Treatment of L5-S1 Spondyloptosis by staged L5 Resection With Reduction and Fusion of L4 Onto S1 (Gaines Procedure)

Lehmer, Steven M.; Steffee, Arthur D.; Gaines, Robert W.

doi:10.1097/00007632-199409000-00010

Cited by 89 publications

(38 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Follow-up of a series reported 25% required reoperation secondary to delayed union or instrumentation failure. 17 The goals of a reduction technique are restoration of global spinal balance by correction of kyphosis at the lumbosacral junction. When achieved with the shortest possible fusion, potential adjacent disc degeneration is avoided and reduces functional restriction in these young patients.…”

mentioning

confidence: 99%

Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young

et al. 2018

View full text Add to dashboard Cite

Background: Surgical management of high-grade spondylolisthesis in the young is not only challenging but also controversial, from in-situ fusion to complete reduction. It is fraught with dangers such as neurological injury, pseudoarthrosis, and progressive deformity with subsequent global sagittal imbalance. We describe our experience of progressive reduction technique and restoration of lumbosacral alignment.Methods: This study is a retrospective review of patients who underwent surgery between 1998 and 2012. The surgical technique involved positioning the hips in extension with traction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, and gradual reduction of the deformity and maintenance of reduction with interbody fusion. All patients were serially assessed at 1, 3, and 6 months and yearly thereafter with clinical, radiological, and Oswestry Disability Index and Visual Analogue Scale outcome measures.Results: Twenty-seven patients with high-grade spondylolisthesis at L5-S1 (3 cases grade 3, 7 grade 4, 17 grade 5) with an average age of 13.9 years were reviewed. Mean follow-up was 120 months (range 24-192). All patients presented a solid fusion at the 6-month visit; mean slip percentage was reduced from 89% to 23%, with all cases reduced to grade 2 or less. The slip angle improved from 458 to 38 postoperatively, with improvement in sacral slope from 138 to 358. Four spondyloptosis patients had concomitant scoliosis which corrected spontaneously after the surgery and did not need further intervention. All but one patient (96.2%) had good functional outcomes and returned to their full normal activities One patient developed a deep infection necessitating implant removal, with eventual deformity progression leading to a poor outcome. Three patients (11.1%) suffered partial drop foot that resolved in full by 12 weeks.Conclusion: Our technique demonstrated a significant reduction of high grade spondylolisthesis, with restoration of global sagittal balance via correction of the lumbosacral kyphosis. Though surgically demanding, it is safe and reproducible.Level of Evidence: IV

show abstract

mentioning

confidence: 99%

Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Reduction of anterolisthesis has been associated with increased neurological complication rates, especially L-5 motor deficit. 29 Sailhan and Roussouly reported 9.1% of neurologic complications following instrumented posterior reduction and fusion without decompression of the neural elements, with a 2.3% of definitive motor deficit represented by a foot drop. 28 In addition to neurological complications, resulting forces on instrumentation have led to implant failures, with a need for revision and extension of the primary construct or addition of pelvic fixation.…”

Section: Discussionmentioning

confidence: 99%

“…26 Several authors have recognized these limitations and proposed modifications to the original Bohlman technique, including replacing the fibular strut graft with a titanium mesh cage 19,27 and reducing and augmenting with pedicle screw or trans-sacral screw instrumentation. 28,29 Modern instrumentation techniques allow complete reduction of anterolisthesis, which presents the option of using standard interbody fusion techniques while making placement of an oblique cage impossible. Although advocates of reduction argue for the benefits of increased surface area for fusion, we are aware of the lack of evidence that residual anterolisthesis affects longterm outcomes as long as stable arthrodesis and kyphosis reduction are achieved.…”

Section: Discussionmentioning

confidence: 99%

“Reverse Bohlman” technique for the treatment of high grade spondylolisthesis in an adult population

Macagno

Hasan

Jalai

et al. 2016

Journal of Orthopaedics

View full text Add to dashboard Cite

“…Lehmer and co-workers [18] pointed to the increased vulnerability of the L5 nerve root. Several retrospective studies have postulated a correlation between the incidence of such complications and the intraoperative reduction distance [5].…”

Section: H Kleihues S Albrecht W Noackmentioning

confidence: 99%

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation

2001

View full text Add to dashboard Cite

Treatment of L5-S1 Spondyloptosis by staged L5 Resection With Reduction and Fusion of L4 Onto S1 (Gaines Procedure)

Cited by 89 publications

References 0 publications

Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young

Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young

“Reverse Bohlman” technique for the treatment of high grade spondylolisthesis in an adult population

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation

Contact Info

Product

Resources

About