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Erschienen in:
01.02.2016 | Original Article
One-stage posterior spinal shortening by L5 partial spondylectomy for spondyloptosis or L5–S1 high-grade spondylolisthesis management
Erschienen in: European Spine Journal | Ausgabe 2/2016
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Study design
A case series of seven consecutive patients with L5–S1 spondyloptosis (SPP) and Meyerding IV spondylolisthesis (HGSPL) treated consecutively by a new surgical technique with partial reduction and fixation after spinal shortening.
Objective
To report clinical and radiological outcomes of a spinal shortening procedure by a single posterior approach in seven patients with HGSPL and SPP.
Background data
The surgical treatment of L5–S1 SPP and HGSPL remains challenging, and numbers of surgical treatment options have been described with several principles. We reported a new surgical technique achieving partial reduction and fixation of L5–S1 SPP and HGSPL and highlighted its clinical and radiological outcomes.
Methods
Seven patients with Meyerding Grade IV (2), and Grade V (5) were operated consecutively between 2004 and 2011 for HGSPL and SPP. Surgery time, blood loss and complications were collected for all patients. The slip angle or Dubousset lumbo-sacral Angle (Dub-LSA), L5 slip percentage (%slip), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK) and C7-tilt were measured pre and postoperatively. All patients underwent posterior one-stage decompression with sacral dome osteotomy, L5 vertebrectomy with L5-S1 discectomy, and partial reduction and instrumented fusion in a single posterior approach.
Results
The mean age and follow-up were, respectively, 20 years and 65 months. The mean preoperative %slip was 115 %, which improved to 63 % postoperatively. The mean preoperative Dub-LSA, PT, LL, TK, and C7-tilt were 37°, 31°, −74°, 30°, and 6°, respectively, which improved to 94°, 25°, −44°, 42° and −0.14° postoperatively. No implant failure or pseudarthrosis were reported at last follow-up.
Conclusion
This novel and efficient one-stage shortening technique offers the possibility to manage lumbosacral kyphosis and spinal local malalignment in L5–S1 SPP.