Reduction of Spondylolithesis



- 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.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 25, 2012 12:49 pm