title: The radiographic results and neurologic complications of instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements: a retrospective review of 44 patients.
abstract: METHODS
  A retrospective review of all cases of high-grade spondylolisthesis treated by 1 surgeon between the years 1991 and 2003.
  
  
  OBJECTIVE
  To report the radiographic results and neurologic complications following instrumented posterior reduction and fusion without decompression of the neural elements.
  
  
  BACKGROUND
  Despite a large number of published reviews of the clinical results of operative intervention, controversy remains about the surgical treatment of high-grade spondylolisthesis.
  
  
  METHODS
  A retrospective review of the clinical charts and radiographs of all patients with L5-S1 spondylolisthesis and more than 50% anterior displacement of L5 on S1 who were treated by the same surgical team at 1 institution.
  
  
  RESULTS
  With this technique, an average reduction in the displacement of L5 on S1 from 64% to 38% was achieved. At a minimum 2-year follow-up (41 patients), we have detected 5 cases with evidence of pseudarthrosis or loss of reduction (11.4%). Overall, a neurologic complication rate of 9.1% occurred in this series, with a 2.3% chance of a persistent motor deficit. We did not detect any loss of bowel or bladder function after surgery. At last follow-up, and after revision procedures, we were able to achieve good or fair clinical results in 40 (90.9%) of 44 patients.
  
  
  CONCLUSIONS
  These data suggest that a posterior instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements can be accomplished with acceptable radiographic and clinical results.
authors.affiliation: Department of Orthopedic Surgery, Centre Des Massues, Lyon, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Sailhan
authors.forename: Sohrab
authors.initials: S
authors.lastname: Gollogly
authors.forename: Pierre
authors.initials: P
authors.lastname: Roussouly
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging* / Q000601:surgery*