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Grade III and IV Spondylolisthesis

- Exam:

- Radiographs:    

- Treatment:
    - these pts have a high deg of lumbosacral kyphosis have sig deformity;
    - prophylactic fusion in children & adolescents w/ slippage > 50% is recommended;
    - w/ a L-5 to S-1 spondylolisthesis, treatment consists of bilateral posterolateral arthrodesis in situfrom L4 to S1 w/ or w/o instrumentation;
           - hence, transverse processes of 4th lumbar vertebra is included in fusion;
           - fusion to L4 is required, for increased stability and because the L4 disc will become degenerative by middle age;
    - reduction:
           - most children & adolescents w/ grade III & even grade IV slips do not require reduction of the displacement;
           - they almost always can be managed successfully by posterior- posterolateral fusion of L4 to S1 and cast immobilization;
    - pitfalls:
           - do not confuse the L5 transverse process w/ L4 transverse process (use intraoperative flouroscopy);
           - give special attention to thorough cleaning out and bone grafting of the L5 transverse process-alar interval;
    - postop:
           - in the past, some surgeons have recommended 2 to 4 wks of halo-femoral traction in mild hyperextension, followed by 4 to 6 mo 
                   of bed rest in a double pantoloon cast;
           - w/ recent improvements in pedicle screw fixation, patients can be mobilized postoperatively if they are fitted w/ a well molded 
                   spinal orthosis;

- Cauda Equina Syndrome:
    - occurrence of acute cauda equina syndrome after in situ arthrodesis for spondylolisthesis has been reported;
          - preop evaluation for clinically unapparent neurogenic bladder in patients with grades III & IV spondylolisthesis is recommended;
          - if cauda equina syndrome occurs after arthrodesis in situ, post. aspect of S-1 vertebral body should be removed;
    - partial reduction of spondylolisthesis is also considered

Staged salvage reconstruction of grade-IV and V spondylolisthesis.

Failed arthrodesis of the spine for severe spondylolisthesis. Salvage by interbody arthrodesis.

Spinal arthrodesis for severe spondylolisthesis in children and adolescents. A long-term follow-up study.

In situ arthrodesis without decompression for Grade-III or IV isthmic spondylolisthesis in adults who have severe sciatica.

Management of severe spondylolisthesis in children and adolescents.

Long-term follow-up of patients with grade-III and IV spondylolisthesis. Treatment with and without posterior fusion.

Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long-term follow-up study.

Severe spondylolisthesis in children and adolescents. A long-term review of fusion in situ.

Severe spondylolisthesis. Reduction and internal fixation.

Treatment of L5-S1 spondyloptosis by staged L5 resection with reduction and fusion of L4 onto S1 (Gaines procedure).

Reduction and stabilization of grade IV spondylolisthesis.

Treatment of severe spondylolisthesis in children by reduction and L4-S4 posterior segmental hyperextension fixation.

Treatment of severe spondylolisthesis by reduction and pedicular fixation. A 4-6-year follow-up study.

Grade 4 spondylolisthesis. Two-stage therapeutic approach of anterior vertebrectomy and anterior-posterior fusion.

Cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction.