Transdiscal screw versus pedicle screw fixation for high-grade L5-S1 isthmic spondylolisthesis in patients younger than 60 years: a case–control study

Collados-Maestre, Isabel; Lizaur-Utrilla, Alejandro; Hermida, Teresa Bas; Pastor-Fernandez, Esther; Gil-Guillén, Vicente

doi:10.1007/s00586-016-4550-0

Cited by 24 publications

(16 citation statements)

References 27 publications

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“…23 Another advantage is that a posterior approach is used more frequently in spine surgeries and is more familiar for less-experienced surgeons. As Collados-Maestre et al 5 reported, it can be difficult to obtain an adequate position of a sacral screw; however, in our experience, this limitation is easily resolved when surgeons have experience in image guidance. Reduction of listhesis is one of the most controversial topics in HGS management.…”

Section: Discussionmentioning

confidence: 64%

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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: 64%

“…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%

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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“…A total of five studies were obtained in the first search [12][13][14][15][16] , and three additional studies 9,12,17 were found in the second, including the study that proposed this technique 9 . One study was not considered because it included many patients with spondylolisthesis grades I and II 16 .…”

Section: Resultsmentioning

confidence: 99%

“…There were two large case series comparing different surgical techniques: one from Collados-Maestre et al 13 and the other from Rodriguez-Olaverri et al 17 . A total of 45 cases were treated with PTD in these studies.…”

Section: Figure 1 -Flow Diagram Of Our Search Mechanism According To mentioning

confidence: 99%

Posterior L5-S1 transdiscal screws for high grade spondylolisthesis - a systematic review

Joaquim

Patel

2018

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: The surgical management of high-grade lumbar spondylolisthesis (HGLS) is complex and aims to achieve both a solid fusion that is able to support the high shear forces of the lumbosacral junction, as well as neural decompression. We performed a systematic literature review of the safety and efficacy of posterior transdiscal (PTD) screw fixation from L5S1 for HGLS and its variations. METHODS: A systematic literature review following the PRISMA guidelines was performed in the PubMed database of the studies describing the use of PTD screw fixation for HGLS. Clinical and radiological data were extracted and discussed. Study quality was assessed with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: Seven studies were included and reviewed; all of them were level IV of evidence. Two of them had large case series comparing different surgical techniques: one concluded that PTD was associated with better clinical outcomes when compared with standard screw fixation techniques and the other suggesting that the clinical and radiological outcomes of PTD were similar to those when an interbody fusion (TLIF) technique was performed, but PTD was technically less challenging. The remaining five studies included small case series and case reports. All of them reported the successful useful of PTD with or without technical variations. CONCLUSIONS: Our review concludes, with limited level of evidence that PTD fixation is a safe and efficient technique for treating HGLS patients. It is technically less demanding than a circumferential fusion, even though proper screw insertion is more demanding than conventional pedicle screw fixation.

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“…This can be particularly helpful in the placement of technically challenging screws or those requiring a steep surgical trajectory; such as C1-C2 transarticular screws, C2 translaminar screws, L5-S1 transdiscal screws, iliac screws, anterior odontoid screws, or in those with anomalous anatomic structures (i.e. Klippel-Feil syndrome, axially rotated vertebrae, kyphosis, scoliosis) [2,4,[13][14][15][16]. Reduced tremor and a guidance arm may also be beneficial to surgical trainees for greater tactile appreciation of optimally placed screws [2].…”

Section: Discussionmentioning

confidence: 99%

First spine surgery utilizing real-time image-guided robotic assistance

Ahmed

Zygourakis

Kalb

et al. 2019

Computer Assisted Surgery

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Robotics in spinal surgery has significant potential benefits for both surgeons and patients, including reduced surgeon fatigue, improved screw accuracy, decreased radiation exposure, greater options for minimally invasive surgery, and less time required to train residents on techniques that can have steep learning curves. However, previous robotic systems have several drawbacks, which are addressed by the innovative ExcelsiusGPS TM robotic system. The robot is secured to the operating room floor, not the patient. It has a rigid external arm that facilitates direct transpedicular drilling and screw placement, without requiring K-wires. In addition, the ExcelsisuGPS TM has integrated neuronavigation, not present in other systems. It also has surveillance marker that immediately alerts the surgeon in the event of loss of registration, and a lateral force meter to alert the surgeon in the event of skiving. Here, we present the first spinal surgery performed with the assistance of this newly approved robot. The surgery was performed with excellent screw placement, minimal radiation exposure to the patient and surgeon, and the patient had a favorable outcome. We report the first operative case with the ExcelsisuGPS TM , and the first spine surgery utilizing real-time image-guided robotic assistance. Case illustration Pre-operative presentationA 69-year-old female presented to the neurosurgical spine service with 10 years of intractable lower back

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Transdiscal screw versus pedicle screw fixation for high-grade L5-S1 isthmic spondylolisthesis in patients younger than 60 years: a case–control study

Abstract: L5-S1 transdiscal screw fixation provided better functional and radiographic outcomes at medium-term than conventional pedicle fixation for high-grade spondylolisthesis, although transdiscal sacral screws are difficult to place in correct position.

Cited by 24 publications

References 27 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

Posterior L5-S1 transdiscal screws for high grade spondylolisthesis - a systematic review

First spine surgery utilizing real-time image-guided robotic assistance

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