title: Transdiscal screw versus pedicle screw fixation for high-grade L5-S1 isthmic spondylolisthesis in patients younger than 60 years: a case-control study.
abstract: To compare outcomes between transdiscal and conventional pedicle fixation for high-grade L5-S1 spondylolisthesis.
  
  
  
  This was a retrospective case-control study with patients prospectively followed. Twenty-five consecutive patients with mean age of 36.7 years underwent transdiscal fixation, and 31 other with mean age of 42.0 years to pedicle fixation were clinically and radiographically compared. Clinical assessments were performed using Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), Short-Form 12 (SF-12), and pain visual analog scale (VAS). Radiographic spinopelvic parameters were also evaluated. The mean follow-up was 2.7 years (range 2.0-5.3).
  
  
  
  Preoperative data were comparable between groups. Surgery time, blood loss, and hospital stay were similar between groups. At last follow-up, clinical and radiographic outcomes were significantly improved in both groups. Postoperatively, both lumbar and leg pain VAS were similar between groups, but ODI (20.2 vs. 31.6, p = 0.010), COMI (1.6 vs. 2.8, p = 0.012), and SF-12 physical (84.3 vs. 61.5, p = 0.004) and mental (81.5 vs. 69.4, p = 0.021) scores were significantly better in the transdiscal group. The neurologic complication rate was similar in both groups. There were 4 pseudoarthroses in the pedicle group, and none in the transdiscal group.
  
  
  
  L5-S1 transdiscal screw fixation provided better functional and radiographic outcomes at medium-term than conventional pedicle fixation for high-grade spondylolisthesis, although transdiscal sacral screws are difficult to place in correct position.
authors.affiliation: Elda University Hospital, Ctra. Elda-Sax s/n, 03600, Elda, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Collados-Maestre
authors.affiliation: Orthopaedic Surgery, Faculty of Medicine, Elda University Hospital, Miguel Hernandez University, Ctra. Elda-Sax s/n, 03600, Elda, Spain. lizaur1@telefonica.net.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lizaur-Utrilla
authors.affiliation: Spine Surgery Unit, La Fe University Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Bas-Hermida
authors.affiliation: Spine Surgery Unit, La Fe University Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Pastor-Fernandez
authors.affiliation: Elda Health Department, Clinical Research Unit, Ctra. Elda-Sax s/n, 03600, Elda, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Gil-Guillen
mesh_terms: D000328:Adult; D001416:Back Pain; D016022:Case-Control Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D065289:Pedicle Screws; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods / Q000706:statistics & numerical data; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Outcome; Pedicle screw; Sacrolumbar; Spondylolisthesis; Transacral screw; Transdiscal screw; Transvertebral screw