Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis

Abstract

Grob et al. (Eur Spine J 5:281-285, 1996) illustrated a new fixation technique in inveterate cases of grade 2-3 spondylolisthesis (degenerative or spondylolytic): a fusion without reduction of the spondylolisthesis. Fixation of the segment was achieved by two cancellous bone screws inserted bilaterally through the pedicles of the lower vertebra into the body of the upper slipped vertebra. Since 1998 we have been using this technique according to the authors' indications: symptomatic spondylolisthesis with at least 25% anterior slippage and advanced disc degeneration. Afterwards this technique was used also in spondylolisthesis with low reduction of the disc height and slippage less than 25%. In every case we performed postero-lateral fusion and fixation with two AO 6.5 Ø thread 16 mm cancellous screws. From 1998 to 2002 we performed 62 fusions for spondylolisthesis with this technique: 28 males (45.16%) and 34 females (54.84%), mean age 45 years (14-72 years). The slipped vertebra was L5 in 57 cases (92%), L4 in 2 cases (3.2%), L3 in 1 case (1.6%), combined L4 and L5 in 2 cases (3.2%). In all cases there was an ontogenetic spondylolisthesis with lysis. Lumbar pain was present in 22 patients and lumbar-radicular pain was present in 40 patients. The mean preoperative VAS was 6.2 (range 5-8) for lumbar pain, and 5.5 (range 4-7) for leg pain. The fusion area was L5-S1 in 53 cases (85.5%), L3-L4 in 1 case (1.6%), L4-S1 in 8 cases (12.9%). A decompression of the spinal canal by laminectomy was performed in 33 procedures (53%). When possible a bone graft was done from the removed neural arc, and from the posterior iliac crest in the other cases. The mean blood loss was about 254 ml (100-1,000). The mean operative time was 75 min (range 60-90). The results obtained by computerized analysis at follow-up at least 5 years after surgery showed a significant improvement in preoperative symptoms. The patients were asymptomatic in 52 cases (83.9%); strained-back pain was present in 8 cases (12.9%), and there was persistent lumbar-radicular pain in 2 cases (3.2%). The mean ODI score was 2.6%, the mean VAS back pain was 1.3, the mean VAS leg pain 0.7. Some complications were observed: a nerve root compression by a screw invasion of intervertebral foramen, resolved by screw removal; an iliac artery compression by a lateral exit screw from pediculo, resolved by screw removal; a deep iliac vein phlebitis with thrombosis caused by external compression due to a wrong intraoperative position, treated by medicine. Two cases of synthesis mobilization and two cases of broken screws was detected. No cases of pseudoarthrosis and immediate or late superficial or deep infection were observed. The analysis of the long-term results of the spondylolisthesis surgical treatment with direct pediculo-body screw fixation and postero-lateral fusion gave a very satisfactory response. The technique is reliable in allowing an optimal primary stability, creating the best biomechanical conditions to obtain a solid fusion.

Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11–13 years

“…Complications included one postoperative hematoma, one leg vein thrombosis, one permanent urine dysfunction syndrome and two peroneal weaknesses after the primary operation. The complication rate is also low in the literature and thus posterolateral fusion can be regarded as a safe procedure [2,15]. Screw breakage observed in postoperative X-rays is the most usual complication occurring during follow-up, often without the need for revision.…”

“…Posterolateral fusion is considered better for the biomechanics of the spine because it is less rigid than an anterior fusion [3]. Zagra [15] has reported after 5 years over 80 % good results with Grob's pediculobody screw fixation and posterolateral fusion in inveterate cases of grade 2-3 spondylolisthesis.…”

Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4–5 spondylolisthesis: clinical outcomes

“…18,27 In patients with spondylolisthesis and related neurological symptoms, the radiographic and clinical outcome of spinal fusion has been suggested to be superior to conservative treatment and decompression alone. 10,19,32,35,38 Traditional posterior approaches in combination with anterior arthrodesis have been advocated and routinely used for spinal fusion in this population with satisfactory results.…”

Transdiscal L5-S1 screws for the treatment of adult spondylolisthesis

“…Grob et al [10] suggest a pediculo-body fixation with two cancellous screws inserted from the S1 pedicle to the L5 vertebral body. This technique was also reported by Zagra et al with satisfactory long-term outcome [17]. Bartolozzi et al [9] described an in situ interbody fusion with a titanium cage inserted according to the Bohlman and Cook [18] technique by a transacral approach associated with pedicle screw fixation.…”