4:4096. Surgical Treatment for Unstable Low-Grade Isthmic Spondylolisthesis in Adults: A Prospective Controlled Study of Posterior Instrumented Fusion Compared With Combined Anterior-Posterior Fusion

Adult isthmic spondylolisthesis most commonly occurs at the L5–S1 level of the lumbar spine. Slip progression is relatively rare in adults with this condition and slippage is typically associated with advanced degeneration of the disk below the pars defect. When symptomatic, radiculopathy is the typical complaint in adults with isthmic spondylolisthesis. When considering options for surgical treatment of adult isthmic spondylolisthesis, the surgeon must consider several different options, such as decompression, fusion, instrumentation, reduction, and type of bone graft to be used. All of these decisions must be individualized as deemed appropriate for each particular patient. This report presents a case of intraoperative slip progression of a L5–S1 adult isthmic spondylolisthesis to a high-grade slip, which was treated with complete surgical reduction and posterior instrumented fusion. This case demonstrates the potential instability of this condition in adults and has not been previously reported. The case details and images are reviewed and the intraoperative decisions, treatment options, and patient outcome are discussed.

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Surgical Treatment of Low-Grade Isthmic Spondylolisthesis With Transsacral Fibular Strut Grafts

Neurosurgery ◽

10.1227/neu.0b013e3182338b2b ◽

2011 ◽

Vol 70 (3) ◽

pp. 758-763 ◽

Cited By ~ 5

Author(s):

Peter G. Passias ◽

Michal Kozanek ◽

Kirkham B. Wood

Keyword(s):

Surgical Treatment ◽

Posterior Approach ◽

Low Grade ◽

Complication Rates ◽

Isthmic Spondylolisthesis ◽

Modified Technique ◽

Instrumented Fusion ◽

Radiographic Outcomes ◽

Circumferential Fusion

Abstract Background: The ideal surgical treatment for adult low-grade isthmic spondylolisthesis (ALIS) remains unknown. Isolated anterior and posterior procedures are popular but have resulted in equivocal outcomes, whereas combined anterior and posterior procedures are associated with higher complication rates despite improved outcome. Objective: To evaluate the clinical and radiographic outcomes following the treatment of ALIS using a 1-stage posterior approach with posterior decompression and posterolateral arthrodesis combined with an interbody fibular allograft strut. Methods: Fifteen patients underwent fusion by a single surgeon using our modified technique. Seven patients were female and 8 were male, with a mean age of 48 years. All patients were classified as Meyerding grade II slips and underwent a posterior approach only, a decompressive laminectomy, and a circumferential fusion with the use of a transsacral fibular allograft and a posterolateral instrumented fusion. Postoperative clinical and radiographic evaluations were performed at 3, 6, and 12 months, and then on an annual basis. Results: The average follow-up interval was 61 months. Three complications were seen: a single dural tear, an L5 radiculopathy secondary to a malpositioned pedicle screw, and one patient with urinary retention. The spines of all patients were determined to be fused by the 6-month postoperative visit. All patients returned to their normal activities of daily living. Significant improvements in the visual analog score were seen at all follow-up intervals. Conclusion: Transsacral interbody fibular allograft can be used successfully to supplement a posterolateral instrumented fusion in selected patients with low-grade ALIS.

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C.04 Comparison of clinical outcomes between posterior instrumented fusion with and without interbody fusion for isthmic spondylolisthesis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.99 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S12

Author(s):

V Chan ◽

A Nataraj

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Interbody Fusion ◽

Research Network ◽

Leg Pain ◽

Isthmic Spondylolisthesis ◽

Instrumented Fusion ◽

Multivariable Regression ◽

Secondary Outcomes ◽

Posterior Instrumented Fusion

Background: The purpose of this study is to compare 1-year postoperative clinical outcomes between posterior instrumented fusion with (P/TLIF) and without (PLF) interbody fusion in patients with isthmic spondylolisthesis. Methods: This is a multi-centre retrospective study using the Canadian Spine Outcomes and Research Network. Adult patients who received surgical management for isthmic spondylolisthesis were included in this study. The primary outcome was change in Oswestry Disability Index at 1-year. Secondary outcomes were change in EQ-5D, SF-12 PCS, back pain, leg pain, estimated blood loss, length of surgery, length of stay, rate of transfusions and adverse events. Descriptive statistics, Student t-test, Chi-Squared test, and stepwise multivariable regression were used for analysis. Results: A total of 300 patients (252 P/TLIF, 48 PLF) were included in this study. The mean age was 50 years. The P/TLIF group had poorer baseline leg pain scores (t=2.02, p=0.01). There were no significant differences in primary and secondary outcomes between the two groups. Addition of interbody fusion was not a significant variable in the stepwise multivariable regression analysis. Conclusions: There were no significant differences in clinical outcomes at 1 year. Addition of interbody fusion was not associated with higher complication rates or length of stay.

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