One-stage decompression and posterolateral and interbody fusion for severe spondylolisthesis. An analysis of 14 patients.
METHODS
A retrospective study of 14 patients with high-grade L5-S1 spondylolisthesis surgically treated with one-stage decompression and posterolateral and interbody fusion (technique of Bohlman and Cook).


OBJECTIVE
To determine the efficacy of this technique in managing severe lumbosacral spondylolisthesis.


BACKGROUND
Controversy exists over the most appropriate method for managing high-grade spondylolisthesis. Circumferential in situ fusion from a single-stage posterior approach was described in 1982, but to the current authors' knowledge, there are not many reports on clinical results in the literature. The current authors studied 14 patients (mean age, 21 years) with severe L5-S1 spondylolisthesis. The percentage of slipping averaged 77%; slip angle averaged 36 degrees. The average follow-up period was 30 months. All patients had severe back or radicular symptoms. Two patients had foot drop, and four had minor neurologic dysfunction. Four patients had extremely tight hamstrings.


METHODS
Pre- and postoperative radiographic films and computed tomography scans were reviewed. Magnetic resonance imaging was carried out in 11 patients before surgery and at follow-up examination. Patients were evaluated for fusion rate, clinical outcome, and complications.


RESULTS
All six patients with motor deficit of the nerve roots showed complete strength recovery at follow-up examination. None of the patients had tightness of hamstrings. Twelve patients demonstrated incorporation of the graft with solid fusion, one patient had a fracture of the fibular graft, and one had graft resorption. All patients but one rated the surgical result as excellent. One patient was not satisfied with the cosmetic result. Transient paresthesias in the leg of the donor graft were documented in two patients.


CONCLUSIONS
Posterior decompression of the spinal canal combined with anterior and posterior arthrodesis performed at one stage through a posterior approach is a safe and effective technique for managing severe spondylolisthesis.
Roca
J
J
Department of Orthopaedics ICATME, Institut Universitari Dexeus, Barcelona, Spain.
Ubierna
M T
MT
Cáceres
E
E
Iborra
M
M
D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005360:Fibula / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012585:Sciatica / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D013168:Spondylolisthesis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome