Lumbosacral spondyloptosis treated using partial reduction and pedicular transvertebral screw fixation in an osteoporotic elderly patient

Case report

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Spondyloptosis is complete dislocation of the L-5 vertebral body on the sacrum anteriorly. Its optimal treatment is still controversial. In particular, choosing the optimal surgical technique is difficult in the osteoporotic elderly patient given the high incidence of instrumentation failure, pseudarthrosis, progressive slippage, and severe sagittal imbalance. The authors of this report used partial reduction and pedicular transvertebral screw fixation of the lumbosacral junction for the treatment of spondyloptosis in an osteoporotic elderly patient.

Article Information

Address correspondence to: Eun-Min Seo, M.D., Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, #153, Kyodong, Chuncheon, Kangwon-do, 200-704, Korea. email: seoem@hallym.or.kr.

Please include this information when citing this paper: published online November 25, 2011; DOI: 10.3171/2011.10.SPINE11161.

© AANS, except where prohibited by US copyright law.

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Figures

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    Standing lumbosacral lateral radiographs showing severe sagittal imbalance (left) and L5–S1 Grade V spondylolisthesis (right).

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    Lumbosacral CT scan (left) showing bilateral discontinuity of the pars interarticularis. Sagittal T2-weighted MR image (right) demonstrating severe spinal canal stenosis at the L5–S1 level due to slippage.

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    Postoperative lumbosacral anteroposterior (left) and lateral (right) radiographs showing pedicular transvertebral screw fixation of the lumbosacral junction and additional anterior lumbar interbody fusion.

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    Sagittal CT scan (left) obtained at the 10-month follow-up, showing partial reduction and interbody bony union between L-5 and S-1. Standing lumbosacral lateral radiograph (inset) and photograph (right) showing improvement in sagittal balance and fully upright standing posture of the patient.

References

1

Abdu WAWilber RGEmery SE: Pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis. A new technique for stabilization. Spine (Phila Pa 1976) 19:7107151994

2

Boachie-Adjei ODo TRawlins BA: Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: clinical and radiographic results in six patients. Spine (Phila Pa 1976) 27:E161E1682002

3

Boos NMarchesi DZuber KAebi M: Treatment of severe spondylolisthesis by reduction and pedicular fixation. A 4-6-year follow-up study. Spine (Phila Pa 1976) 18:165516611993

4

Boxall DBradford DSWinter RBMoe JH: Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 61:4794951979

5

Bradford DS: Spondylolysis and spondylolisthesis. Curr Pract Orthop Surg 8:12371979

6

Bradford DSBoachie-Adjei O: Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long-term follow-up study. J Bone Joint Surg Am 72:106010661990

7

Bradford DSGotfried Y: Staged salvage reconstruction of grade-IV and V spondylolisthesis. J Bone Joint Surg Am 69:1912021987

8

Bunnell WP: Back pain in children. Orthop Clin North Am 13:5876041982

9

Dimar JRHoffman G: Grade 4 spondylolisthesis. Two-stage therapeutic approach of anterior vertebrectomy and anteriorposterior fusion. Orthop Rev 15:5045091986

10

Esses SINatout NKip P: Posterior interbody arthrodesis with a fibular strut graft in spondylolisthesis. J Bone Joint Surg Am 77:1721761995

11

Flynn JCPrice CT: Sexual complications of anterior fusion of the lumbar spine. Spine (Phila Pa 1976) 9:4894921984

12

Harris IEWeinstein SL: Long-term follow-up of patients with grade-III and IV spondylolisthesis. Treatment with and without posterior fusion. J Bone Joint Surg Am 69:9609691987

13

Hensinger RN: Spondylolysis and spondylolisthesis in children and adolescents. J Bone Joint Surg Am 71:109811071989

14

Lakshmanan PAhuja SLewis MHowes JDavies PR: Transsacral screw fixation for high-grade spondylolisthesis. Spine J 9:102410292009

15

Laurent LEOsterman K: Operative treatment of spondylolisthesis in young patients. Clin Orthop Relat Res 117:85911976

16

Petraco DMSpivak JMCappadona JGKummer FJNeuwirth MG: An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction. Spine (Phila Pa 1976) 21:1133 11391996

17

Ponnusamy KEIyer SGupta GKhanna AJ: Instrumentation of the osteoporotic spine: biomechanical and clinical considerations. Spine J 11:54632011

18

Roca JUbierna MTCáceres EIborra M: One-stage decompression and posterolateral and interbody fusion for severe spondylolisthesis. An analysis of 14 patients. Spine (Phila Pa 1976) 24:7097141999

19

Sasso RCShively KDReilly TM: Transvertebral transsacral strut grafting for high-grade isthmic spondylolisthesis L5-S1 with fibular allograft. J Spinal Disord Tech 21:3283332008

20

Smith JADeviren VBerven SKleinstueck FBradford DS: Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade l5-s1 spondylolisthesis. Spine (Phila Pa 1976) 26:222722342001

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