Therapy of Spondylolisthesis by Repositioning and Fixation of the Olisthetic Vertebra

Snijder, J.G.N.; Seroo, J.M.; Snijder, C. J.; Schijvens, A.W.M.

doi:10.1097/00003086-197606000-00019

Cited by 2 publications

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“…He also reported minimal pain in the posterior side of the upper legs. Our modified traction method (without external fixation pins or a halo-pelvic apparatus) has been described by Balderston and Bradford [3], Ohki et al [28] and Snijder et al [36]. Forward bending was severely restricted, to 25°, and somewhat painful.…”

Section: Casementioning

confidence: 99%

Remodelling of the sacrum in high-grade spondylolisthesis: a report of two cases

2003

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IntroductionWiltse et al. [41] proposed a classification of spondylolysis and spondylolisthesis, the different forms being defined as: dysplastic, isthmic, degenerative, traumatic and pathological spondylolisthesis. Most high-grade spondylolisthesis patients have an isthmic form, but often with dysplastic phenomena such as a bifid arch or subluxation of the facet joints.The treatment of high-grade spondylolisthesis (slip percentage of more than 50%, Meyerding grade 3, 4 or 5) is highly controversial. This condition is relatively rarely seen, and large series comparing non-operative and operative treatment or different operative treatments are not available. Although Weinstein mentions, in a review article [40], that 11 non-operated patients with a high-grade spondylolisthesis led an active life with only minor adjustments 18 years after the original diagnosis, most patients and orthopaedic surgeons favour an operative treatment [21]. In the same review article, 21 patients treated by fusion in situ had even fewer symptoms than the untreated group. The degree of slip did not influence the re-sults. However, several other authors mention dissatisfaction among patients after a fusion in situ for high-grade spondylolisthesis [6, 17]. Even neurologic complications are described after fusion in situ [23,32], but they are more frequent after reduction manoeuvres [1, 5, 6, 14,24,26]. The literature seems convincing on the fact that fusion in situ is a good and relatively safe option for patients with significant complaints due to a high-grade spondylolisthesis [13, 15, 16,29,33,34]. This in fact is rather surprising, since the original deformity is not dealt with. MRI observations in two patients lead us to believe that remodelling of the upper sacrum and the lumbo-sacral junction could play a role in achieving these good results. Case reports Case1A 12-year-old girl was first seen with fatigue in the lumbar region of 1 year's duration. She experienced pain in her legs, which disappeared after she stopped jazz ballet and ballroom dancing. Forward bending was severely restricted, to 20°, and straight leg raising was only possible to 45°bilaterally. The strength of the m. ex-Abstract Two young patients are described, who were operated on for high-grade spondylolisthesis. A good posterolateral fusion was achieved, without decompression and without reduction. The clinical course was favourable, the tight hamstring syndrome resolved. Disappearance of the posterior-superior part of the sacrum and of the posterior part of the L5-S1 disc was observed on comparing pre-and postoperative magnetic resonance (MR) images. This resulted in normalisation of the width of the spinal canal. Around the L5 nerve roots in the L5-S1 foramina some fat reappeared. These anatomical changes on MRI could play a role in the disappearance of clinical symptoms.

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Section: Casementioning

confidence: 99%

Remodelling of the sacrum in high-grade spondylolisthesis: a report of two cases

2003

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A new technique for the reduction and stabilisation of severe spondylolisthesis

Sijbrandij

1985

International Orthopaedics

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A one stage operation by the posterior route has been carried out in a series of nine patients for the reduction and fusion of severe spondylolisthesis and spondyloptosis. For this purpose special instruments have been designed to exert a controlled force on the displaced vertebra in two perpendicular directions. Technical details of the procedure are reported. Bone is resected from the sacrum and the fifth lumbar vertebra to avoid too much tension on the nerve roots. After the reduction L5 is held in place by two screws and a sacral bar. The lumbosacral kyphosis seen in severe spondylolisthesis can also be corrected by this method. Bone grafts from the ileum or tibia are not needed and lumbosacral fusion is achieved within 3-6 months because of the close contact between the raw bone of the vertebral bodies. All patients achieved a sound fusion with significant remission of symptoms.

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Therapy of Spondylolisthesis by Repositioning and Fixation of the Olisthetic Vertebra

Cited by 2 publications

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Remodelling of the sacrum in high-grade spondylolisthesis: a report of two cases

Remodelling of the sacrum in high-grade spondylolisthesis: a report of two cases

A new technique for the reduction and stabilisation of severe spondylolisthesis

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