Transdiscal L5-S1 screws for the treatment of adult spondylolisthesis

Logroscino, Carlo Ambrogio; Tamburrelli, Francesco Ciro; Scaramuzzo, Laura; Schirò, Giuseppe; Sessa, S.; Proietti, Luca

doi:10.1007/s00586-012-2229-8

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…However, neurological complications are described in 25%-30% of cases. 10,15,19 In a recent review of HGS, mainly in the pediatric population, Longo et al 17 showed that there was no statistically significant difference in neurological complications in patients with reduction compared with those patients without reduction, but pseudarthrosis was more frequent in patients with in situ fixation (17.8% vs 5.5%, p = 0.004). In our series, we did not perform a reduction, as there was no sagittal imbalance in any patient.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent intraoperative complication described is dural tear, accounting for 17.8% of the reported complications. 4,14,23,26 Other postoperative complications frequently described are infection (5%), 5,15,23 hardware failure (4.5%), 5,23 and implant malplacement (9%). 5,15 As Collados-Maestre et al…”

Section: Discussionmentioning

confidence: 99%

“…Malplacement of hardware and its failure are both common complications of transdiscal fixation for the treatment of spondylolisthesis. 15,23 Screw failure could also be related to increased forces due to malplacement. In these cases, online 3D image guidance offers a better approach, improving security in the moment of the implant position and decreasing the incidence of complications, as we have shown in our series.…”

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confidence: 99%

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Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Delgado-Fernández¹,

Pulido²,

García-Pallero³

et al. 2018

Neurosurgical Focus

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OBJECTIVESpondylolisthesis is a prevalent spine disease that recent studies estimate could be detected in 9% of the population. High-grade spondylolisthesis (HGS), however, is much less frequent, which makes it difficult to develop a general recommendation for its treatment. Posterior transdiscal fixation was proposed in 1994 for HGS, and the use of spine navigation could make this technique more accessible and reduce the morbidity associated with the procedure. The purpose of this study was to present a case series involving adult patients with HGS and correct spinal alignment who were treated with transdiscal pedicle screw placement guided with neuronavigation and compare the results to those achieved previously without image guidance.METHODSThe authors reviewed all cases in which adult patients with correct spinal alignment were treated for HGS with posterior transdiscal instrumentation placement guided with navigation between 2014 and 2016 at their institution. The authors compared preoperative and postoperative spinopelvic parameters on standing radiographs as well as Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for low-back pain. Follow-up CT and MRI studies and postoperative radiographs were evaluated to identify any screw malplacement or instrumentation failure. Any other intraoperative or postoperative complications were also recorded.RESULTSEight patients underwent posterior transdiscal navigated instrumentation placement during this period, with a mean duration of follow-up of 16 months (range 9–24 months). Six of the patients presented with Meyerding grade III spondylolisthesis and 2 with Meyerding grade IV. In 5 cases, L4–S1 instrumentation was placed, while in the other 3 cases, surgery consisted of transdiscal L5–S1 fixation. There was no significant difference between preoperative and postoperative spinopelvic parameters. However, there was a statistically significant improvement in the mean VAS score for low-back pain (6.5 ± 1.5 vs 4 ± 1.7) and the mean ODI score (49.2 ± 19.4 vs 37.7 ± 22) (p = 0.01 and p = 0.012, respectively). Six patients reduced their use of pain medication. There were no intraoperative or postoperative complications during the hospital stay, and as of the most recent follow-up, no complications related to pseudarthrosis or hardware failure had been observed.CONCLUSIONSTreatment with posterior transdiscal pedicle screws with in situ fusion achieved good clinical and radiological outcomes in patients with HGS and good sagittal spinal balance. The use of navigation and image guidance was associated with improved results in this technique, including a reduction in postoperative and intraoperative complications related to screw malplacement, pseudarthrosis, and instrumentation failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Delgado-Fernández¹,

Pulido²,

García-Pallero³

et al. 2018

Neurosurgical Focus

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“…57 Higher mechanical stability and faster symptomatic resolution can be achieved by modifying the Grob technique to involve a trans-discal L5-S1 fixation with L5-S1 pedicle screw instrumentation. 58 To evaluate the efficacy of circumferential fusion, Ferrero et al 59 examined the radiological and functional outcomes of HGS in 20 patients treated by intrasacral fixation, dome resection, and circumferential fusion. At a mean follow-up of 7.2 years, the authors found that lumbosacral angle kyphosis and olisthesis were reduced (658 6 14 versus 998 6 11, P , .001 and 81% 6 19 versus 45% 6 18, P , .001, respectively).…”

Section: Circumferential Interbody Fusionmentioning

confidence: 99%

High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management

et al. 2020

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Background: Information regarding the treatment of high-grade spondylolisthesis (HGS) in adults has been previously described; however, previous descriptions of the evaluation and surgical management of HGS do not represent more recent and now established approaches. The purpose of the current review is to discuss current concepts in the evaluation and management of patients with HGS. Methods: Literature review. Results: HGS is diagnosed in up to 11.3% of adults with spondylolisthesis and typically presents as nonspecific lower back pain. Regarding evaluation, a thorough history and physical examination should be performed, which may help predict the presence of HGS. Diagnostic imaging, and specifically the use of spino-pelvic parameters, are now commonly implicated in guiding treatment course and prognosis. When surgical intervention is indicated, surgical approaches include in situ fusion variations, reduction and partial reduction with fusion, and vertebrectomy. Although the majority of studies suggest improvements with these approaches, the literature is limited by a low level of evidence with regards to the superiority of one technique when compared with others. Conclusions: HGS is a unique cause of low back pain in adults that carries considerable morbidity, but rarely presents with neurologic symptoms. Although the definitions, classifications, and methods of diagnosis of this spinal deformity have been established and accepted, the ideal surgical management of this deformity remains highly debated. Fusion in situ techniques are often technically easier to perform and provide lower risk of neurologic complications, whereas reduction and fusion techniques offer greater restoration of global spino-pelvic balance. Preoperative spinopelvic parameters may have utility in assisting in procedural selection; however, future, higher-quality and longer-term studies are warranted to determine the optimal surgical intervention among the widely available techniques currently used, and to better define the indications for these interventions.

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“…The literature has more clinical and biomechanical studies about the issue in a broad range because the technique has several applications and can be performed in different regions of the spine not only lumbosacral spine. [19][20][21][22][23][24] Besides the advantages of the intradiscal fixations, it has some difficulties and risk factors. Transdiscal fixation is generally performed following a careful reduction.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of transdiscal fixation and posterior fixation with and without transforaminal lumbar interbody fusion in the treatment of L5–S1 lumbosacral joint

Özalp

Özkaya

Yaman

et al. 2018

Proc Inst Mech Eng H

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Transdiscal screw fixation is generally performed in the treatment of high-grade L5-S1 spondylolisthesis. The main thought of the study is that the biomechanical performances of the transdiscal pedicle screw fixation can be identical to standard posterior pedicle screw fixations with or without transforaminal lumbar interbody fusion cage insertion. Lumbosacral portions and pelvises of 45 healthy lambs' vertebrae were dissected. Animal cadavers were randomly and equally divided into three groups for instrumentation. Three fixation systems, L5-S1 posterior pedicle screw fixation, L5-S1 posterior pedicle screw fixation with transforaminal lumbar interbody fusion cage insertion, and L5-S1 transdiscal pedicle screw fixation, were generated. Axial compression, flexion, and torsion tests were conducted on test samples of each system. In axial compression, L5-S1 transdiscal fixation was less stiff than L5-S1 posterior pedicle screw fixation with transforaminal lumbar interbody fusion cage insertion. There were no significant differences between groups in flexion. Furthermore, L5-S1 posterior fixation was stiffest under torsional loads. When axial compression and flexion loads are taken into consideration, transdiscal fixation can be alternatively used instead of posterior pedicle screw fixation in the treatment of L5-S1 spondylolisthesis because it satisfies enough stability. However, in torsion, posterior fixation is shown as a better option due to its higher stiffness.

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Transdiscal L5-S1 screws for the treatment of adult spondylolisthesis

Cited by 16 publications

References 15 publications

Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management

Biomechanical comparison of transdiscal fixation and posterior fixation with and without transforaminal lumbar interbody fusion in the treatment of L5–S1 lumbosacral joint

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