Introduction: Management of high-grade spondylolisthesis(HGS)remains challenging and is associated with significant controversies.The best surgical procedure still remains debatable,considering the absence of high-quality studies in the literature demonstrating superiority of one approach over another.This retrospective multicenter study was conducted to assess the safety of reduction and circumferential instrumented fusion for HGS along with evaluation of clinical and radiographic outcome.
Methods: Adult patients with HGS(Meyerding grade 3-4)who underwent open decompression,reduction and circumferential instrumented fusion were reviewed.Pre and post-operative Meyerding grade, slip angle and sacral inclination were analyzed to quantify the spinal deformity correction.Surgical details and medical records were reviewed for intraoperative techniques,and intra and post operative complications. Clinical outcome was assessed using Prolo and Oswestry Disability Index(ODI) scores at last follow up.
Results: A total of 25 cases of HGS were identified.Mean age of patients was 41 years(range,19-72 years)with follow up(FU)ranging from 2 to 33 months(mean,21 months).At the most recent follow up, there was significant improvement in mean Meyerding grade(3.4 versus 1.5,p< 0.01) and slip angle(17.3 versus minus 5.1,p < 0.01). Mean ODI and Prolo scores were 20%(minimum disability) and 8.2(grade 1)respectively with improvement of mean VAS score for back pain from 7.7 to 2.4(p<0.01). Interbody fusion was performed in 17 patients( 15 TLIF , 1 PLIF and 1 ALIF ) while 5 patients underwent sacral dome osteotomies.New neurological deficit after surgery occurred in 1(4%)patient with 1 (4%) construct related complication.Fusion occurred in all 16 patients who had at least 12 months FU following surgery.
Conclusions: Open decompression, reduction and instrumented fusion with correction of slip angle for HGS is safe and can result in excellent clinical and radiographic outcome with minimal morbidity.
Patient Care: This multicenter study demonstrates the efficacy and safety of open decompression, reduction and instrumented fusion for HGS and would help surgeons select the optimal surgical approach for HGS.
Learning Objectives: By conclusion of this session , participants should be able to :
1) Diagnose and evaluate HGS
2) Understand the overall deformity in this subgroup of spondylolisthesis
3) Understand the benefit and overall outcome following open decompression, reduction and instrumented fusion with correction of slip angle for HGS