Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results
| Autor: | Cheng Hung Lee, Yun Ming Wang, Cheng Min Shih, Kao Chang Tu, Chien Chou Pan, Cheng En Hsu, Kun Hui Chen, Fuu Cheng Jiang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Pelvic tilt medicine.medical_specialty Arthrodesis medicine.medical_treatment Cantilever Diseases of the musculoskeletal system 03 medical and health sciences 0302 clinical medicine Lumbar Rheumatology medicine Humans High grade spondylolisthesis Orthopedics and Sports Medicine Mono-segment instrumentation Retrospective Studies Fixation (histology) Reduction 030222 orthopedics Lumbar Vertebrae business.industry Research Lumbosacral Region medicine.disease Spondylolisthesis Severe spondylolisthesis Surgery Pseudarthrosis Spinal Fusion Treatment Outcome RC925-935 Lumbosacral angle Orthopedic surgery Lordosis business 030217 neurology & neurosurgery Sagittal balance |
| Zdroj: | BMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-10 (2021) BMC Musculoskeletal Disorders |
| ISSN: | 1471-2474 |
| Popis: | Backgrounds Surgical reduction for high-grade spondylolisthesis is beneficial for restoring sagittal balance and improving the biomechanical environment for arthrodesis. Compared to posterior total laminectomy and long instrumentation, anterior lumbar inter-body fusion (ALIF) is less invasive and has the biomechanical advantage of restoring the original disk height and increasing lumbar lordosis, thus improving sagittal balance. However, the application of ALIF is still limited in treating low-grade spondylolisthesis. In this study, we developed a new technique termed anterior cantilever procedure to directly reduce the slippage of high-grade lumbosacral spondylolisthesis. The purpose of our study was to investigate the surgical outcomes of the anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation in high-grade spondylolisthesis. Methods All patients with high-grade spondylolisthesis who underwent anterior cantilever procedure followed by anterior lumbar inter-body fusion (ALIF) and posterior mono-segment instrumented fixation between November 2006 and July 2017 were enrolled in our study. The slip percentage, Dubousset’s lumbosacral angle, pelvic tilt, sacral slope, pelvic incidence, and sagittal alignment were measured pre-operatively and postoperatively at the last follow-up. Surgery time, blood loss, complications, and hospital stay were also collected and analysed. Results A total of 11 consecutive patients with high-grade spondylolisthesis patients were included and analysed. All of the high-grade spondylolisthesis in our series occurred at the L5-S1 level. The median age was 37 years, and the median follow-up duration was 36 months. The average slip reduction was 30% (60 to 30%, P P Conclusions Anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation is a valid procedure for treating high-grade spondylolisthesis. It achieved a high fusion rate, partially reduced slippage, and significantly improved lumbosacral angle, while minimizing common complications, such as pseudarthrosis, nerve traction injury, excessive soft tissue dissection, and blood loss in posterior reduction procedures. However, posterior instrumentation is still required to the structural stability in the ALIF procedure. Level of evidence IV |
| Databáze: | OpenAIRE |
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