One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5-S1 spondylolisthesis.
METHODS
A retrospective clinical study was conducted.


OBJECTIVE
To evaluate the clinical and radiologic outcomes of one-stage posterior decompression-stabilization after partial reduction and trans-sacral interbody fusion with a titanium cage for severe L5-S1 spondylolisthesis.


BACKGROUND
Trans-sacral interbody fusion for the management of severe L5-S1 spondylolisthesis with or without partial reduction and pedicular fixation has been previously described. The use of a trans-sacral titanium cage has not been previously reported.


METHODS
Fifteen patients with severe L5-S1 spondylolisthesis were treated consecutively with posterior decompression, partial reduction, pedicular fixation, and posterior lumbar interbody fusion using a trans-sacral titanium cage. The mean age at the time of surgery was 22.4 years (range, 11-37 years). The mean follow-up period was 31.4 months (range, 12-58 months). Nine patients had severe back pain and six patients radicular pain. Three patients had a partial unilateral L5 motor deficit and two an L5 sensory deficit. Five patients had extremely tight hamstrings. The mean preoperative percentage of slipping was 69.3% (range, 53-91%). Patients were evaluated for complications and fusions, and outcomes were collected using the modified Scoliosis Research Society Outcomes Instrument.


RESULTS
At follow-up, all patients, except one with major vascular complications, were extremely or reasonably satisfied with the surgery. All patients showed improvements in radiologic indexes and stable fusion at the final follow-up examination.


CONCLUSIONS
Posterior decompression and partial reduction followed by circumferential stabilization performed in one stage combining pedicle fixation with trans-sacral titanium cage interbody fusion is an effective and safe technique for the management of severe spondylolisthesis.
Bartolozzi
Pietro
P
Department of Orthopaedic Surgery, Verona University School of Medicine, Verona, Italy. ortopvr@libero.it
Sandri
Andrea
A
Cassini
Marco
M
Ricci
Matteo
M
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D002648:Child; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D008161:Lumbosacral Region; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D012449:Safety; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D014025:Titanium; D016896:Treatment Outcome
D014025:Titanium