A novel technique for stabilization of high-grade spondylolisthesis with transvertebral fusion without reduction. (February 2019)

• Record Type: Journal Article
• Authors: Donnally, Chester J.; Madhavan, Karthik; Butler, Alexander J.; Sheu, Jonathan I.; Massel, Dustin H.; Green, Barth A.; Gjolaj, Joseph P.
• Is Part Of: Journal of clinical neuroscience. Volume 60(2019)
• Page Start: 170
• Page End: 175
• Publication Date: 2019-02
• Subjects: Novel technique -- High-grade spondylolisthesis -- L5 spondylectomy -- Spino-pelvic balance -- Spondyloptosis; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.11.001
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: One-stage technique manages local malalignment with a technique that minimizes risk. Bilateral threaded pedicle screws of large diameter and length instead of a single fibula allograft. Placing pedicle screws with a transvertebral trajectory through the two end plates. Report on 3 patients- no CSF leaks, intragenic insults, implant failures, or revisions. The minimal complications and favorable outcomes make this technique an effective, efficient and safe procedure. Abstract: Surgical treatment of high-grade spondylolisthesis and spondyloptosis is recommended in symptomatic patients, yet there exists much debate regarding the optimal surgical approach and the need for reduction. Similar to the Bohlman technique in that fixation is achieved across two vertebral endplates, we discuss a novel technique with the advantage of using bilateral threaded pedicle screws of large diameter and length instead of a single fibula allograft. Patients underwent posterior instrumented fusion without spondylolisthesis reduction using a novel technique placing pedicle screws with a transvertebral trajectory through the two end plates involved in the spondylolisthesis. Following screw placement, patients underwent decompression ± discectomy. Screws were connected to adjacent pedicle screws either in the upper adjacent vertebrae (i.e. L5) or the more rostral adjacent vertebrae (i.e. L4) if spinal alignment or instability necessitate including additional levels of fixation. Three patients were reviewed with ages of 67, 62, 58 years, operative times of 377–790 min, estimated blood loss 400–1050 cc, and follow-up times of 478–1082 days. There were no CSF leaks, intragenic neurologic deficits post-operatively, implant failures, revisions, or other systemic events. Two patients achieve radiographic fusion assessed by CT. At the time of final follow up, all patients were satisfied and essentially pain free. This one-stage technique offers the ability to manage local malalignment with a technique that inherently minimizes risk. The minimal complications and favorable outcomes make this technique an effective, efficient and safe procedure. Additional studies will focus on long term outcomes and should include larger patient samples.