Transsacral Screw Fixation for High-Grade L5/S1 Spondylolisthesis Including Spondyloptosis

2012 ◽  
pp. 385-390
Author(s):  
Palaniappan Lakshmanan ◽  
Sashin Ahuja
Keyword(s):  
Screw Fixation ◽  
High Grade

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

2016 ◽  
Vol 17 (6) ◽  
pp. 645-650 ◽  
Author(s):  
Ali Palejwala ◽  
Jared Fridley ◽  
Andrew Jea
Keyword(s):  
Screw Fixation ◽  
Present Report ◽  
Surgical Techniques ◽  
Pedicle Screws ◽  
Considerable Improvement ◽  
High Grade ◽  
Low Back ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Basic Procedure

The surgical management of high-grade spondylolisthesis in adolescents remains a controversial issue. Because the basic procedure, posterolateral fusion, is associated with a significant rate of pseudarthrosis and listhesis progression, there is a pressing need for alternative surgical techniques. In the present report, the authors describe the case of an adolescent patient with significant low-back pain who was found to have Grade IV spondylolisthesis at L5–S1 that was treated with transsacral transdiscal screw fixation. Bilateral pedicle screws were placed starting from the top of the S-1 pedicle, across the L5–S1 intervertebral disc space, and into the L-5 body. At 14 months after surgery, the patient had considerable improvement in his pain and radiographic fusion across L5–S1. The authors conclude that transsacral transdiscal pedicle screws may serve as an efficacious and safe option for the correction of high-grade spondylolisthesis in adolescent patients.

Transsacral screw fixation for high-grade spondylolisthesis

2009 ◽  
Vol 9 (12) ◽  
pp. 1024-1029 ◽  
Author(s):  
Palaniappan Lakshmanan ◽  
Sashin Ahuja ◽  
Mark Lewis ◽  
John Howes ◽  
Paul R. Davies
Keyword(s):  
Screw Fixation ◽  
High Grade

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

2018 ◽  
Vol 64 (12) ◽  
pp. 1147-1153
Author(s):  
Andrei F. Joaquim ◽  
Alpesh A. Patel
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Screw Fixation ◽  
Case Reports ◽  
Surgical Techniques ◽  
Case Series ◽  
High Grade ◽  
Screw Insertion ◽  
Pubmed Database ◽  
Circumferential Fusion

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.

Transvertebral interbody cage and pedicle screw fixation for high-grade spondylolisthesis

2004 ◽  
Vol 100 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Hakan Bozkus ◽  
Curtis A. Dickman
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
High Grade ◽  
Partial Reduction ◽  
Interbody Cage ◽  
Viable Option ◽  
Content Type ◽  
Lumbosacral Spondylolisthesis ◽  
Grade Iii

✓ Surgical stabilization of high-grade lumbosacral spondylolisthesis is clinically challenging, and the success of deformity reduction and fusion varies. The authors describe a patient with Grade III spondylolisthesis at L5—S1. Partial reduction was achieved and fusion involved pedicle screw fixation and a posterior transvertebral interbody cage. This patient had developed progressive spondylolisthesis after decompression and posterolateral fusion for L5—S1 spondylolisthesis failed. Clinical and early radiographic results were excellent. Transsacral cage fixation can be considered a viable option to buttress the region in which high-grade L5—S1 spondylolisthesis has been reduced. The cage provides substrate for interbody arthrodesis and acts as a biomechanical stabilizer that helps prevent pedicle screw failure.

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

2016 ◽  
Vol 25 (6) ◽  
pp. 1806-1812 ◽  
Author(s):  
Isabel Collados-Maestre ◽  
Alejandro Lizaur-Utrilla ◽  
Teresa Bas-Hermida ◽  
Esther Pastor-Fernandez ◽  
Vicente Gil-Guillen
Keyword(s):  
Pedicle Screw ◽  
Case Control Study ◽  
Screw Fixation ◽  
Case Control ◽  
Pedicle Screw Fixation ◽  
High Grade ◽  
Isthmic Spondylolisthesis ◽  
Control Study

High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons

2014 ◽  
Vol 20 (5) ◽  
pp. 523-530 ◽  
Author(s):  
Robert A. Hart ◽  
Christopher M. Domes ◽  
Brady Goodwin ◽  
Charles R. D'Amato ◽  
Jung U. Yoo ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Perioperative Complications ◽  
Pedicle Screw Fixation ◽  
Motor Deficit ◽  
Slip Angle ◽  
High Grade ◽  
Estimated Blood Loss

Object The ideal surgical management of high-grade spondylolisthesis remains unclear. Concerns regarding the original Bohlman transsacral interbody fusion technique with stand-alone autologous fibular strut include late graft fracture and incomplete reduction of lumbosacral kyphosis. The authors' goal was to evaluate the radiographic and surgical outcomes of patients treated for high-grade spondylolisthesis with either transsacral S-1 screws or standard pedicle screw fixation augmenting the Bohlman posterior transsacral interbody fusion technique. Methods A retrospective review of patients who underwent fusion for high-grade spondylolisthesis in which a Bohlman oblique posterior interbody fusion augmented with either transsacral or standard pedicle screw fixation was performed by 4 spine surgeons was completed. Estimated blood loss, operating time, perioperative complications, and need for revision surgery were evaluated. Upright pre- and postsurgical lumbar spine radiographs were compared for slip percent and slip angle. Results Sixteen patients (12 female and 4 male) with an average age of 29 years (range 9–66 years) were evaluated. The average clinical follow-up was 78 months (range 5–137 months) and the average radiographic follow-up was 48 months (range 5–108 months). Ten L4–S1 and 6 L5–S1 fusions were performed. Five fibular struts and 11 titanium mesh cages were used for interbody fusion. Six patients had isolated transsacral screws placed, with 2 (33%) of the 6 requiring revision surgery for nonunion. No nonunions were observed in patients undergoing spanning pedicle screw fixation augmenting the interbody graft. Six patients experienced perioperative complications including 3 iliac crest site infections, 1 L-5 radiculopathy without motor involvement, 1 deep vein thrombosis, and 1 epidural hematoma requiring irrigation and debridement. The average estimated blood loss and operating times were 763 ml and 360 minutes, respectively. Slip percent improved from an average of 62% to 37% (n = 16; p < 0.01) and slip angle improved from an average of 18° to 8° (n = 16; p < 0.01). No patient experienced L-5 or other motor deficit postoperatively. Conclusions The modified Bohlman technique for treatment of high-grade spondylolisthesis has reproducible outcomes among multiple surgeons and results in significant improvements in slip percent and slip angle. Fusion rates were high (14 of 16; 88%), especially with spanning instrumentation augmenting the oblique interbody fusion. Rates of L-5 motor deficit were low in comparison with techniques involving reduction of the anterolisthesis.

1278: The Role of Diagnostic Criteria of Obstruction in Patients with High Grade Cystocele: Correlation to Subjective Symptoms

2007 ◽  
Vol 177 (4S) ◽  
pp. 421-421
Author(s):  
Veronica Triaca ◽  
Christian O. Twiss ◽  
Ramdev Konijeti ◽  
Larissa V. Rodriguez ◽  
Shlomo Raz
Keyword(s):  
Diagnostic Criteria ◽  
High Grade ◽  
Subjective Symptoms
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