Transsacral transdiscal L5–S1 screws for the management of high-grade spondylolisthesis in an adolescent

Palejwala, Ali H.; Fridley, Jared; Jea, Andrew

doi:10.3171/2015.12.peds15535

Cited by 11 publications

(9 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…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%

“…The remaining five studies included small case series or case reports: Abdu et al 9 with three cases (the technique was described in one of them), François et al 14 with four cases and, finally, with one case report each, Beringer et al 12 , Jo et al 18 and Palejwala et al 15 . A total of 10 cases were performed in those five remaining studies.…”

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

confidence: 99%

“…Palejwala et al 15 reported the results of a case report of an adolescent patient (12 years-old) with an L5S1 grade IV spondylolisthesis treated with bilateral transsacral transdiscal screw fixation and additional L4 pedicle screws, with decompression of the neural elements with graft obtained from the local bone decompression. The patient had progressive back pain despite conservative management.…”

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

confidence: 99%

See 1 more Smart Citation

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

Joaquim

Patel

2018

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

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.

show abstract

“…A.p. palejwala представлен случай транссакральной транспедикулярной фиксации in situ у 12-летнего подростка со спондилолистезом 4-й степени [31]. Фиксации in situ рекомендуются при сохранности параметров сагиттального баланса [32].…”

Section: Introductionunclassified

Surgical treatment of lower lumbar spine pathology in children and adolescents

Krutko

Владимирович²,

Sanginov

et al. 2018

Pediatr Traum Orthop Reconstr Surg

View full text Add to dashboard Cite

Introduction. Analysis of the modern literature shows that the number of children complaining of low back pain of varying intensity in the spine increases annually. Publications on the surgical treatment of juvenile osteochondrosis were scarce. Currently, there are no algorithms for choosing a surgical treatment for children and adolescents with lumbar spine pathology, particularly high-grade listhesis, methods and terms of surgical treatment, and the use of reduction maneuvers remain debatable. There are no high-quality evidence studies. Aim. This study aimed to summarize the experience of treatment of children and adolescents with pathology of the lower lumbar spine. Material and methods. We performed a retrospective analysis of the treatment outcomes in patients with lower lumbar spine pathology who were younger than 18 years and who underwent surgery in the Neurosurgical Department No. 2 of the Tsiv’yan Novosibirsk Research Institute of Traumatology and Orthopedics between 2008 and 2018. The mean age of the patients was 15.5 years. We structured pathologies and interventions in children and adolescents and evaluated the clinical and radiological outcomes of treatment and the rate of intraoperative and postoperative complications. Results and discussion. From 2008 to 2018, 11,428 patients with degenerative spine disease and isthmic/dysplastic spondylolisthesis underwent surgery at the Neurosurgical Department No. 2. Of these, 55 (0.5%) patients were younger than 18 years. In all patients, surgical treatment led to pain relief and physical activity recovery. Decompression/stabilization surgery through the posterior approach enabled formation of an artificial block in 100% of cases. The rate of surgical treatment complications was 8.6% and 28.6% in children and adolescents with herniated lumbar intervertebral discs and spondylolisthesis, respectively. Conclusion. Surgical treatment of children and adolescents with pathology of the lower lumbar spine demonstrated an excellent clinical outcome. Disc herniation did not recur 4.9 years after decompression surgery for herniated lumbar intervertebral discs. Decompression/stabilization surgery through the posterior approach in children and adolescents with spondylolisthesis facilitated abolition of pain, regression of neurological disorders, full recovery of physical activity, and formation of a reliable artificial block. Potential complications were resolved without consequences and did not downplay the importance of surgical techniques in the treatment of this group of patients.

show abstract

Transsacral transdiscal L5–S1 screws for the management of high-grade spondylolisthesis in an adolescent

Cited by 11 publications

References 41 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

Surgical treatment of lower lumbar spine pathology in children and adolescents

Contact Info

Product

Resources

About