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Clinical and radiological outcomes of gradual reduction and circumferential fusion of high-grade spondylolisthesis in adolescents: a prospective cohort study of 29 young patients

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Abstract

Aim

The objective of this study was to evaluate the safety and efficacy of a novel technique of formal reduction and circumferential fusion for pediatric high-grade spondylolisthesis (HGS).

Purpose

The safety and efficacy of formal reduction for high-grade spondylolisthesis (HGS) has never been thoroughly examined. This study reports the outcomes of 29 children with HGS who underwent a procedure of gradual reduction and circumferential fusion.

Methods

29 children (13 males, 16 females) were recruited between 2006 and 2010. Radiographic measurements (including % of slip, lumbosacral angle—LSA, pelvic incidence—PI, pelvic tilt—PT, sacral slope—SS, and proximal femoral angle—PFA) and quality of life assessment (SRS-22 questionnaire) were prospectively obtained at baseline and at the last post-operative follow-up (> 2 years post-op). Radiological measurements were used to classify patients according to the Spine Deformity Study Group (SDSG) classification.

Results

Mean baseline slip % was 69.9 ± 16.5%. There were 13 patients with a balanced pelvic (SDSG Type 4) and 16 with an unbalanced pelvis (SDSG Type 5 and 6). On average, a reduction of 45.5 ± 15.3% (range 20–86%) was achieved safely with no major complication. In particular, of the 29 patients, only 3 had a L5 radiculopathy postoperatively that was self-resolved at follow-up. From a radiological standpoint, we observed a mean improvement of LSA from 80.3 ± 17.9° to 91.7 ± 13.6°. We also observed a statistically significant improvement in global HRQOL, and in the function and body image domains.

Conclusion

This prospective study suggests that formal reduction of HGS followed by circumferential fusion is safe when using a standardized surgical technique based on gradual reduction. Performing this intervention could also help improve QOL in some patients.

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Data availability

Measurements and analysis done at the CHU Sainte-Justine are on a password protected server. Access may be arranged through application to the IRB.

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Funding

Chair in Movement Sciences, CHU Sainte-Justine and University of Montréal.

Author information

Authors and Affiliations

  1. CHU Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada

    Antoine Dionne, Jean-Marc Mac-Thiong, Stefan Parent, Julie Joncas, Soraya Barchi & Hubert Labelle

  2. Université de Montréal, Montréal, QC, Canada

    Antoine Dionne, Jean-Marc Mac-Thiong, Stefan Parent, Jesse Shen & Hubert Labelle

  3. Centre de Recherche de l’Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada

    Antoine Dionne & Jean-Marc Mac-Thiong

  4. Centre Hospitalier Universitaire de l’Université de Montréal, Montréal, QC, Canada

    Jesse Shen

Authors
  1. Antoine Dionne
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Contributions

Antoine Dionne: Data acquisition, Analysis interpretation of data, Drafting the work, Critical revision, Final approval, Agree to be accountable for all aspects of the work. Jean-Marc Mac-Thiong: Design of the work, Data acquisition, Analysis interpretation of data, Critical revision, Supervision, Final approval, Agree to be accountable for all aspects of the work. Stefan Parent: Design of the work, Data acquisition, Critical revision, Final approval, Agree to be accountable for all aspects of the work. Jesse Shen: Data acquisition, Drafting the work, Critical revision, Final approval, Agree to be accountable for all aspects of the work. Julie Joncas: Data acquisition, Drafting the work, Critical revision, Final approval, Agree to be accountable for all aspects of the work. Soraya Barchi: Data acquisition, Analysis interpretation of data, Drafting the work, Critical revision, Supervision, Final approval, Agree to be accountable for all aspects of the work. Hubert Labelle: Design of the work, Analysis interpretation of data, Drafting the work, Critical revision, Supervision, Final approval, Agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Hubert Labelle.

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Conflict of interest

AD has received a scholarship from the Medtronic Research Chair in Spinal Trauma at Université de Montréal. JMMT is chairholder of the Medtronic research chair in spinal trauma at Université de Montréal, owns stocks and is a board member in Spinologics, and has received a scholarship and research grants from the Fonds de recherche du Québec—Santé, an investigator-initiated research grant from Medline Industries, educational grants from Medtronic and Depuy-Synthes, as well as research grants from the U.S. Department of Defense—Congressionally directed medical research programs, Craig H. Neilsen Foundation, from Social Sciences and Humanities Research Council, Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council, Praxis Spinal Cord Institute, Abbvie, Asahi Kasei Pharma and Vertex Pharmaceutical. SP has received outside the submitted work: royalties from EOS imaging, he is Co-founder of the company Spinologics Inc., he received consultancy fees from K2M, Medtronic and DePuy Synthes Spine, he received grants from DePuy Synthes Spine, Canadian Institutes of Health Research, Pediatric Orthopaedic Society of North America, Scoliosis Research Society, Medtronic, EOS imaging, Canadian Foundation for Innovation, Setting Scoliosis Straight Foundation, Natural Sciences and Engineering Council of Canada, Fonds de recherche Québec—Santé, grants and Orthopaedic Research and Education Foundation, he received fellowship support from DePuy Synthes and Medtronic, he is the holder of the Academic Chair in Pediatric Spinal Deformities of CHU Ste-Justine, he is member of speaker bureau of Orthopaediatrics. JS has received financial interests from Statera Medical, research grant from Scoliosis Research Society and research support from Centre de Recherche du Centre Hospitalier de l'Université de Montréal. JJ, and SB declare that they have no conflict of interest. HL is the co-founder of the company Spinologics Inc.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the ethics Committee of the CHU Sainte-Justine.

Consent to participate

All research participants or their legal guardians provided written consent to be a part of the database and have the data collected be used in ongoing research on scoliosis.

Consent for publication

We obtained consent from the responsible authorities to submit this scientific work.

IRB approval

Institutional Review Board approval was obtained for this study from CHU Sainte-Justine IRB.

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Dionne, A., Mac-Thiong, JM., Parent, S. et al. Clinical and radiological outcomes of gradual reduction and circumferential fusion of high-grade spondylolisthesis in adolescents: a prospective cohort study of 29 young patients. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00884-1

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