Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis

Background Data: Surgical management for high-grade spondylolisthesis is challenging and associated with high morbidity. There are many surgical techniques available for lumbosacral fixation and correction that differ in approaches and outcomes. The main concern during surgery is to decompress the n...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Amr Farid Khalil, MD, Hosam Shata, MD, Ashraf S Zidan, MD., Basem I Awad, MD.
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2019
Materias:	high-grade spondylolisthesis reduction in situ fusion lumbar spine degenerative Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/9a1ab4bd4b98406ea4238e281d6cc15e
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:9a1ab4bd4b98406ea4238e281d6cc15e
record_format	dspace
spelling	oai:doaj.org-article:9a1ab4bd4b98406ea4238e281d6cc15e2021-12-02T12:09:12ZReduction versus Fusion In-Situ in High-Grade Spondylolisthesis10.21608/esj.2019.13664.11042314-89502314-8969https://doaj.org/article/9a1ab4bd4b98406ea4238e281d6cc15e2019-07-01T00:00:00Zhttps://www.esj.journals.ekb.eg/article_75847_fd896572acdfa37088d1422482398010.pdfhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Surgical management for high-grade spondylolisthesis is challenging and associated with high morbidity. There are many surgical techniques available for lumbosacral fixation and correction that differ in approaches and outcomes. The main concern during surgery is to decompress the neural element, correct focal kyphotic deformity, and restore or maintain global sagittal alignment. Purpose: The purpose of this study was to present a case series of patients with high-grade spondylolisthesis who were treated with reduction and fixation and compare the results to in situ fusion technique. Study Design: Retrospective observational study. Patients and Methods: We retrospectively reviewed patients with L5/S1 high-grade spondylolisthesis who underwent surgery at our institute in the period between March 2013 and March 2017. Patient’s demographic, preoperative, and postoperative data were collected. Taillard’s technique and Meyerding’s grade for spondylolisthesis were assessed for all cases. Additionally, we measured the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) pre- and postoperatively. The Bridwell grading system was used to assess the degree of radiographic fusion. Preoperative and postoperative clinical outcomes were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Complication rates were collected during the follow-up period. Results: We included 16 cases in the current study. Patients were divided into two groups: reduction group includes nine patients, and in situ group includes seven. There was no significant difference in demographics or radiological data between groups. Moreover, operative data demonstrated comparable results between the two groups (P<0.05). Reduction group showed significant increase in L5 palsy compared to the in situ fusion group (0.037), although reduction showed more significant changes regarding correction of deformity (PT and SS). Both techniques were efficient in relieving pain and improving disability at 3-month and last follow-up visits (P<0.001). Conclusion: The present study showed that both reduction and in situ fusion techniques are effective surgical tools in improving clinical outcomes for patients with L5/S1 high-grade spondylolisthesis. Attempt of complete reduction carries a high risk of L5 nerve root injury. Partial reduction under complete L5 nerve root decompression and visualization is crucial in reducing risk of injury. However, reduction technique demonstrated superior deformity correction at the index level of spondylolisthesis. (2019ESJ181) Amr Farid Khalil, MDHosam Shata, MDAshraf S Zidan, MD.,Basem I Awad, MD.Egyptian Spine Associationarticlehigh-grade spondylolisthesisreductionin situ fusionlumbar spinedegenerativeNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 31, Iss 1, Pp 2-13 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	high-grade spondylolisthesis reduction in situ fusion lumbar spine degenerative Neurology. Diseases of the nervous system RC346-429
spellingShingle	high-grade spondylolisthesis reduction in situ fusion lumbar spine degenerative Neurology. Diseases of the nervous system RC346-429 Amr Farid Khalil, MD Hosam Shata, MD Ashraf S Zidan, MD., Basem I Awad, MD. Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis
description	Background Data: Surgical management for high-grade spondylolisthesis is challenging and associated with high morbidity. There are many surgical techniques available for lumbosacral fixation and correction that differ in approaches and outcomes. The main concern during surgery is to decompress the neural element, correct focal kyphotic deformity, and restore or maintain global sagittal alignment. Purpose: The purpose of this study was to present a case series of patients with high-grade spondylolisthesis who were treated with reduction and fixation and compare the results to in situ fusion technique. Study Design: Retrospective observational study. Patients and Methods: We retrospectively reviewed patients with L5/S1 high-grade spondylolisthesis who underwent surgery at our institute in the period between March 2013 and March 2017. Patient’s demographic, preoperative, and postoperative data were collected. Taillard’s technique and Meyerding’s grade for spondylolisthesis were assessed for all cases. Additionally, we measured the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) pre- and postoperatively. The Bridwell grading system was used to assess the degree of radiographic fusion. Preoperative and postoperative clinical outcomes were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Complication rates were collected during the follow-up period. Results: We included 16 cases in the current study. Patients were divided into two groups: reduction group includes nine patients, and in situ group includes seven. There was no significant difference in demographics or radiological data between groups. Moreover, operative data demonstrated comparable results between the two groups (P<0.05). Reduction group showed significant increase in L5 palsy compared to the in situ fusion group (0.037), although reduction showed more significant changes regarding correction of deformity (PT and SS). Both techniques were efficient in relieving pain and improving disability at 3-month and last follow-up visits (P<0.001). Conclusion: The present study showed that both reduction and in situ fusion techniques are effective surgical tools in improving clinical outcomes for patients with L5/S1 high-grade spondylolisthesis. Attempt of complete reduction carries a high risk of L5 nerve root injury. Partial reduction under complete L5 nerve root decompression and visualization is crucial in reducing risk of injury. However, reduction technique demonstrated superior deformity correction at the index level of spondylolisthesis. (2019ESJ181)
format	article
author	Amr Farid Khalil, MD Hosam Shata, MD Ashraf S Zidan, MD., Basem I Awad, MD.
author_facet	Amr Farid Khalil, MD Hosam Shata, MD Ashraf S Zidan, MD., Basem I Awad, MD.
author_sort	Amr Farid Khalil, MD
title	Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis
title_short	Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis
title_full	Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis
title_fullStr	Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis
title_full_unstemmed	Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis
title_sort	reduction versus fusion in-situ in high-grade spondylolisthesis
publisher	Egyptian Spine Association
publishDate	2019
url	https://doaj.org/article/9a1ab4bd4b98406ea4238e281d6cc15e
work_keys_str_mv	AT amrfaridkhalilmd reductionversusfusioninsituinhighgradespondylolisthesis AT hosamshatamd reductionversusfusioninsituinhighgradespondylolisthesis AT ashrafszidanmd reductionversusfusioninsituinhighgradespondylolisthesis AT basemiawadmd reductionversusfusioninsituinhighgradespondylolisthesis
_version_	1718394704507174912

Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis

Ejemplares similares