Skip to main content
  • Fusion for high-grade pediatric lumbar spondylolisthesis: A short case series with focus on the importance of S2 alar-iliac screws for pelvic fixation as a salvage strategy in revision spondylolisthes

    Final Number:
    340

    Authors:
    Amey R Savardekar MCh; Richard P Menger MD MPA; Devi Prasad Patra MD, M.CH, MRCS; Anil Nanda MD FACS; Anthony H. Sin MD

    Study Design:
    Other

    Subject Category:
    Spine

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2018

    Introduction: Literature pertaining to failed fusions and revision pediatric spondylolisthesis surgery is scarce. Salvage strategies in the form of iliac screws for the commonly occurring S1 screw failures have been described; however, limitations exist. We illustrate the utilization of S2AI screw as a salvage strategy in revision pediatric spondylolisthesis surgery.

    Methods: Three consecutive surgically managed pediatric high-grade spondylolisthesis patients were retrospectively analyzed. Pre-operative, post-operative and follow-up clinical and radiological data pertaining to the cases was retrieved from the hospital electronic database.

    Results: All three patients were petite, pre-pubertal females (Risser grade I) presenting with symptomatic Meyerding grade IV spondylolisthesis at the L5-S1 level. As per the SDSG classification system, case 1 was type 6; while, cases 2 and 3 were type 5. Patients underwent successful operative management with wide decompression of neural structures, reduction of spondylolisthesis (to maximum possible extent) and posterior fusion. Case 1 had failed fusion at 12 months follow-up due to bilateral S1 screw breakage. The distal fixation at revision was achieved by utilizing S2-alar iliac screws as salvage strategy in order to get pelvic fixation into the construct.

    Conclusions: Certain issues like incorporation of pelvic support in primary surgery remain contentious due to the thin built and prominent pelvic bones encountered in children. The S2 alar-iliac screw may be safely considered as a salvage procedure in cases of failed fusion or may even be incorporated to enhance the strength of the construct (by including pelvic support) in high grade pediatric spondylolisthesis in unbalanced spines.

    Patient Care: We highlight the the inclusion of a S2 alar-iliac screw as a salvage procedure in cases of failed fusion. It may even be incorporated to enhance the strength of the construct (by including pelvic support) in high grade pediatric spondylolisthesis in unbalanced spines.

    Learning Objectives: Management of high grade pediatric lumbar spondylolisthesis

    References: 1. Bouyer B, Bachy M, Courvoisier A, Dromzee E, Mary P, Vialle R: High-grade lumbosacral spondylolisthesis reduction and fusion in children using transsacral rod fixation. Childs Nerv Syst 30:505-513, 2014 2. Bridwell KH: Surgical treatment of high-grade spondylolisthesis. Neurosurg Clin N Am 17:331-338, vii, 2006 3. Bridwell KH: Utilization of iliac screws and structural interbody grafting for revision spondylolisthesis surgery. Spine (Phila Pa 1976) 30:S88-96, 2005 4. Chang TL, Sponseller PD, Kebaish KM, Fishman EK: Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976) 34:436-440, 2009 5. Cunningham BW, Lewis SJ, Long J, Dmitriev AE, Linville DA, Bridwell KH: Biomechanical evaluation of lumbosacral reconstruction techniques for spondylolisthesis: an in vitro porcine model. Spine (Phila Pa 1976) 27:2321-2327, 2002 6. Ishida W, Elder BD, Holmes C, Goodwin CR, Lo SF, Kosztowski TA, et al: S2-Alar-Iliac Screws are Associated with Lower Rate of Symptomatic Screw Prominence than Iliac Screws: Radiographic Analysis of Minimal Distance from Screw Head to Skin. World Neurosurg 93:253-260, 2016 7. Jain A, Hassanzadeh H, Strike SA, Menga EN, Sponseller PD, Kebaish KM: Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection. J Bone Joint Surg Am 97:1521-1528, 2015 8. Labelle H, Mac-Thiong JM, Roussouly P: Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J 20 Suppl 5:641-646, 2011 9. Lebwohl NH, Cunningham BW, Dmitriev A, Shimamoto N, Gooch L, Devlin V, et al: Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine (Phila Pa 1976) 27:2312-2320, 2002 10. Lengert R, Charles YP, Walter A, Schuller S, Godet J, Steib JP: Posterior surgery in high-grade spondylolisthesis. Orthop Traumatol Surg Res 100:481-484, 2014 11. Logroscino G, Mazza O, Aulisa G, Pitta L, Pola E, Aulisa L: Spondylolysis and spondylolisthesis in the pediatric and adolescent population. Childs Nerv Syst 17:644-655, 2001 12. Mac-Thiong JM, Labelle H: A proposal for a surgical classification of pediatric lumbosacral spondylolisthesis based on current literature. Eur Spine J 15:1425-1435, 2006 13. McCord DH, Cunningham BW, Shono Y, Myers JJ, McAfee PC: Biomechanical analysis of lumbosacral fixation. Spine (Phila Pa 1976) 17:S235-243, 1992 14. Molinari RW, Bridwell KH, Lenke LG, Ungacta FF, Riew KD: Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine (Phila Pa 1976) 24:1701-1711, 1999 15. Newton PO, Johnston CE, 2nd: Analysis and treatment of poor outcomes following in situ arthrodesis in adolescent spondylolisthesis. J Pediatr Orthop 17:754-761, 1997 16. Ogilvie JW: Complications in Spondylolisthesis Surgery. Spine 30:S97-S101, 2005

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy