Surgery for Severe Spondylolisthesis and Spondyloptosis

Objective Restoration of a normal profile of spinal column by complete or almost complete reduction, stabilization achieved by instrumentation and fusion of the lumbosacral intervertebral segment. Alleviation or at least marked reduction of pain and neurologic deficits present before surgery. Indications High grade, that means usually spondylolisthesis grade IV according to Meyerding or spondyJoptosis. Patients with progression of slip. Contraindications Osteopenia. Spondylolistheses which do not necessitate an opening of the spinal canal. Possibility of adequate anterior access to the lumbosacral disk. Surgical Technique Posterior decompression and resection of the sacral dome, reduction of L5 over the sacrum and posterior interbody fusion L5/$1 with two autogenous bi- or tricortical bone grafts harvested from the lilac crest. Results Between January 1995 and January 1998 , we used the described technique in eleven patients. Six patients had a grade IV spondylolisthesis and five a spondyloptosis. Previous surgery had been done in four patients. A complete or almost complete reduction was possible in ten patients. No pseudarthrosis nor loss of correction were seen. Neurologic deficits im proved in five of six patients. All patients noted an improvement of symptoms. Postoperative complications in previously operated patients: one dura lesion, one deficit of the $I nerve root diagnosed postoperatively, and one inadequate reduction. Postoperative complications in the remaining seven, not previously operated patients: one instability of the adjacent segment and a transient irritation of the L5 nerve root in two patients.