Therapy of spondylolisthesis by repositioning and fixation of the olisthetic vertebra.
A new method for reduction of the slip and stabilization in spondylolisthesis is presented. A detailed description of the operative technique is given. Of special importance to repositioning of the olisthetic vertebra is sectioning of the ilio-lumbar and ilio-transverse ligaments. It is also most important to remove a portion of the superior surface of S1 in those cases with greater than 30 per cent olisthesis. A distinction in the technique of surgery is drawn between cases with less than 30 per cent of slip and those with greater than 30 per cent. In those with less than 30 per cent 2 bone grafts taken from one iliac crest are placed between the repositioned body of L5 and the body of S1. In those with more than 30 per cent slip grafts are not necessary. In these a portion of the superior surface of S1 is removed in such a way that the body of S1 fits snugly against the under surface of the repositioned body of L5. A special traction apparatus with wires through the spinous processes of L3 and L4 is used to accomplish reduction of the olisthetic vertebra. This apparatus is spring-loaded and is mounted on a modified Milwaukee brace. The patient remains in bed while this is worn. When it is believed that there is enough solidity in the fusion between the bodies of L5 and S1 the traction apparatus is removed and the patient allowed up.
D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000628:therapy; D016025:Bone Transplantation; D001915:Braces; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011859:Radiography; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D014143:Traction; D014182:Transplantation, Autologous