SURGICAL MANAGEMENT OF HIGH GRADE SPONDYLOLISTHESIS IN THE YOUNG- OUR EXPERIENCE IN 17 PATIENTS

Abstract

We present in this study our experience in wide decompression, gradual acute reduction and fusion performed in a single sitting, for high grade spondylolisthesis in 17 adolescent cases.

Between 1994 and 2005 we undertook surgical management of 17 adoloscents with high dysplastic Spondy-lolisthesis. All our patients were young females except for one with average age of 13.9 years. All of our cases involved the lumbosacral junction. 8/14 cases presented with frank spondyloptosis (Grade5). Of the remaining 9 cases, 5/14 cases were grade4 and 4/14 were grade3 dysplastic spondylolisthesis respectively. Our indication for surgery in all these patients was unremitting back pain, radicular pain, abnormal posture, gait abnormalities and progressive slip. All these patients underwent single stage wide decompression, posterior instrumentation and reduction of the slips and postero lateral fusion. Since 1999 in addition to the above we routinely performed inter body fusion with cages in lumbosacral segment (9/17 cases).

All patients’ spondylolistheses were reduced to < grade2.16/17 of our patients had a very satisfactory outcome. Our average follow-up of these patients is 4 years (range 1–9 years).4/17 of our patients developed some dorsiflexion weakness postoperatively and all recovered within 3 months of operation.1 patient developed deep postoperative infection necessitating the removal of the implant.

We conclude that acute correction of high grade spondylolisthesis is a demanding procedure. The newer instrumentation (improved sacral fixation) made reduction less difficult and the final outcome is highly satisfying for the patient and the surgeon.