J Korean Soc Spine Surg.  2001 Sep;8(3):362-371. 10.4184/jkss.2001.8.3.362.

Problems in Reduction of High-Grade Spondylolisthesis

• Ha KY

• KMID: 2209758
• DOI: http://doi.org/10.4184/jkss.2001.8.3.362

Abstract

There has been discussion about surgical strategies for treatment of high-grade isthmic spondylolisthesis(grade III or IV). Reduction is combined unnecessary by many authors because of the reliability of in situ fusion. However, some investigator have stated a need for reduction is not only restoration of normal spinal alignment and biomechanics; A reduced position is believed to enhance fusion, relieve neurological abnormalities and pain, and improve the cosmetic appearance. Many different techniques have been developed for reduction of spondylolisthesis after Jenkin's initial description in 1936. The techniques include halofemoral traction, cast reduction, instrumentation, L5 corpectomy, and the combined anterior and posterior approach. Recently, newly developed pedicular instrumentation was widely used to reduce high-grade spondylolisthesis and had high fusion rates. But these instrumentations cannot prevent complications such as nerve root lesions due to the traction on the L5 root during reduction. Anyway, there is much controversy about the most effective surgical treatment option for highgrade isthmic spondylolisthesis. As well symptoms may vary depending the age of patient. Surgical decision making and preoperative planning need to address not only the anatomic deformity but also the symptoms complex as manifested by the predominance of either back pain and/or radicular symptoms. However, the patients with high-grade isthmic spondylolisthesis are very limited in Korea. Therefore, the best reliable reduction method for high-grade spondylolisthesis remains a challenging procedure, requiring great surgical attention to detail.

Keyword

High-grade; Spondylolisthesis; Reduction; Problem

MeSH Terms

Back Pain
Congenital Abnormalities
Decision Making
Humans
Korea
Research Personnel
Spondylolisthesis*
Traction

Figure

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  Fig. 1. Diagrams of the classification. Dural station • dural station I(DSI) : the center of the dural sac in AP direction(asterisk) is anterior to the line connection the most prominent portion of the isthmic defects into the spinal canal(balck transverse line).• dural station II(DSII) : the center of the dural sac in AP direction(asterisk) is posterior to the line(black transverse line) Lateral compression of dural sac • N : non-compression type • C : compression type Root station • root station I(RSI) : the nerve root is located in the lateral recess.• root station II(RSII) : the nerve root is deviated from the lateral recess. Spinal canal type • Hool(asterisk) and smooth type(arrow).

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  Fig. 2. Diagrams of measurement methods for intervertebral disc height, depth of lateral recess and AP and transverse diameters of the dural sac. Fig. 2-A. Intervertebral disc height at the lesion is calculated by a+b / 2 in millimeters. Fig. 2-B. Depth of lateral recess is measured from posterior vertebral margin to anteromedial aspect of the isthmic defect in millimeters. Fig. 2-C, D. AP and transverse diameters of the dural sac are measured at the midxection level of the pedicle in millimeters.

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  Fig. 3. Differences in the location of the nerve root in the neural foramen according to the spinal canal type and percent slip. Nerve root of the hook type(A) entered neural foramen under the pedicle, whereas that of the smooth type(B) entered at various locations depending on the degrees of percent slip.

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  Fig. 4. Classification according to the findings of posmyelographic computed tomogram. Fig. 4-A. The patient is classified as dural station II, non-compression type, root station I and hook type on both right and left sides(II-N-I-H-H). Fig. 4-B. The patient is classified as dural station I, compression type, root station I and smooth type on both right and left sides(I-C-I-I-S-S). Fig. 4-C. The patient is classified as dural station I, non-compression type, root station II and smooth type on both right and left sides(I-N-II-II-S-S). Fig. 4-D. The patient is classified as dural station II, compression type, root station I and hook type on both right and left sides(II-C-I-I-H-H). S; superior articular process Fig. 4-E. The patient is classified as dural station II, non-compression type, root station I on both right and left sides, smooth type on both right side, hook type on the left side(II-N-I-I-S-H).

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  Fig. 5-A. Preoperative lateral radiographs of a 12-year-old girl with spondyloptosis causing severe back pain and tight hamstring spasm. Fig. 5-B. MRI showing spondyloptosis Fig. 5-C. Postoperative lateral radiographs of the posterior interbody fusion and posterior instrumentation with posterolateral fusion. The slip angle was well reduced. The patient had a good clinical result and complete resolution of the hamstring spasm.

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  Fig. 6. (A) Preoperative AP and (B) Lateral radiographs of a 42-year-old woman with low bake pain with radiation to the both legs. (C) Postoperative AP and (D) lateral radiographs show posterior interbody fusion and pedicle screw instrumentation. Anterior interbody fusion was performed to make a strut for L5 over the sacrum. Reduction of kyphosis and improvement of translation are noted.

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