TREATMENT OF SPONDYLOLISTHESIS WITH A DEVICE FOR EXTERNAL TRANSPEDICULAR SPINAL FIXATION

Abstract

Objectives. To analyze issues of surgical treatment of complicated spondylolisthesis in the lumbar spine.

Materials and Methods. Forty-five patients at the age of 14 to 62 years were operated on with a device for external transpedicular fixation. All patients underwent clinical, radiological and physiologic examinations. To characterize the degree of spondylolisthesis the Meyerding classification was used. Grade I and II dislocations were treated by laminectomy of a displaced vertebra, excision of scars and mobilization of a dural sack, discectomy at a pathologic level involving both end plates of the adjacent vertebral bodies, impacting of 2 autografts (of the bone excised during laminectomy) into a disc space, and placement of a device for external transpedicular fixation. For Grade III and IV the second stage was performed after instrumentation and maximum possible reduction of dislocation. The procedure included anterior fusion of displaced and adjacent vertebrae in the achieved position either with autografts of the illiac crest or with porous nickel titanium implants through trans- or extraperitoneal approach.

Results. Achieved results of application of the device for external transpedicular fixation in patients with spondylolisthesis enable to consider clinically justified a partial or total reduction of a displaced vertebra followed by neurologic status monitoring and radiological control during the post-operative period. Use of porous nickel titanium implant accelerates the formation of a bony block and decreases the time of surgery, as there is no need for autograft preparation.