SURGICAL TREATMENT FOR L5 SPONDYLOLISTHESIS WITH TRANSPEDICULAR FIXATORS

Abstract

Study Design. A clinical retrospective study was conducted.

Objective. To evaluate the clinical and radiographic outcomes of reduction followed by pedicle screw fixation and L5-S1 interbody fusion for L5 isthmic spondylolisthesis.

Methods. 30 patients underwent treatment for L5 isthmic spondylolisthesis with reduction followed by pedicle screw fixation. Interbody fusion at L5-S1 level was performed in 28 cases: in 22 cases - anterior interbody fusion by Burns method through retroperitoneal approach, in 4 cases - posterior transsacral interbody fusion with cortical allograft and in 2 cases - PLIF with Interfix cages. The average follow-up period was 29 months (range, 9-72 months). According to Meyerding grading scale there were 10 cases with Grade I-II, 17 - with Grade III-IV and 3 - with spondyloptosis.

Results. Good clinical results with complete pain relief were achieved in 93,3 % of cases, satisfactory - in 6,7 %. There were 2 cases of postoperative neurological complications. Implant breakage occurred in 7 cases without initial interbody fusion. Radiographic indexes demonstrated improvement with partial reduction and fusion.

Conclusions. Pedicle screw instrumentation followed by interbody fusion is an effective technique for L5 isthmic spondylolisthesis, as assessed by radiographic and clinical criteria. Pedicle screw instrumentation for high-grade spondylolisthesis requires interbody fusion with cortical allograft.