SURGICAL TREATMENT OF HIGH-GRADE LUMBOSACRAL SPONDYLKOLISTHESIS IN CHILDREN AND ADOLESCENTS USING DOUBLE PLATE COMPRESSION: LONG-TERM RESULTS IN A CONSECUTIVE SERIES OF 40 PATIENTS

Abstract

Purpose of the study: Appropriate surgical treatment for severe lumbosacral spondylolisthesis remains a subject of controversy. Correction of the anterior displacement of L5 and the lumbosacral kyphosis is considered dangerous because of the risk of neurological complications. We present a consecutive series of 40 patients who were treated with the Padovani double plate method for high-grade spondylolisthesis. The long-term outcome was assessed. The reasons for abandoning this method were also discussed.

Material and methods The files of 40 patients (15 boys and 25 girls, aged 8–20 years) underwent surgery in our center from 1979 to 1996. All presented anterior displacement of L5 greater than 50%. After release of the L5 and S1 roots via a posterior approach and insertion posteriorly to anteriorly of two anchors in the S1 body, correction of the L5 displacement was achieved via a transperitoneal anterior approach using a plate applied to the anterior surface of L5 and progressively bolted to the S1 anchors. Clinical and radiological outcome was assessed. Spineview was used for angle measurements. The Beaujon and Japanese Ortopaedic Association scores were used for the clinical assessment.

Results: Lumbosacral fusion was achieved in all patients with complete correction of the L5 displacement in 38. A postoperative radicular deficit was noted in twelve patients and resolved completely in ten. Six patients experienced progressive destabilization of the L4–L5 level. Deep infections in contact with implanted material were noted in five patients. At 18 years mean follow-up, 35 patients are symptom free.

Discussion: This technique enables excellent correction of the L5 displacement and an excellent rate of fusion. The method is particularly challenging technically and the rate of complications is high. Reduction of the displacement appears to be associated with numerous radicular deficits, even after prior release. The plate which was rather large for the youngest patients led to lesions of the L4–L5 disc and destabilization of the suprajacent levels.

Conclusion: Although this technique enables optimal and definitive correction of the lumbosacral deformation, the high rate of complications has led us to change our strategy for the treatment of high-grade lumbosacral spondylolisthesis.