Study Design. A retrospective clinical study was conducted.

Objectives. To evaluate the clinical and radiologic outcomes of one-stage posterior decompression-stabilization after partial reduction and trans-sacral interbody fusion with a titanium cage for severe L5–S1 spondylolisthesis.

Summary of the Background Data. Trans-sacral inter-body fusion for the management of severe L5–S1 spondylolisthesis with or without partial reduction and pedicular fixation has been previously described. The use of a transsacral titanium cage has not been previously reported.

Methods. Thirty-two patients with severe L5–S1 spondylolisthesis were treated consecutively with posterior decompression, partial reduction, pedicular fixation, and posterior lumbar interbody fusion using a trans-sacral titanium cage. The mean age at the time of surgery was 24.6 years (range, 11–55 years). The mean follow-up period was 48.3 months (range, 12–102 months). Twenty-three patients had severe back pain and twenty-five patients radicular pain. Nine patients had a partial unilateral L5 motor deficit and twenty-one an L5 sensory deficit. Twelve patients had extremely tight hamstrings. The mean preoperative percentage of slipping was 71.7% (range, 52–91%). Patients were evaluated for complications and fusions, and outcomes were collected using the modified Scoliosis Research Society Outcomes Instrument.

Results. At follow-up, all patients, except one with major vascular complications, were extremely or reasonably satisfied with the surgery. All patients showed improvements in radiologic indexes and stable fusion at the final follow-up examination.

Conclusions. Posterior decompression and partial reduction followed by circumferential stabilization performed in one stage combining pedicle fixation with trans-sacral titanium cage interbody fusion is an effective and safe technique for the management of severe spondylolisthesis.

A clinical retrospective study was conducted. Results of isolated decompression for degenerative lumbar stenosis was compared with the outcome in patients who underwent decompression-stabilisation.

From January 1992 to December 2002, 127 patients (average age 65.5) with lumbar degenerative stenosis surgically treated were studied. In all patients the Roy-Camille technique was used for decompression; in 41 patients decompression and posterior stabilisation procedures were carried out. Average follow-up was 6 years (range 2–11 years).

The outcomes, evaluated according to Lassale classification, were satisfactory in 81% of the decompressed group while improved to 88% in the stabilised–decompressed group. Three patients of the first group required stabilisation for intractable low back pain (one patient) and lumboradicular symptoms (two patients), while problems related to the device (one hardware failure) and two instances of adjacent segmental instability were seen in the second group.

Decompression alone is associated with an increased rate of residual low back pain (one patient in this cohort required fusion). The decompression–stabilisation procedure reduces the incidence of low back pain but is associated with other complications such as significant blood loss, possible wound infections, urinary tract infections (due to increased surgical time), device failures, root impingement and late adjacent segmental pathologies.

The Roy Camille technique is effective for achieving adequate decompression. The surgeon should always be aware of patients who might require fusion. The instrumented stabilisation should be reserved for patients with chronic low back pain and evident instability, degenerative spondylolisthesis and spine deformities such as scoliosis or kyphosis.