title: Surgical treatment of high-grade dysplastic spondylolisthesis using intraoperative electrophysiological monitoring: report of two cases and review of the literature.
abstract: Treatment of high-grade dysplastic spondylolisthesis in adolescents remains challenging. Surgical treatment of spondylolisthesis has been recommended in adolescents with pain refractory to conservative treatment, slippage progression, or severe slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. Moreover, some authors reported the incidence of L5 root palsy during the reduction procedure. We performed 2 cases of surgical treatment using intraoperative electrophysiological monitoring for patients with high-grade dysplastic spondylolisthesis in adolescence. Each patient received treatment consisting of decompression of nerve with surgical microscope, reduction, and circumferential fusion with transpedicular and monosegmental fixation surgery with intraoperative neurological monitoring with transcranial electric motor evoked potentials and continuous spontaneous electromyography recording. Intraoperative monitoring did not show any abnormal changes. The patients got well after surgery, and they showed no postoperative motor paralysis of the extremities. A postoperative radiogram showed reduction of the slippage, and computed tomogram showed bone union between L5 and S1 vertebral body. This report describes 2 cases of surgical treatment using intraoperative electrophysiological monitoring with transcranial electric motor evoked potentials and continuous spontaneous electromyography for patients with high-grade dysplastic spondylolisthesis in adolescence. We successfully perform the surgery without any neurological deficit using intraoperative electrophysiological monitoring.
authors: Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan. toshinakamae623813@yahoo.co.jp
authors: Toshio
authors: T
authors: Nakamae
authors: Nobuhiro
authors: N
authors: Tanaka
authors: Kazuyoshi
authors: K
authors: Nakanishi
authors: Naosuke
authors: N
authors: Kamei
authors: Takahiko
authors: T
authors: Hamasaki
authors: Bunichiro
authors: B
authors: Izumi
authors: Yuki
authors: Y
authors: Fujioka
authors: Ryo
authors: R
authors: Ohta
authors: Mitsuo
authors: M
authors: Ochi
mesh_terms: D000293:Adolescent; D001848:Bone Diseases, Developmental / Q000150:complications*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D013168:Spondylolisthesis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome