J Korean Neurosurg Soc.  2025 Mar;68(2):150-158. 10.3340/jkns.2024.0172.

Posterior Lumbar Element Enforcement by Decompression Alone with Interspinous Fixation without Interbody Fusion for the Surgical Management of Lumbar Spondylolisthesis

• Park HW
• Han MS
• Jung JH
• Hong JH
• Lee SS
• Lee JK

• KMID: 2565273
• DOI: http://doi.org/10.3340/jkns.2024.0172

Abstract

Objective
: In degenerative lumbar spondylolisthesis, interbody fusion surgery (IFS) has long been recommended as the gold standard of surgical management. However, IFS is less recommended for high-risk patients such as the elderly because it involves extensive surgery, with a long operation time and high volumes of blood loss, which lead to marked perioperative morbidity. We report an alternative primary and salvage treatment technique for high-risk lumbar spondylolisthesis through posterior lumbar element reinforcement using interspinous fixation and decompression alone without interbody fusion.
Methods
: Plain radiographs, computed tomography scans, and magnetic resonance imaging, taken at different intervals, were used to measure local disc height (DH), vertebral body slippage (BS), and segmental motion angle (SMA). A Visual analogue scale and the Oswestry disability index (ODI) were applied pre-operation and at the last follow-up.
Results
: The local SMA decreased significantly by 3.46°±3.07°, from 10.61°±3.42° preoperatively to 7.15±3.70 at the last follow-up (p<0.001). The DH decreased from 8.61±2.88 mm preoperatively to 8.41±2.48 mm at the last follow-up (p=0.074). The BS decreased from 3.49±4.29 mm preoperatively to 3.41±4.91 mm at the last follow-up (p=0.092). None of the patients reported worsening pain or an increased ODI after surgery, and there were no surgery-related complications.
Conclusion
: Posterior lumbar element reinforcement by decompression alone with SPIRE™ fixation is an alternative primary and salvage treatment option for select patients with spondylolisthesis.

Keyword

Spondylolisthesis; Interbody fusion surgery; Posterior lumbar element reinforcement; Interspinous fixation

Figure

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  Fig. 1. A : Radiological measurements in the sagittal view of the CA and lumbar disk height. Disc height was measured by (Ant-DH + Post-DH) / 2. B : Body slippage (BS) of the segmental vertebral bodies. BS was defined as the distance between the line drawn on the posterior of the two spondylolisthetic vertebral bodies in the plane sagittal view. CA : Cobb angle, Ant-DH : disc height anterior, Post-DH : disc height posterior.

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  Fig. 2. Intraoperative photographs. A : A small hole was mad into the interspinous ligament at the target level using right angle-Kelly forceps. B : The spinous process construct is fixed to the insertion instrument and inserted. One half of the construct is placed on each side of the spinous processes, with the sliding post lying in the space between the spinous processes. C : Hand-held compression instruments are used to clamp the plates toward each other, driving the spikes into the bone. D : A locking screw is inserted and tightened to a predetermined torque.

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  Fig. 3. Interspinous fixation device (SPIRE; Medtronic, Dublin, Ireland) made up of two titanium plates with spikes.

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  Fig. 4. Case illustration. A and B : Radiological findings of the lumbar spine show an L 4/5 spondylolisthesis grade I. C and D : The disc height (DH) and body slippage (BS) were measured as 11.2 mm and 6.3 mm, respectively, and the segmental motion angle (SMA) was measured as 10.4°. E : Postoperative lateral whole-spine lateral radiography. F and G : At the last follow-up, DH and BS were measured as 9.0 mm and 6.2 mm, respectively, and the SMA was measured as 8.5°.

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  Fig. 5. Changes in the segmental motion angle recorded preoperatively, immediately after surgery, at 1 year post-operatively, and at the last follow-up.

Reference

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