title: Bilateral tubular minimally invasive surgery for low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS): analysis of a series focusing on postoperative sagittal balance and review of the literature.
abstract: OBJECTIVE
  To report our early experience with minimally invasive surgery (MIS) in low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS), and to analyze the impact of surgery on postoperative spino-pelvic and sacro-pelvic parameters.
  
  
  METHODS
  Eight patients (mean age 47.6 years) underwent MIS for LDLLS involving in all but one the L5-S1 level. VAS and ODI were used for clinical assessment. Imaging included pre-operative X-rays, CT and MRI scans. Post-operatively, all patients underwent X-rays and CT-scans. Pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) values as well as lumbar lordosis (LL) have been derived from pre- and post-operative standard X-rays.
  
  
  RESULTS
  Mean follow-up is 30.12 months (range 15-42). No complications related to the surgical procedure were observed. Patients reported a satisfactory clinical outcome, as demonstrated by variation in mean VAS (from 9.1 to 3.6) and ODI (from 70.50 to 28.25 %) scores. Comparison between pre- and post-operative sacro-pelvic parameters documented moderate changes, with reduction of PT and increase of SS in all but one patient. Overall sagittal balance of the spine has been evaluated using the sagittal vertical axis (SVA), obtained from post-operative X-rays. Mean value of SVA demonstrated a good sagittal balance of the spine.
  
  
  CONCLUSIONS
  This series demonstrates that MIS is feasible and effective for LDLLS, as witnesses by the satisfactory clinical results maintained at medium-term follow-up. We submit that TLIF is a valid option but an adequately sized and positioned interbody cage is a key factor to allow satisfactory restoration of segmental lordosis.
authors.affiliation: Neurosurgery Department, Policlinico "G. Rodolico" University Hospital, Viale XX Settembre 45, 95129, Catania, Italy, giuseppebarbagal@hotmail.com.
authors.forename: Giuseppe M V
authors.initials: GM
authors.lastname: Barbagallo
authors.forename: Mario
authors.initials: M
authors.lastname: Piccini
authors.forename: Abdulrazzaq
authors.initials: A
authors.lastname: Alobaid
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Al-Mutair
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Albanese
authors.forename: Francesco
authors.initials: F
authors.lastname: Certo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D004856:Postural Balance; D012447:Sacrum / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion; D013168:Spondylolisthesis / Q000503:physiopathology / Q000601:surgery*