- Discussion:
- progression of severe slips after apparently solid in situ arthrodesis has led
some to consider reduction and instrumentation for spondylolithesis;
- another rationale for reduction of the slip is improvement in cosmetic appearance of the trunk;
-
slip angle:
- risk factor to predict postop progression is preop
slip angle > 35 deg;
- slip angle is measured by drawing line perpendicular to a line drawn along posterior aspect of first
sacral vertebral body and measuring angle between that & line parallel to inferior end plate of L-5;
-
complications of reduction: neurologic injury;
- nerve root injuries not only occur at level of
spondylolisthesis but may also occur throughout the
lumbosacral plexus because of the trunk lengthening that occurs w/ reduction;
- most studies of spondylolisthesis reductions report new
L-5 root deficits, some of which are permanent;
- Technique of Reduction:
- reduction of forward translation & of lumbosacral kyphosis that accompanies
severe slips is performed w/ serial casting, traction, external fixators, or
w/ posterior implants (pedicle screws, plates, & rods);
Treatment of severe spondylolisthesis by reduction and pedicular fixation. A 4-6-year follow-up study.
Passive reduction of spondylolisthesis on the operating room table: a prospective study.
Treatment of severe spondylolisthesis in children by reduction and L4-S4 posterior segmental hyperextension fixation.
Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long-term follow-up study.
Reduction and stabilization of grade IV spondylolisthesis.
Reduction of severe lumbosacral spondylolisthesis. A report of 22 cases with a ten-year follow-up period.
Long-term evaluation of adolescents treated operatively for spondylolisthesis. A comparison of in situ arthrodesis only with in situ arthrodesis and reduction followed by immobilization in a cast.
Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long-term follow-up study.
