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J Neurol Surg A Cent Eur Neurosurg 2024; 85(03): 322-329
DOI: 10.1055/a-2091-6921
Surgical Technique Article

Surgical Treatment of Developmental Dysplastic Lumbosacral Spondylolisthesis: Additional Help from an Intervertebral Distraction, Correction, and Reduction Device

Thomas Lübbers
1   Department of Neurosurgery, Klinikum Leer gGmbH, Leer, Germany
,
Gerd Sandvoss
2   Department of Neurosurgery, Krankenhaus Ludmillenstift, Meppen, Niedersachsen, Germany
,
Rainer Baalmann
3   Department of Neurosurgery, MediClin Hedon Klinik, Lingen, Niedersachsen, Germany
,
Peter Wigt
4   Department of Orthopedic, Krankenhaus Ludmillenstift, Meppen, Niedersachsen, Germany
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Abstract

Background In mid- to high-grade adult dysplastic spondylolisthesis, surgeons are faced with three underlying components: angular, translational, and collapse of the disk. In extremely narrow intervertebral spaces, it is difficult to distract and lift the vertebral bodies by the pedicle screw system alone. In this prospective case control study, we analyzed the efficacy of the latest prototypes (distraction, correction, and reduction [DCR] instrument) with intervertebral application in terms of distraction, correction of segmental kyphosis, and slip reduction.

Methods Twelve adult patients (5 male and 7 female patients) were enrolled in this study. The average age was 42 years (range: 17–67 years) and in all cases the maneuver was documented during the surgery. The amount of slip reduction, the lumbosacral angle according to the Spinal Deformity Study Group dysplastic angle (dys-SDGG), and the disk height were measured preoperatively, intraoperatively, 3 months after surgery, and during the latest follow-up (range: 3–44 months). The relative height of the lumbosacral disk was determined in relation to the disk height in L3/L4.

Results Slippage ranged from 17 to 67%. Overall, the average slippage was 45% preoperatively and 4.8% after the reduction maneuver. The average ratio of the disk height was 0.3 preoperatively, 1.0 intraoperatively, and 0.9 at the latest follow-up. Two patients showed significant kyphotic changes, and these patients had an 18- and 21-degree lordotic improvement. From those who had a lumbosacral kyphosis >20 degrees, only one patient did not show any lordotic improvement. All other patients had a significant lordotic improvement. In total, the lumbosacral angle changed from 15 to 23 degrees.

Conclusion The application of an intervertebral distractor with a mobile thigh has a good clinical and radiologic outcome for mid- to high-grade adult dysplastic spondylolisthesis in terms of distraction, kyphosis correction, and reduction of underlying slippage. The described hardware failures and the complications were not related to the DCR device.

Keywords

dysplastic spondylolisthesis - lumbosacral kyphosis - reduction of spondylolisthesis - posterior lumbar interbody fusion


Publication History

Received: 14 January 2023

Accepted: 09 May 2023

Accepted Manuscript online:
11 May 2023

Article published online:
24 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res 1976; (117) 23-29
    PubMedGoogle Scholar
  • 2 Marchetti PG, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In: Bridwell K, DeWald R. eds. The Textbook of Spinal Surgery. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1997: 1211-1254
    Google Scholar
  • 3 Amundson G, Edwards CC, Garfin SR. Spondylolisthesis. In: Herkowitz HN, Garfin SR, Balderston RA. , et al, eds. The Spine. Philadelphia, PA: WB. Saunders; 1992: 913-969
    Google Scholar
  • 4 Berthonnaud E, Dimnet J, Labelle H. et al. Spondylolisthesis. In: O'Brien MF, Kuklo TR, Blanke KM. et al., eds. Spinal Deformity Group Radiographic Measurement Manual. Memphis, TN: Medtronik Sofamor Danek; 2004: 95-108
    Google Scholar
  • 5 Boxall D, Bradford DS, Winter RB, Moe JH. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 1979; 61 (04) 479-495
    CrossrefPubMedGoogle Scholar
  • 6 Frennered AK, Danielson BI, Nachemson AL. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study. J Pediatr Orthop 1991; 11 (02) 209-213
    CrossrefPubMedGoogle Scholar
  • 7 Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet 1932; 54: 371-377
    PubMedGoogle Scholar
  • 8 Taillard W. Spondylolisthesis in children and adolescents. Acta Orthop Scand 1954; 24 (02) 115-144
    PubMedGoogle Scholar
  • 9 DeWald RL, Faut MM, Taddonio RF, Neuwirth MG. Severe lumbosacral spondylolisthesis in adolescents and children. Reduction and staged circumferential fusion. J Bone Joint Surg Am 1981; 63 (04) 619-626
    CrossrefPubMedGoogle Scholar
  • 10 Burkus JK, Lonstein JE, Winter RB, Denis F. Long-term evaluation of adolescents treated operatively for spondylolisthesis. A comparison of in situ arthrodesis only with in situ arthrodesis and reduction followed by immobilization in a cast. J Bone Joint Surg Am 1992; 74 (05) 693-704
    CrossrefPubMedGoogle Scholar
  • 11 Hu SS, Bradford DS. Spondylolysis and spondylolisthesis. In: Weinstein SL. ed. The Pediatric Spine Principles and Practice. Philadelphia, PA: Lippincott Williams and Wilkins; 2001: 433-451
    Google Scholar
  • 12 Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O'Brien M. The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine 2005; 30 (06) S27-S34
    CrossrefPubMedGoogle Scholar
  • 13 Mardjetko S, Albert T, Andersson G. et al. Spine/SRS spondylolisthesis summary statement. Spine 2005; 30 (06) S3
    CrossrefPubMedGoogle Scholar
  • 14 Petraco DM, Spivak JM, Cappadona JG, Kummer FJ, Neuwirth MG. An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction. Spine 1996; 21 (10) 1133-1138 , discussion 1139
    CrossrefPubMedGoogle Scholar
  • 15 Lamartina C, Zavatsky JM, Petruzzi M, Specchia N. Novel concepts in the evaluation and treatment of high-dysplastic spondylolisthesis. Eur Spine J 2009; 18 (Suppl 1): 133-142
    CrossrefPubMedGoogle Scholar
  • 16 Edwards C. Reduction of spondylolisthesis. In: Bridwell K, DeWald R. eds. The Textbook of Spinal Surgery. Philadelphia, PA: JB Lippincott; 1991: 605-634
    Google Scholar
  • 17 Boos N, Marchesi D, Zuber K, Aebi M. Treatment of severe spondylolisthesis by reduction and pedicular fixation. A 4-6-year follow-up study. Spine 1993; 18 (12) 1655-1661
    CrossrefPubMedGoogle Scholar
  • 18 Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation after decompression in spondylolytic spondylolisthesis. Spine 1997; 22 (02) 210-219 , discussion 219–220
    CrossrefPubMedGoogle Scholar
  • 19 Ruf M, Koch H, Melcher RP, Harms J. Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis. Spine 2006; 31 (03) 269-274
    CrossrefPubMedGoogle Scholar
  • 20 Shufflebarger HL, Geck MJ. High-grade isthmic dysplastic spondylolisthesis: monosegmental surgical treatment. Spine 2005; 30 (06) S42-S48
    CrossrefPubMedGoogle Scholar
  • 21 Lian XF, Hou TS, Xu JG. et al. Single segment of posterior lumbar interbody fusion for adult isthmic spondylolisthesis: reduction or fusion in situ. Eur Spine J 2014; 23 (01) 172-179
    CrossrefPubMedGoogle Scholar
  • 22 Ani N, Keppler L, Biscup RS, Steffee AD. Reduction of high-grade slips (grades III-V) with VSP instrumentation. Report of a series of 41 cases. Spine 1991; 16 (06) S302-S310
    CrossrefPubMedGoogle Scholar
  • 23 Okuda S, Oda T, Yamasaki R, Haku T, Maeno T, Iwasaki M. Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes: clinical article. J Neurosurg Spine 2014; 21 (02) 171-178
    CrossrefPubMedGoogle Scholar
  • 24 Vialle R, Charosky S, Padovani J-P, Rigault P, Glorion C. Surgical treatment of high-grade lumbosacral spondylolisthesis in childhood, adolescent and young adult by the “double-plate” technique: a past experience. Eur Spine J 2006; 15 (08) 1210-1218
    CrossrefPubMedGoogle Scholar
  • 25 Spruit M, Pavlov PW, Leitao J, De Kleuver M, Anderson PG, Den Boer F. Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome. Eur Spine J 2002; 11 (05) 428-433
    CrossrefPubMedGoogle Scholar
  • 26 Kluger P, Weidt F, Puhl W. Spondylolisthesis and pseudospondylolisthesis. Treatment by segmental reposition and interbody fusion with fixateur interne. Orthopade 1997; 26 (09) 790-795
    CrossrefPubMedGoogle Scholar
  • 27 Li P, Zhao Z, Jia N, Wang L, Sun Z, Jin X. A ball-slide-type interbody distractor is effective in posterior reduction and internal fixation for patients with mid- to high-grade isthmic spondylolisthesis enrolled in a randomized clinical trial. Medicine (Baltimore) 2019; 98 (47) e17947
    CrossrefPubMedGoogle Scholar
  • 28 Tsuji H. Fundamental Techniques and Principles in Lumbar Spine Surgery. Tokyo: Nankodo Co., Ltd.; 1988
    Google Scholar
  • 29 Lübbers T, Rommel F. Spondylolisthesis vera. In: Börm W, Meyer F. eds. Spinale Neurochirugie. Stuttgart: Schattauer Verlag Seite; 2009: 245-251
    Google Scholar
  • 30 Hurxthal LM. Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Ther Nucl Med 1968; 103 (03) 635-644
    CrossrefPubMedGoogle Scholar
  • 31 Brantigan JW. Pseudarthrosis rate after allograft posterior lumbar interbody fusion with pedicle screw and plate fixation. Spine 1994; 19 (11) 1271-1279 , discussion 1280
    CrossrefPubMedGoogle Scholar
  • 32 McAfee PC, Boden SD, Brantigan JW. et al. Symposium: a critical discrepancy-a criteria of successful arthrodesis following interbody spinal fusions. Spine 2001; 26 (03) 320-334
    CrossrefPubMedGoogle Scholar
  • 33 Fourney DR, Prabhu SS, Cohen ZR, Gokaslan ZL, Rhines LD. Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: case report. Neurosurgery 2002; 51 (06) 1507-1510 , discussion 1510–1511
    CrossrefPubMedGoogle Scholar
  • 34 Chen L, Yang H, Tang T. Cage migration in spondylolisthesis treated with posterior lumbar interbody fusion using BAK cages. Spine 2005; 30 (19) 2171-2175
    CrossrefPubMedGoogle Scholar
  • 35 McAfee PC, DeVine JG, Chaput CD. et al. The indications for interbody fusion cages in the treatment of spondylolisthesis: analysis of 120 cases. Spine 2005; 30 (06) S60-S65
    CrossrefPubMedGoogle Scholar
  • 36 Shedid D, Weil AG, Lieberman I. A novel minimally invasive technique for the treatment of high-grade isthmic spondylolisthesis using a posterior transsacral rod. J Spinal Disord Tech 2014; 27 (02) E41-E48
    CrossrefPubMedGoogle Scholar
  • 37 Schär RT, Sutter M, Mannion AF. et al. Outcome of L5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high-grade L5-S1 isthmic spondylolisthesis and the role of intraoperative neurophysiological monitoring. Eur Spine J 2017; 26 (03) 679-690
    CrossrefPubMedGoogle Scholar
  • 38 Lehmer SM, Steffee AD, Gaines Jr RW. Treatment of L5-S1 spondyloptosis by staged L5 resection with reduction and fusion of L4 onto S1 (Gaines procedure). Spine 1994; 19 (17) 1916-1925
    CrossrefPubMedGoogle Scholar
  • 39 Hu SS, Bradford DS, Transfeldt EE, Cohen M. Reduction of high-grade spondylolisthesis using Edwards instrumentation. Spine 1996; 21 (03) 367-371
    CrossrefPubMedGoogle Scholar
  • 40 Tokuhashi Y, Ajiro Y, Umezawa N. Subsidence of metal interbody cage after posterior lumbar interbody fusion with pedicle screw fixation. Orthopedics 2009; 32 (04) x
    CrossrefPubMedGoogle Scholar