Introduction: Reduction of higher grades of spondylolisthesis remains a surgical challenge. We present our results using a novel minimally invasive "Rocking" technique which consistently achieves complete anatomic monosegmental reduction.
Methods: A cohort study consisting of a total of 41 consecutive patients over a period of 7 years. Patients with varying grades of lumbar spondylolisthesis (Meyerding: 32 grade II, 9 grade III) were treated with operative reduction via minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using the “Rocking” technique. The clinical outcomes were measured using the Visual Analog Pain Scale (VAS) and the Revised Oswestry Disability Index (ODI) for low back pain/dysfunction scoring. Radiological parameters of Grade (Meyerding), Pelvic Incidence (PI), Lumbar Lordosis (LL), Disc Space Angle (DSA), Pelvic Tilt (PT) and Sacral Slope (SS) were assessed to measure the radiological outcomes. These were prospectively reviewed for each patient for a minimum of 2 years.
Results: At most recent follow-up, 94% of patients were pain free. There were two patients (6%) who had moderate pain (which corresponded to higher grade of listhesis), but all showed an improvement in pain scores (p < 0.05). Mean VAS improved from 6.8 (SD 1.3) preoperatively to 1.4 (SD 1.2) and mean ODI score improved from 55.9 (SD 12.3) preoperatively, to 23.8 (SD 14.2) at 2-year follow-up.
Good fusion achieved in 97% of the patients (Bridwell grade 1 & 2) with implants in-situ at 2 year follow up. 100% complete reduction of all grades of spondylolisthesis was achieved. The overall sagittal profile improved dramatically. No major perioperative complications encountered.
Conclusions: Minimally invasive monosegmental transforaminal lumbar interbody fusion for listhesis reduction using this “Rocking” technique is effective in the treatment of various grades of spondylolisthesis with excellent correction of overall sagittal profile, along with avoidance of including the healthy adjacent segment into the fusion construct.
Patient Care: This novel technique has the potential to treat higher grade of spondylolisthesis effectively and consistently using a minimally invasive approach. The long term results are encouraging with good sagittal balance and patient outcome scores.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Consider reduction of higher grade of spondylolisthesis
2. Understand minimally invasive "Rocking" technique for complete reduction of spondylolisthesis
3. Maintaining sagittal balance by overall reduction of lumbar lordosis.