Surgical treatment of high-grade spondylolisthesis: Technique and results

Background Surgical management of high-grade spondylolisthesis is not only challenging but also controversial, from in situ fusion to complete reduction. We report our results of a safe three-stage spinal procedure in a single surgical session with seven patients diagnosed high-grade spondylolisthesis. Hypothesis Posterior fixation combined with interbody fusion is effective on reduction, ossification and clinical outcomes in high-grade spondylolisthesis. Patients and methods This study is a retrospective review of patients who underwent surgery between 2016 and 2018. The surgical method involved specific installation for deformity reduction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, gradual reduction of the deformity, and sometimes maintenance of the reduction with interbody fusion. Patients were checked out at 2, 6 and 12 months and yearly after the procedure. Clinical, radiological, Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI) outcomes measures were collected. Results Seven patients with high-grade spondylolisthesis at L5-S1 (2 patients grade II, 4 patients grade IV and 1 patient grade V), with a median age of 37 years [17; 72] were included. Median follow-up was 24 months [12; 25 months]. All patients have a fused joint at 6 months except one. Median lumbosacral angle (LSA) improved from 76°[59; 85] to 94°[76; 104]. Meyerding grade of 2 cases was stable after surgery, 3 cases with loss of two ranks and 2 cases with loss of one rank. The radiological parameters showed statistically significant difference (p = 0.036) postoperatively. There was not deep infection. Medians VAS and ODI showed improved pain and disability scores. Conclusion This procedure allows correct reduction rate of high-grade spondylolisthesis with good clinic-radiologic outcomes. Though surgically demanding, it was safe and reproducible. Level of evidence IV, retrospective.