Surgical Treatment of Developmental Spondylolisthesis: Contemporary Series With a Two-Surgeon Team
| Autor: | Michael P. Glotzbecker, John B. Emans, M. Timothy Hresko, Leslie A. Kalish, Lawrence I. Karlin, David G. Deckey, Brian D. Snyder, Daniel J. Hedequist, Mark R. Proctor |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Reoperation Risk medicine.medical_specialty Adolescent Decompression Iatrogenic Disease Physical examination Neurosurgical Procedures Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Peripheral Nerve Injuries medicine Humans Orthopedic Procedures Orthopedics and Sports Medicine Child Retrospective Studies Patient Care Team Postoperative Care 030222 orthopedics medicine.diagnostic_test business.industry Lumbosacral Region Retrospective cohort study Orthopedic Surgeons medicine.disease Spondylolisthesis Surgery Neurosurgeons Treatment Outcome Child Preschool Orthopedic surgery Neurosurgery Complication business 030217 neurology & neurosurgery Lumbosacral joint Follow-Up Studies |
| Zdroj: | Spine Deformity. 7:275-285 |
| ISSN: | 2212-134X |
| DOI: | 10.1016/j.jspd.2018.08.004 |
| Popis: | Retrospective case series.To report operative outcomes of contemporary surgical treatment of spondylolisthesis in the pediatric population.Surgical treatment of developmental spondylolisthesis is controversial, with limited data on complication and reoperation rates.A retrospective study followed pediatric patients with either L5-S1 high-grade spondylolisthesis (HGS) or L5-S1 symptomatic low-grade spondylolisthesis (LGS) for a minimum of two years. All patients underwent a contemporary, single-stage decompression, partial reduction, and posterior instrumented fusion (DRPF) or in situ stabilization by a combined orthopedic and neurosurgeon team at a single institution during 2005-2015. Clinical examination and radiographic data were collected preoperatively and at discharge, 1 year, 2 years, and terminal visit (defined as the last follow-up at2 years).Thirty-four patients (79% HGS), mean (±standard deviation) age at surgery 13.5 (±3.3) years, were followed for 4.8 (±2.3) years. The patients who underwent DRPF (n = 26) had mean lumbosacral angle increase from 79.8° (±20.8) to 92.5° (±16.1) (p.001) and mean listhesis reduce from 63.2% (±21.9) to 26.0% (±20.1) (p.001). Preoperatively, 18 (53%) had neurologic symptoms. At one- and two-year follow-up, new or residual neurologic symptoms were present in four patients (12%) (p.001). Postoperative symptoms were not significantly related to amount of reduction. Sixteen (47%) underwent reoperation at an average of 24.8 months, 10 for planned prominent instrumentation removal, and 6 for true complications.Surgical reduction and decompression of spondylolisthesis in the pediatric population restores spinopelvic alignment. We found no evidence that a greater amount of reduction was associated with a higher incidence of postoperative complications. However, patients should be advised that prominent instrumentation may require future removal. Although previous reports suggest complication rates and permanent neurologic sequelae in up to 20% after operative treatment of spondylolisthesis, our results suggest that a contemporary approach with a two-surgeon team may provide improved results.Level IV. |
| Databáze: | OpenAIRE |
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