Reduction of high-grade isthmic and dysplastic spondylolisthesis in 5 adolescents.
Treatment of high-grade isthmic and dysplastic spondylolisthesis in children and adolescents remains a challenge. Surgical treatment of spondylolisthesis has been recommended in adolescents with pain refractory to nonoperative modalities, slippage progression, or > 50% slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. In this report, we describe 5 cases of high-grade isthmic and dysplastic spondylolisthesis in adolescents and review the literature on surgical treatment for this entity. Operative records, charts, x-rays, and Scoliosis Research Society outcome questionnaires (SRS-22) were retrospectively evaluated for 5 consecutive patients diagnosed with and treated for high-grade spondylolisthesis. Each patient received treatment consisting of decompression, reduction, and circumferential fusion with transpedicular and segmental fixation from a posterior approach. Two patients had transient L5 nerve root deficit, which resolved within 3 months. Reduction benefits include a decrease in shear stresses (and resulting decreased rates of postoperative pseudarthrosis and slip progression), restoration of sagittal alignment and lumbosacral spine balance, and improvement in clinical deformity.
Lonner
Baron S
BS
Hospital for Joint Diseases-NewYork University Medical Center, New York, NY 10021, USA. blonner@nyc.rr.com
Song
Edward W
EW
Scharf
Carrie L
CL
Yao
Jeff
J
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures; D011183:Postoperative Complications; D012447:Sacrum / Q000601:surgery; D012600:Scoliosis / Q000150:complications / Q000601:surgery; D013123:Spinal Fusion; D013168:Spondylolisthesis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*