Abstract | INTRODUCTION: High-grade L5-S1 spondylolisthesis alters sagittal spinopelvic balance, which can cause low back pain and progressive neurologic disorder. The present study assessed spondylolisthesis reduction and maintenance over time with L4-S1 versus L5-S1 fusion using a lever-arm system and posterior fusion combined with lumbosacral graft. MATERIALS AND METHODS: Forty patients were operated on for symptomatic high-grade spondylolisthesis, 34 of whom had full pre- and post-operative radiological analysis, with a mean follow-up of 5.4years. There were 9 L5-S1 and 25 L4-S1 instrumentations. Analysis of spinopelvic and slipping parameters and the evolution of segmental lordosis compared results between L5-S1 and L4-S1 instrumentation. RESULTS: Mean Taillard spondylolisthesis index decreased from 64% to 37% (P=0.0001). Overall sagittal spinopelvic balance was not significantly changed. Overall L1-S1 and segmental L4-L5 lordosis were not affected by instrumentation. Mean L5-S1 segmental lordosis increased from 11° to 18°. There was loss of reduction from 19° to 14° with L5-S1 instrumentation, in contrast to maintained reduction with L4-S1 instrumentation (P=0.006). CONCLUSION: The lever-arm system provided anterior-posterior reduction of spondylolisthesis and corrected slippage. Postoperative change in overall sagittal spinopelvic balance was slight and constant. Posterior L4-S1 fusion provided better long-term control of L5-S1 lordosis reduction than the shorter L5-S1 fusion. Retrospective study of level IV.
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Authors | R Lengert, Y P Charles, A Walter, S Schuller, J Godet, J-P Steib |
Journal | Orthopaedics & traumatology, surgery & research : OTSR
(Orthop Traumatol Surg Res)
Vol. 100
Issue 5
Pg. 481-4
(Sep 2014)
ISSN: 1877-0568 [Electronic] France |
PMID | 25002197
(Publication Type: Journal Article)
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Copyright | Copyright © 2014 Elsevier Masson SAS. All rights reserved. |
Topics |
- Adolescent
- Adult
- Bone Screws
- Female
- Fibula
(transplantation)
- Follow-Up Studies
- Humans
- Lordosis
(diagnostic imaging, surgery)
- Lumbar Vertebrae
(diagnostic imaging, surgery)
- Male
- Radiography
- Retrospective Studies
- Sacrum
(diagnostic imaging, surgery)
- Spinal Fusion
- Spondylolisthesis
(diagnostic imaging, surgery)
- Young Adult
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