Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction

Abstract

Backgroundspondylolisthesis is a condition in which a vertebra slips out of the proper position onto the bone below it as a result of pars interarticularis defect. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and neural breach.Materials and methodsA randomized and double blinded study consisted of 41 patients aged 36-69 years (18 females and 28 males) treated for symptomatic spondylolisthesis between December,2006 and December, 2009. All patients were randomly distributed into two groups I and II. Twenty patients were in Group I; they underwent reduction of the slipped vertebrae by using Reduction-Screw Technique and posterior lumbar interbody fixation (PLIF). Group II consisted of twenty one patients who underwent only surgical fixation (PLIF) without reduction. All patients in this study had same pre and post operative management.Resultsonly one case had broken rod in group I that required revision. Superficial wound infection was experienced in two patients and one patient, from group II, developed wound hematoma. The outcome in both groups was variable on the short term but was almost the same on the long term follow up.Conclusionsurgical management of symptomatic low grade spondylolisthesis should include neural decompression and surgical fixation. Reduction of slipped vertebral bodies is unnecessary as the ultimate outcome will be likely similar.

Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes

“…Although slip reduction can provide better function of the lumbosacral junction, at least in theory, several authors have recommended in situ fusion surgery rather than reduction surgery, considering postoperative complications such as neurological deficits. 1,[4][5][6]11,13,17,20,26,27,29 On the other hand, previous reports have detailed that pseudarthrosis rates were decreased by reduction. 2,3,12,19,28,30,31,33 Therefore, surgery for isthmic spondylolisthesis requires management of both postoperative neurological deficits and the union rate.…”

Segmental spinal canal volume in patients with degenerative spondylolisthesis

“…In addition to decompression, reduction of the slipped vertebrae as a part of surgical approach is still a controversial issue in spine surgery [20, 21] . In a randomized and double blinded study of symptomatic patients with Meyerding grade I and II isthmic spondylolisthesis, Audat et al concluded that the outcome is almost similar in patients who underwent surgical fixation and decompression with or without reduction of the slippage [20] . Many other authors proposed that reduction of the slippage should be considered to correct sagittal deformity and enhance the spinal biomechanics [22, 23] .…”

Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) for Spondylolisthesis in 282 Patients: In Situ Arthrodesis versus Reduction

“…However, it still remains controversial whether to reduce the spondylolisthesis or to fuse in situ (4,23,24,36,46). The present study compared the complications, perioperative factors, and fusion success in patients undergoing MI-TLIF for degenerative spondylolisthesis between those in whom reduction occurred and in those that were fused in situ.…”

“…Many studies have investigated MI-TLIF for multiple spinal pathologies; however, few have specifically investigated MI-TLIF in degenerative spondylolisthesis, and to our knowledge, none have compared the perioperative outcomes for reduction or fusion in situ. In contrast, a few studies have investigated this in patients undergoing other methods of arthrodesis (4,8,23,24,29,36). Thus far, the literature supports the notion that reduction does not increase the risk of complications, most importantly neurological deficit, and the clinical and radiographic outcomes are similar with the exception of possible improved fusion rates when reduction is employed (24).…”

“…Despite the advances in spondylolisthesis operative management, it still remains controversial whether to reduce the spondylolisthesis or to not reduce and fuse in situ (4,23,24,36,46). Effective neural decompression and spinal stability reconstruction may be achieved with or without reduction.…”