title: Posterior surgery in high-grade spondylolisthesis.
abstract: BACKGROUND
  High-grade L5-S1 spondylolisthesis alters sagittal spinopelvic balance, which can cause low back pain and progressive neurologic disorder. The present study assessed spondylolisthesis reduction and maintenance over time with L4-S1 versus L5-S1 fusion using a lever-arm system and posterior fusion combined with lumbosacral graft.
  
  
  METHODS
  Forty patients were operated on for symptomatic high-grade spondylolisthesis, 34 of whom had full pre- and post-operative radiological analysis, with a mean follow-up of 5.4years. There were 9 L5-S1 and 25 L4-S1 instrumentations. Analysis of spinopelvic and slipping parameters and the evolution of segmental lordosis compared results between L5-S1 and L4-S1 instrumentation.
  
  
  RESULTS
  Mean Taillard spondylolisthesis index decreased from 64% to 37% (P=0.0001). Overall sagittal spinopelvic balance was not significantly changed. Overall L1-S1 and segmental L4-L5 lordosis were not affected by instrumentation. Mean L5-S1 segmental lordosis increased from 11° to 18°. There was loss of reduction from 19° to 14° with L5-S1 instrumentation, in contrast to maintained reduction with L4-S1 instrumentation (P=0.006).
  
  
  CONCLUSIONS
  The lever-arm system provided anterior-posterior reduction of spondylolisthesis and corrected slippage. Postoperative change in overall sagittal spinopelvic balance was slight and constant. Posterior L4-S1 fusion provided better long-term control of L5-S1 lordosis reduction than the shorter L5-S1 fusion. Retrospective study of level IV.
authors.affiliation: Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France. Electronic address: regis.lengert@chru-strasbourg.fr.
authors.forename: R
authors.initials: R
authors.lastname: Lengert
authors.affiliation: Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: Y P
authors.initials: YP
authors.lastname: Charles
authors.affiliation: Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Walter
authors.affiliation: Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Schuller
authors.affiliation: Département de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Godet
authors.affiliation: Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Steib
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D005260:Female; D005360:Fibula / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: High-grade spondylolisthesis; Instrumentation length; Lumbosacral fusion; Sagittal balance; Segmental lordosis; Slippage parameters