). The clinical and radiographic records were reviewed.ResultsThe clinical and radiographic outcomes were similar in both groups. The operative time and intraoperative blood loss in the OLIF-SA group were lower than those in the OLIF-PPS group (P < 0.05). However, the OLIF-PPS group had significantly better disc height (DH) and postoperative forward spondylolisthesis distance (FSD) improvement at 6 months (P < 0.05). The OLIF-PPS group had a significantly lower cage subsidence value than the OLIF-SA group (P < 0.05). Improvement of the lumbar lordotic angle (LA) and fusion segmental lordotic angle (FSA) in the OLIF-PPS group was significantly better than that in the OLIF-SA group (P < 0.05). In terms of fusion types, the OLIF-SA group tended to undergo fusion from the edge of the vertebral body. Fusion in the OLIF-PPS group began more often in the bone graft area of the central cage of the vertebral body. The fusion speed of the OLIF-SA group was faster than that of the OLIF-PPS group.ConclusionOLIF-SA has the advantages of a short operative time, less intraoperative blood loss, and reduced financial burden, while PPS has incomparable advantages in the reduction of spondylolisthesis, restoration of lumbar physiological curvature, and long-term maintenance of intervertebral DH. In addition, the SA group had a unique vertebral edge fusion method and faster fusion speed.

Surgical treatment of spondylolisthesis by oblique lumbar interbody fusion and transpedicular screw fixation: Comparison between conventional double position versus navigation-assisted single lateral position.

Oblique lumbar interbody fusion (OLIF) procedures involve anterior insertion of interbody cage in lateral position. Following OLIF, insertion of pedicle screws and rod system is performed in a prone position (OLIF-con). The location of the cage is important for restoration of lumbar lordosis and indirect decompression. However, inserting the cage at the desired location is difficult without reduction of spondylolisthesis, and reduction after insertion of interbody cage may limit the amount of reduction. Recent introduction of spinal navigation enabled both surgical procedures in one lateral position (OLIF-one). Therefore, reduction of spondylolisthesis can be performed prior to insertion of interbody cage. The objective of this study was to compare the reduction of spondylolisthesis and the placement of cage between OLIF-one and OLIF-con. We retrospectively reviewed 72 consecutive patients with spondylolisthesis for this study; 30 patients underwent OLIF-one and 42 underwent OLIF-con. Spinal navigation system was used for OLIF-one. In OLIF-one, the interbody cage was inserted after reducing spondylolisthesis, whereas in OLIF-con, the cage was inserted before reduction. The following parameters were measured on X-rays: pre- and postoperative spondylolisthesis slippage, reduction degree, and the location of the cage in the disc space. Both groups showed significant improvement in back and leg pains (p < .05). Transient motor or sensory changes occurred in three patients after OLIF-con and in two patients after OLIF-one. Pre- and postoperative slips were 26.3±7.7% and 6.6±6.2% in OLIF-one, and 23.1±7.0% and 7.4±5.8% in OLIF-con. The reduction of slippage was 74.4±6.3% after OLIF-one and 65.4±5.7% after OLIF-con, with a significant difference between the two groups (p = .04). The cage was located at 34.2±8.9% after OLIF-one and at 42.8±10.3% after OLIF-con, with a significant difference between the two groups (p = .004). Switching the sequence of surgical procedures with OLIF-one facilitated both the reduction of spondylolisthesis and the placement of the cage at the desired location.

Minimally Invasive Approach for Degenerative Spondylolisthesis: Lateral Single-Position Surgery with Intraoperative Computed Tomography Navigation and Fluoroscopy: A Technical Note

Degenerative spondylolisthesis (DS) is a prevalent condition that leads to low back pain and neurological symptoms. This technical note presents a novel surgical strategy for treating DS using lateral single-position surgery (SPS) in combination with intraoperative computed tomography navigation and fluoroscopy. Fifteen patients (5 males and 10 females, mean age 70.2years) diagnosed with DS with a slip of 5mm or more underwent lateral lumbar interbody fusion (LLIF) with percutaneous pedicle screw (PPS) fixation using this technique. The procedure involved slip reduction using an upside PPS and rod fixation, followed by LLIF performed in the same lateral position. The term "upside PPS" refers to a PPS that is inserted on the ceiling side of the patient's surgical field. Preoperative and postoperative radiographic assessments were conducted to evaluate the effectiveness of the lateral SPS. The results demonstrated significant improvements in various parameters, including spondylolisthesis reduction, segmental lordosis, disc height, and spinal canal dimensions. The lateral-SPS procedure exhibited several advantages over traditional flip LLIF approaches for slip reduction. Additionally, the technique provided accurate intraoperative navigation guidance through computed tomography imaging, ensuring precise implant placement and slip reduction. Combining LLIF and PPS fixation in a single procedure presents a precise, efficient approach for DS treatment, minimizing repositioning needs. This technique enables effective lumbar reconstruction, restoration of spinal stability, and improved patient outcomes. Although further investigation is warranted, lateral SPS surgery may hold promise as an innovative solution for managing DS by reducing surgical invasiveness and optimizing surgical efficiency.

A New Technique for Lumbar Spondylolisthesis Reduction Using T-Shaped Tools.

Retrospective study. To introduce a simple technique to facilitate lumbar spondylolisthesis reduction during posterior lumbar interbody fusion (PLIF). Spondylolisthesis reduction has been conducted in various ways, but most of them require special complicated tools. T-shaped levering tool was newly designed. This study included 23 patients who underwent PLIF for lumbar spondylolisthesis treatment using newly designed T-shaped tools and followed up for >2 years. Demographic, clinical, and surgical data, which had been routinely collected in a database, were analyzed. The degree of listhesis was measured on lateral radiographs by the Taillard method. The authors could achieve lumbar spondylolisthesis reduction without difficulty using newly designed T-shaped tools. Immediate postoperative lateral radiographs revealed a reduced preoperative slip of 36.9%±9.6% to 1.2%±1.9%, showing a correction rate of 96.7%. The final follow-up radiographs revealed the mean final slip of 2.6%±2.7%, showing a correction rate of 93.0%. This technique allowed lumbar spondylolisthesis reduction without difficulty.

Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion (PETLIF): Current Techniques, Clinical Outcomes, and Narrative Review.

Full endoscopic techniques are becoming more popular for degenerative lumbar pathologies. Percutaneous endoscopic lumbar interbody fusion (PETLIF) is a minimally invasive surgical technique for spondylolisthesis and lumbar spinal canal stenosis with instability. Nagahama first introduced PETLIF in 2019. This study investigated the clinical outcomes and complications of 24 patients who underwent PETLIF in our facility and compared them with previous studies. Literature searches were conducted on PubMed and Web of Science. The PETLIF surgical technique involves three steps to acquire disc height under general anesthesia. The procedure includes bone harvesting, spondylolisthesis reduction, endoscopic foraminoplasty, disc height expansion using an oval dilator, and intervertebral disc curettage. A cage filled with autologous bone is inserted into the disc space and secured with posterior fixation. Patients underwent PETLIF with an average operation time of 130.8 min and a blood loss of 24.0 mL. Postoperative hospital stays were 9.5 days. Improvement in VAS, disc height, spinal canal area, and % slip was observed, while lumbar lordosis remained unchanged. Complications included end plate injury, subsidence, and exiting nerve root injury. The differences between PETLIF and the extracted literature were found in patients' age, direct decompression, epidural or local anesthesia, approach, order of PPS, and cage insertion. In conclusion, PETLIF surgery is a practical, minimally invasive surgical technique for patients with lumbar degenerative diseases suffering from back and leg pain, demonstrating significant improvements in pain scores. However, it is essential to carefully consider the potential complications and continue to refine the surgical technique further to enhance the safety and efficacy of this procedure.

Scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and fixation.

To explore scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and internal fixation. We retrospectively analyzed 56 children with dysplastic spondylolisthesis who underwent surgical reduction and internal fixation. Patients were grouped according to presence of scoliosis before surgery. Radiographic parameters measured before surgery included pelvic incidence, pelvic tilt, sacral slope, coronal Cobb angle, slip percentage, Dubousset's lumbosacral angle, lumbar lordosis, sagittal vertical axis, and Spinal Deformity Study Group index. Groups were compared using logistic regression. Receiver operating characteristic analysis was performed to determine the optimal Spinal Deformity Study Group index cut-off value. All patients were followed up for at least 2 years. The scoliosis group comprises 36 patients (mean age: 9.6 ± 2.7 years), while the no scoliosis group comprises 20 (mean age: 9.1 ± 2.4 years). Slip percentage and Spinal Deformity Study Group index were significantly higher in the scoliosis group (p < 0.01). Sacral slope and pelvic incidence were lower in the scoliosis group (p < 0.05). Univariate logistic regression analysis showed that slip percentage, Spinal Deformity Study Group index, pelvic incidence, and sacral slope were significantly associated with scoliosis. In the multivariate logistic regression analysis, only Spinal Deformity Study Group index was an independent risk factor for scoliosis. The optimal cut-off value for Spinal Deformity Study Group index was 0.288. Mean Cobb angle decreased from 20.3° ± 8.8° before surgery to 8.5° ± 8.9° at last follow-up; the mean scoliosis correction rate was 59.3%. Severe S1 dysplasia and high slip percentage may be risk factors for developing scoliosis in patients with dysplastic spondylolisthesis. Scoliosis resolved spontaneously after spondylolisthesis reduction and fixation in most patients. 3.

Effect of bone cement-reinforced pedicle screws combined with fusion repositioning therapy on lumbar spine function and postoperative complications in patients with severe lumbar spondylolisthesis

ObjectiveTo retrospectively study the efficacy of bone cement-enhanced pedicle screws combined with interbody fusion reduction in the treatment of severe lumbar spondylolisthesis, its effect on lumbar function and complications. MethodsFrom January 2019 to June 2021, 82 cases of severe lumbar spondylolisthesis in our hospital were analyzed. According to the different treatment plans, the patients were divided into two groups: A and B, in which group A patients were treated with pedicle screws combined with fusion and reduction, and group B patients were treated with bone cement reinforced pedicle screws combined with fusion and reduction. Perioperative indexes, pain severity (VAS), Oswestry dysfunction index (ODI), and low back and leg pain score of Japan Orthopedic Association (JOA), spondylolisthesis reduction, intervertebral space height, intervertebral foramen height, complications, and screw loosening were compared between the two groups. ResultsThere was no significant difference in the amount of intraoperative bleeding between group A and group B (P > 0.05). The operation time of group B was longer than that of group A, and the hospitalization time was shorter than that of group A. The vertebral fusion rate of group B was higher than that of group A (P < 0.05). The VAS, ODI and JOA scores at the last follow-up in both groups were lower than those before surgery, and group B was lower than group A (P < 0.05). Compared with the preoperative period, the postoperative slippage degree grading improved in both groups, while the improvement rate in group B was higher than that in group A (P < 0.05). At the last follow-up, the scores of intervertebral foramen height and intervertebral space height in both groups were higher than those before operation, and those in group B were higher than those in group A (P < 0.05). There was no difference in the incidence of complications and screw loosening between the two groups (P > 0.05). ConclusionCompared with conventional screw treatment, bone cement-reinforced pedicle screws combined with fusion repositioning can further improve the repositioning rate of slipped vertebrae in the treatment of severe LSL, while achieving a better intervertebral fusion rate. Therefore, the treatment of severe LSL with bone cement reinforced pedicle fusion and reduction is a safe and effective method.

A novel less invasive endoscopic-assisted procedure for complete reduction of low-and high-grade isthmic spondylolisthesis performed by anterior and posterior combined approach.

The optimal surgical management of low- and high-grade isthmic spondylolisthesis (LGS and HGS -IS) is debated as well as whether reduction is needed especially for high-grade spondylolisthesis. Both anterior and posterior techniques can be associated with mechanical disadvantages as hardware failure with loss of reduction and L5 injury. We purpose a novel endoscopic-assisted technique (Sled technique, ST) to achieve a complete reduction in two surgical steps: first anteriorly through a retroperitoneal approach to obtain the greatest part of correction and then posteriorly to complete reduction in the same operation. ST efficacy and complications rate were evaluated through a retrospective functional and radiological analysis. Thirty-one patients, 12 male (38.7%) and 19 female (61.3%), average age: 45.4years with single level IS underwent olisthesis reduction by ST. Twenty-three IS involved L5 (74.2%), 7 L4 (22.5%) and 1 L3 (3.3%). No intraoperative complications were recorded. One patient required repositioning of a pedicle screw. A significant improvement of functional and radiological parameters (L4-S1 and L5-S1 lordosis) outcomes was recorded (p < 0.001). ST provides a complete reduction in the slippage in LGS and HGS. The huge anterior release as well as the partial reduction in the slippage by the endoscopic-assisted anterior procedure, because of the cage is acting as a "guide rail", facilitate the final posterior reduction, always complete in our series, minimizing mechanical stresses and neurological risks. gov Identifier: NCT03644407.

Reduction of spondylolisthesis and restoration of lumbar lordosis after anterior lumbar interbody fusion (ALIF)

BackgroundAnterior lumbar interbody fusion (ALIF) is a well-established surgical treatment option for various diseases of the lumbar spine, including spondylolisthesis. This study aimed to evaluate the postoperative correction of spondylolisthesis and restoration of lumbar and segmental lordosis after ALIF.MethodsPatients with spondylolisthesis who underwent ALIF between 2013 and 2019 were retrospectively assessed. We assessed the following parameters pre-and postoperatively (6-months follow-up): Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), lumbar lordosis (LL), segmental lordosis (SL), L4/S1 lordosis, and degree of spondylolisthesis.Results96 patients were included. In 84 cases (87.50%), additional dorsal instrumentation was performed. The most frequent diagnosis was isthmic spondylolisthesis (73.96%). VAS was reduced postoperatively, from 70 to 40, as was ODI (50% to 32%). LL increased from 59.15° to 64.45°, as did SL (18.95° to 28.55°) and L4/S1 lordosis (37.90° to 44.00°). Preoperative spondylolisthesis was 8.90 mm and was reduced to 6.05 mm postoperatively. Relative spondylolisthesis was 21.63% preoperatively and 13.71% postoperatively. All clinical and radiological improvements were significant (all p < 0.001). No significant difference considering the lordosis values nor spondylolisthesis was found between patients who underwent ALIF surgery without dorsal instrumentation and patients who received additional dorsal instrumentation. Venous laceration was the most frequent complication (10.42%).ConclusionsWith ALIF, good clinical results and safe and effective reduction of spondylolisthesis and restoration of lordosis can be achieved. Additional dorsal instrumentation does not significantly affect postoperative lordosis or spondylolisthesis. Individual vascular anatomy must be reviewed preoperatively before considering ALIF.

Surgical treatment of degenerative lumbar spondylolisthesis: Effect of TLIF and slip reduction on sagittal alignment

IntroductionThe surgical treatment of lumbar degenerative spondylolisthesis (LDS) remains controversial. The aim of this study was to determine the effect of adding transforaminal lumbar interbody fusion (TLIF) to posterolateral fusion (PLF) on the local lordosis, sagittal alignment and potential complications. The second aim was to evaluate the effect of slip reduction on the same parameters. HypothesisThe initial hypothesis was that TLIF provides better correction of the local lordosis and that reducing the slip improves the global sagittal balance. MethodsIn this retrospective, single-center study, patients who had been operated on for LSD at one or two levels by laminectomy and PLF, with or without a TLIF cage, were included. Data collected consisted of age, sex, number of levels fused and whether or not a TLIF cage was used. Fusion was defined as the absence of indirect nonunion signs on radiographs at 2 years postoperative. The occurrence and time frame of any complications and the need for reoperation were documented. Lateral radiographs of the entire spine were analyzed preoperatively, in the early postoperative period (3 to 6 months) and at a minimum follow-up of 2 years. The following parameters were measured: pelvic parameters, C7 sagittal tilt (C7ST), spinosacral angle (SSA), maximum lumbar lordosis (LL), lordosis at slipped level (LS), slip percentage. The analysis compared patients treated by PLF and TLIF and determined the impact of slip reduction. ResultsOne hundred and three patients were included in the study (71% women). The mean follow-up was 38 months. The mean age was 69 years. Seventy-seven patients (75%) underwent PLF. Comparing the preoperative and early postoperative data identified 5.4% better spondylolisthesis reduction in the TLIF group than the PLF group (−8.9±9.5% vs −3.5±7.6%; p=0.04) that was not maintained at the final follow-up. The fusion rate was comparable between groups: 94% in APL and 89% in TLIF (p=0.7). The overall complication rate was 46% in the TLIF group versus 33% in the PLF group (p=0.35). A comparison based on whether or not the slip was reduced found significant improvement in the reduction group of the SSA by more than 6° (6.8°±6° vs 0.5°±7.4°; p=0.04). The fusion rate was 91% in the reduced group and 95% in the non-reduced group (p=0.81); the complication rate was 44% versus 28% in the non-reduced group (p=0.10). ConclusionThis study shows that slip reduction helps to improve the sagittal alignment by increasing the SSA when treating LDS. Posterolateral fusion and TLIF produce comparable radiographic outcomes at 2 years postoperative in the segmental lordosis, slip reduction, global sagittal alignment and fusion rate. Level of evidenceIV.

The quest for ideal alignment: Complete reduction and fusion for high-grade spondylolisthesis

The quest for ideal alignment: Complete reduction and fusion for high-grade spondylolisthesis

High Degree Spondylolisthesis in Adults: Monosegmental Reduction and Fixation in Our Perspective

Objective: To evaluate a method to reduce high degree spondylolisthesis in adults with monosegmental fixing preserving the adjacent level and the improvement of sagittal balance. Methods: A prospective study, with 8 adult patients with high degree spondy\olisthesis (III and IV) in adults who underwent surgery by the same team. We included 5 women and 3 men with a mean age of 37 years that had no improvement with conservative treatment. The surgical technique used was total or partial reduction by Spondylolisthesis Reduction Instrument SRI System. Results: The L5-S1 level was involved in five patients, L4-L5 in two and VT-S1 in one patient. Isthmic type predominated in five patients, followed by dysplastic type in two and one a-spondytolisthesis. These patients were assessed by the Oswestry scale. Which showed a preoperative average of 59% and postoperative average of 12.4%. Conclusion: The method of high- grade spondylolisthesis reduction with instrumentation only at the affected level is a treatment option with good results, with control of the pain profile and functional improvement in patients.