Restoration of normal pelvic balance from surgical reduction in high-grade spondylolisthesis

Alzakri, Abdulmajeed; Hresko, M. Timothy; Parent, Stefan; Sucato, Daniel J.; Lenke, Lawrence G.; Marks, Michelle C.; Mac-Thiong, Jean Marc

doi:10.1007/s00586-019-05973-8

Cited by 23 publications

(21 citation statements)

References 26 publications

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“…Recent literature suggests that quality of life improvement in pediatric patients with high-grade lumbosacral spondylolisthesis undergoing surgical reduction, specifically when they have an unbalanced pelvis and spine. [5] The neurological deficits have been reported more in the series of patients who underwent surgical reduction. [6,7] According to the SRS database, the neurological deficits were higher in patients who had a surgical reduction of the high-grade lumbosacral spondylolisthesis.…”

Section: Discussionmentioning

confidence: 99%

Cauda equina syndrome a rare early surgical complication in a pediatric patient with dysplastic high-grade lumbosacral spondylolisthesis: A case report

Alzakri¹

2022

JMSR

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Recent literature supports the surgical reduction of high-grade spondylolisthesis, particularly with an unbalanced pelvis and spine. Drop foot is the most common neurological complication reported in the literature. Scoliosis Research Society database reported only one patient (child) with cauda equina syndrome after surgery for dysplastic high-grade lumbosacral spondylolisthesis. The lack of longitudinal clinical follow-up of that patient limited their result. There is another report of 12 cauda equina syndrome cases after in situ arthrodesis for lumbosacral spondylolisthesis. The current report is the first case in the literature of cauda equina syndrome after partial reduction of dysplastic high-grade lumbosacral spondylolisthesis in a child. The aim was to raise awareness of the possibility of this post-operative complication happening in children and the possibility of avoiding it. A child who developed a cauda equina syndrome as an early neurological complication after surgery, which recovered completely 6 weeks after revision surgery, is reported. During the revision surgery, an L5-S1 transforaminal interbody fusion was performed by insertion of polyetheretherketone cage. Bilateral anal compound muscle action potential is seen after implant removal and sacral dome resection. Using somatosensory, motor evoked potential and continuous electromyogram for both rectal and external bladder sphincters in children with high-grade lumbosacral dysplastic spondylolisthesis undergoing surgical reduction are important to prevent a devastating neurological complication. Sacral dome resection and appropriate L5-S1 discectomy prevent stretching of the cauda equina over the posterosuperior border of the sacrum postoperatively.

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Section: Discussionmentioning

confidence: 99%

Cauda equina syndrome a rare early surgical complication in a pediatric patient with dysplastic high-grade lumbosacral spondylolisthesis: A case report

Alzakri¹

2022

JMSR

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“…Traditionally, surgical reduction of high-grade spondylolisthesis can only be achieved via the posterior approach [ 9 , 16 – 23 ]. Min et al described single-stage posterior reduction with sacral dome resection in 15 patients, reporting that slip percentage had improved from 94 to 23% [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the role of surgical reduction in high-grade spondylolisthesis is still controversial because of its potential complications, including neurologic deficits, prolonged operative time, and implant failure [ 5 – 8 ]. In a recent study which evaluated the effect of surgical reduction from 60 high-grade spondylolisthesis patients, surgical reduction in high- to low-grade slip was found to be more effective for maintaining and restoring a normal pelvic balance postoperatively [ 9 ].…”

Section: Backgroundsmentioning

confidence: 99%

Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results

Shih

Chen

et al. 2021

BMC Musculoskelet Disord

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Backgrounds Surgical reduction for high-grade spondylolisthesis is beneficial for restoring sagittal balance and improving the biomechanical environment for arthrodesis. Compared to posterior total laminectomy and long instrumentation, anterior lumbar inter-body fusion (ALIF) is less invasive and has the biomechanical advantage of restoring the original disk height and increasing lumbar lordosis, thus improving sagittal balance. However, the application of ALIF is still limited in treating low-grade spondylolisthesis. In this study, we developed a new technique termed anterior cantilever procedure to directly reduce the slippage of high-grade lumbosacral spondylolisthesis. The purpose of our study was to investigate the surgical outcomes of the anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation in high-grade spondylolisthesis. Methods All patients with high-grade spondylolisthesis who underwent anterior cantilever procedure followed by anterior lumbar inter-body fusion (ALIF) and posterior mono-segment instrumented fixation between November 2006 and July 2017 were enrolled in our study. The slip percentage, Dubousset’s lumbosacral angle, pelvic tilt, sacral slope, pelvic incidence, and sagittal alignment were measured pre-operatively and postoperatively at the last follow-up. Surgery time, blood loss, complications, and hospital stay were also collected and analysed. Results A total of 11 consecutive patients with high-grade spondylolisthesis patients were included and analysed. All of the high-grade spondylolisthesis in our series occurred at the L5-S1 level. The median age was 37 years, and the median follow-up duration was 36 months. The average slip reduction was 30% (60 to 30%, P < 0.01), and the average correction of Dubousset’s lumbosacral angle was 13.8° (84.1° to 97.9°, P < 0.01). The median intra-operative blood loss was 300 mL. All patients attained improved sagittal balance after the operation and achieved solid fusion within 9 months after surgery. No incidences of implant failure, permanent neurological deficit, or pseudarthrosis were recorded at the last follow-up. Conclusions Anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation is a valid procedure for treating high-grade spondylolisthesis. It achieved a high fusion rate, partially reduced slippage, and significantly improved lumbosacral angle, while minimizing common complications, such as pseudarthrosis, nerve traction injury, excessive soft tissue dissection, and blood loss in posterior reduction procedures. However, posterior instrumentation is still required to the structural stability in the ALIF procedure. Level of evidence IV

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“…Reduction of this deformity to restore lumbopelvic balance is associated with increased fusion rate and improved quality of life. 20,[26][27][28]…”

Section: Discussionmentioning

confidence: 99%

“…18 This also did not review the most recent literature that has emphasized and refined the importance of sagittal plane alignment to classify, determine treatment plan, and evaluate the surgical result. [19][20][21][22][23][24][25][26][27][28] This new focus includes percent slip, global sagittal balance, and lumbosacral parameters to ascertain degree of severity and pelvic balance.…”

Section: Introductionmentioning

confidence: 99%

High-Grade Pediatric Lumbar Spondylolisthesis: Expert Panel Approach

Bauer¹,

Robert²,

Lebel³

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

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Management of the pediatric patient with a high-grade spondylolisthesis is challenging. Differences in treatment goals and technique exist between differing surgeons for differing patients. In this panel discussion, three experts discuss their approach to an adolescent with a Grade 3 spondylolisthesis. The authors discuss what’s important to consider and how to execute their treatment strategy.

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Restoration of normal pelvic balance from surgical reduction in high-grade spondylolisthesis

Cited by 23 publications

References 26 publications

Cauda equina syndrome a rare early surgical complication in a pediatric patient with dysplastic high-grade lumbosacral spondylolisthesis: A case report

Cauda equina syndrome a rare early surgical complication in a pediatric patient with dysplastic high-grade lumbosacral spondylolisthesis: A case report

Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results

High-Grade Pediatric Lumbar Spondylolisthesis: Expert Panel Approach

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