Abstract
Objective: To report a consecutive series of patients who underwent staged reduction and fusion with the Magerl External Fixator and 360° fusion for high grade slips and spondyloptosis.
Design: Prospective observational study.
Patients & methods: There were 11 patients, average age 17 years (range 9–25 years).
All these patients had equal or greater than Meyerding grade III slips.
Clinical presentation included severe back pain with disability and a severe cosmetic deformity (including flexed knees, proptotic abdomen and loin creases).
The indications for surgery were pain relief and neurological symptoms/signs, and to improve the sagittal alignment.
Surgery consisted of first stage Gill procedure, L5 root decompression, and insertion of Schanz pins into L4 pedicles and ilium, and application of the fixateur-externe. Second stage consisted of gradual correction of kyphosis and translation (average 1 week duration). Third stage entailed anterior interbody fusion, removal of fixator and instrumented fusion L5 to sacrum.
Outcome measures: Functional out comes (pain scores [VAS], activities of daily living) cosmesis, complications (including neurologic status) and radiographic parameters.
Results: Average follow-up was 3 years and 3 months. Postoperatively none of these patients developed a neurological deficit. Imaging confirmed solid fusion in all patients. In terms of reduction, 1 patient failed to reduce (fusion in-situ) and 1 patient developed subsequent L4 on L5 spondylolisthesis. There was no case of permanent neurologic deficit.
Nine (82%) patients reported improved pain scores on the VAS, improved quality of life and cosmetic appearance.
There was significant reduction of the translation (in most cases to grade II) and correction of the lumbosacral kyphosis. All patients went on to a solid arthrodesis and there was no late loss of correction.
Conclusions: Staged reduction and Fusion not only improves a severe cosmetic deformity but also restores sagittal balance. We recommend this technique as there is negligible risk of neurological complications, and avoids fusion involving two motion segments.
Correspondence should be addressed to: Mr N. J. Henderson, BASS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
