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How to Reduce Unbalanced Severe Isthmic Spondylolisthesis

February 19, 2016

Contributors: Angelo Toscano, MD; Raffaele Borghi, MD; Daniele Fabbri, MD; Alberto Corrado Di Martino, MD, PhD; Camilla Pungetti, MD; Mohammadreza Chehrassan, MD; Francesco Traina, MD, PhD; Cesare Faldini, MD; Cesare Faldini, MD

The management of high grade isthmic spondylolisthesis (HGIS) is a challenge for the orthopaedic surgeon. Even though it has been addressed in the past by either anterior, posterior, or combined approaches, more recently most authors agree to treat this disease by posterior reduction and instrumented interbody fusion. Briefly, the surgical steps in our video include pedicle identification by anatomic landmarks and pedicle screw insertion technique, an accurate and gentle reduction of the vertebral slippage, lumbar decompression by L5 laminectomy, and intersomatic cage insertion by a posterior approach. The aim of this video is to show the surgical technique of reduction of L5 HGIS in a 36 years old female who suffered from chronic low back pain associated with intractable L5 bilateral radiculopathy. Graphic illustrations are inserted to support the video in better explaining the technique. A total of 23 consecutive patients affected by HGIS high grade symptomatic L5-S1 isthmic spondylolisthesis were operated using this technique; one of them is shown in our video presentation. Each patient was evaluated by mean of Odom's criteria, radiographs, CT and MRI. At the last follow up, clinical results were excellent in 13 cases, good in seven, and moderate in three. The listhesis reduction was over 50% in 13 patients and under 25% in 10. Arthrodesis was achieved three months after surgery in 22 patients, while in one case occurred a mobilization of the intersomatic cage. There were two postoperative complications: one patient presented palsy bladder and dysesthesia of the perineal region, while another suffered from a transient unilateral paresis of the sciatic nerve due to a large hematoma in the surgical site. Both complications evolved in spontaneous and complete resolution in six months. In conclusion, posterior instrumented arthrodesis, reduction, and interbody fusion is an effective treatment for high grade spondylolisthesis. This video may help the young surgeons to know how to approach HGIS and manage it appropriately.