title: Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade l5-s1 spondylolisthesis.
abstract: METHODS
  A clinical retrospective study was conducted.
  
  
  OBJECTIVE
  To evaluate the clinical and radiographic outcome of reduction followed by trans-sacral interbody fusion for high-grade spondylolisthesis.
  
  
  BACKGROUND
  In situ posterior interbody fusion with fibula allograft has improved the fusion rates for patients with high-grade spondylolisthesis. The use of this technique in conjunction with partial reduction has not been reported.
  
  
  METHODS
  Nine consecutive patients underwent treatment of high-grade (Grade 3 or 4) spondylolisthesis with partial reduction followed by posterior interbody fusion using cortical allograft. The average age at the time of surgery was 27 years (range, 8-51 years), and the average follow-up period was 43 months (range, 24-72 months). Before surgery, eight patients had low back pain, seven patients had radiating leg pain, and five patients had hamstring tightness. The average grade of spondylolisthesis by Meyerding grading was 3.9 (range, 3-5). Charts and radiographs were evaluated, and outcomes were collected by use of the modified SRS outcomes instrument.
  
  
  RESULTS
  Radiographic indexes demonstrated significant improvement with partial reduction and fusion. The slip angle, as measured from the inferior endplate of L5, improved from 41.2 degrees (range, 24-82 degrees ) before surgery to 21 degrees (range, 5-40 degrees ) after surgery. All the patients were extremely or somewhat satisfied with surgery. The two patients who underwent this operation without initial instrumentation experienced fractures of their interbody grafts. Both of these patients underwent repair of the pseudarthrosis with placement of trans-sacral pedicle screw instrumentation and subsequent fusion.
  
  
  CONCLUSIONS
  Partial reduction followed by posterior interbody fusion is an effective technique for the management of high-grade spondylolisthesis in pediatric and adult patient populations, as assessed by radiographic and clinical criteria. Pedicle screw instrumentation with the sacral screws capturing L5 is recommended when this technique is used for the treatment of high-grade spondylolisthesis. According to the clinical and radiographic results from this study, partial reduction and posterior fibula interbody fusion supplemented with pedicle screw instrumentation is an effective technique for select patients with high-grade spondylolisthesis at L5-S1.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Smith
authors.forename: V
authors.initials: V
authors.lastname: Deviren
authors.forename: S
authors.initials: S
authors.lastname: Berven
authors.forename: F
authors.initials: F
authors.lastname: Kleinstueck
authors.forename: D S
authors.initials: DS
authors.lastname: Bradford
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation; D002648:Child; D005260:Female; D005360:Fibula / Q000637:transplantation; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D013168:Spondylolisthesis / Q000601:surgery; D016896:Treatment Outcome