Severe lumbosacral spondylolisthesis in adolescents and children. Reduction and staged circumferential fusion

R. L. DeWald, M. M. Faut, R. F. Taddonio, M. G. Neuwirth

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Abstract

Using a new surgical regimen, 14 patients with lumbosacral spondylolisthesis and more than 50% slipping were treated by reduction of the slip with two Harrington distraction rods extending from the first lumbar laminae to the sacral alae and bilateral posterolateral fusion from the fourth lumbar to the second sacral segment. Then, at a second procedure, 13 had an anterior lumbosacral fusion using two bicortical wedge-shaped iliac grafts. The distraction rods were removed 6 to 12 months later. At follow-up, correction of the slips ranged from 70 to 100%. In 4 of the 13 patients the reduction was improved by 10 to 13% during the anterior procedure. In one patient, a 21-year-old woman with a slip of more than 100%, a cauda equina syndrome developed after the reduction and posterolateral fusion, and this necessitated removal of the rods and cancellation of the anterior fusion. This patient recovered completely and her final result was a solid posterolateral fusion in situ, with her abnormal posture and gait unchanged. The other 13 patients, after follow-up ranging from 2 years to 6 years and 7 months, had solid fusion, normal spinal alignment, normal anatomy of the spinal canal, and normal posture and gait. Only one patient had loss of correction during follow-up, which amounted to 7%. We concluded that correction of severe spondylolisthesis (50% or more) in properly selected patients can be accomplished by this two-stage procedure without risk of further slipping, pseudarthrosis, persistent deformity, or recurrence of the slip due to late remodeling.

Original languageEnglish
Pages (from-to)619-626
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume63
Issue number4
DOIs
StatePublished - 1981
Externally publishedYes

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