International Orthopaedics

, Volume 40, Issue 6, pp 1127–1133 | Cite as

Operative management of high-grade dysplastic L5 spondylolisthesis with the use of external transpedicular fixation: advantages and drawbacks

  • Oksana G. Prudnikova
  • Elena N. ShchurovaEmail author
Original Paper



The aim of our study was to analyze clinical and radiographic outcomes of operative management of L5 high-grade dysplastic spondylolisthesis with the apparatus for external transpedicular fixation (AETF), and to compare the results of its use for reduction and spondylodesis.


There were 13 patients with L5 dysplastic spondylolisthesis of grade 4 (Meyerding grading) and having a mean age of 25.0 ± 3.6 years. The management included two stages: gradual reduction with the AETF, followed by either isolated anterior spondylodesis with the same AETF (group 1, n = 8), or by spondylodesis using a combined method (internal transpedicular instrumentation and posterior lumbar interbody fusion [PLIF]) (group 2, n = 5). Clinical evaluation included pain (VAS scale) and functional status (Oswestry questionnaire [ODI]). Reduction and fusion completeness were assessed radiographically after treatment and at a mean follow-up of 2.1 ± 0.4 years.


Initial slippage was reduced by 51.6 % with AETF and was of grade 1 or 2. Reduction made up 31.1 % at follow-ups (grade 2 or 3). Pain decreased by 57.6 % (p < 0.01). The functional status improved. ODI decreased by 37.7 % (p < 0.01) after treatment and by 41.7 % (p < 0.01) at follow-ups. Fusion at the level of the involved segment was poor in group 1. All the cases fused in group 2.


The use of AETF for L5 high-grade dysplastic spondylolisthesis provides gradual controlled reduction of the slipped vertebra, decompression of cauda equine roots, and recovery of the local sagittal spinal column balance. It creates conditions for achieving stability of lumbosacral segments with combined spondylodesis (internal transpedicular instrumentation and PLIF). AETF is not suitable for spondylodesis due to a high rate of pseudarthrosis.


High-grade dysplastic spondylolisthesis Reduction Apparatus for transpedicular external fixation Spondylodesis Pseudarthrosis 


Compliance with ethical standards

Informed consent statements were given by all the parents. The study was approved by the ethics committee of our institution and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Conflicts of interest



  1. 1.
    Martiniani M, Lamartina C, Specchia N (2012) “In situ” fusion or reduction in high-grade high dysplastic developmental spondylolisthesis (HDSS). Eur Spine J 21(1):134–140. doi: 10.1007/s00586-012-2230-2 CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Min K, Liebscher T, Rothenfluh D (2012) Sacral dome resection and single-stage posterior reduction in the treatment of high-grade high dysplastic spondylolisthesis in adolescents and young adults. Eur Spine J 21(6):785–791. doi: 10.1007/s00586-011-1949-5 CrossRefGoogle Scholar
  3. 3.
    Bouyer B, Bachy M, Courvoisier A, Dromzee E, Mary P, Vialle R (2014) High-grade lumbosacral spondylolisthesis reduction and fusion in children using transsacral rod fixation. Childs Nerv Syst 30(3):505–513. doi: 10.1007/s00381-013-2260-z CrossRefPubMedGoogle Scholar
  4. 4.
    Lengert R, Charles YP, Walter A, Schuller S, Godet J, Steib JP (2014) Posterior surgery in high-grade spondylolisthesis. Orthop Traumatol Surg Res 100(5):481–484. doi: 10.1016/j.otsr.2014.03.018 CrossRefPubMedGoogle Scholar
  5. 5.
    Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V (2014) Evidence-based surgical management of spondylolisthesis: reduction or arthrodesis in situ. J Bone Joint Surg Am 96(1):53–58. doi: 10.2106/JBJS.L.01012 CrossRefPubMedGoogle Scholar
  6. 6.
    Mehdian SM, Arun R, Jones A, Cole AA (2005) Reduction of severe adolescent isthmic spondylolisthesis: a new technique. Spine 30(19):579–584CrossRefGoogle Scholar
  7. 7.
    Agabegi SS, Fischgrund JS (2010) Contemporary management of isthmic spondylolisthesis: pediatric and adult. Spine J 10(6):530–543. doi: 10.1016/j.spinee.2010.02.023 CrossRefPubMedGoogle Scholar
  8. 8.
    Verbiest H (1979) The treatment of lumbar spondyloptosis orimpending lumbar spondyloptosis accompanied by neurologic deficit and/or neurogenic intermittent claudication. Spine 4(1):68–77CrossRefPubMedGoogle Scholar
  9. 9.
    Frennered AK, Danielson BI, Nachemson AL, Nordwall AB (1991) Midterm follow-up of young patients fused in situ for spondylolisthesis. Spine 16(4):409–416CrossRefPubMedGoogle Scholar
  10. 10.
    Transfeldt EE, Mehbod AA (2007) Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips. Spine 32(19):126–129CrossRefGoogle Scholar
  11. 11.
    Harrington PR, Tullos HS (1971) Spondylolisthesis in children. Observations and surgical treatment. Clin Orthop Relat Res 79:75–84CrossRefPubMedGoogle Scholar
  12. 12.
    Bradford DS (1979) Treatment of severe spondylolisthesis: a combined approach for reduction and stabilization. Spine 4(5):423–429CrossRefPubMedGoogle Scholar
  13. 13.
    Boos N, Marchesi D, Zuber K, Aebi M (1993) Treatment of severe spondylolisthesis by reduction and pedicular fixation. A 4–6 year follow-up study. Spine 18(12):1655–1661. doi: 10.1097/00007632-199309000-00014 CrossRefPubMedGoogle Scholar
  14. 14.
    Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation after decompression in spondylolytic spondylolisthesis. Spine 22(2):210–219. doi: 10.1097/00007632-199701150-00016 CrossRefPubMedGoogle Scholar
  15. 15.
    Marchetti PG, Bartolozzi P (1997) Classification of spondylolisthesis as a guideline for treatment. In: Bridwell KH, DeWald RL (eds) The textbook of spinal surgery, 2nd edn. Lippincott-Raven, Philadelphia, pp 1211–1254Google Scholar
  16. 16.
    Brown CA, Eismont FJ (1998) Complications in spinal fusion. Orthop Clin North Am 29(4):679–699CrossRefPubMedGoogle Scholar
  17. 17.
    Bartolozzi P, Sandri A, Cassini M, Ricci M (2003) One-stage posterior decompression-stabilisation and trans-sacral interbody fusion after partial reduction for severe L5–S1 spondylolisthesis. Spine 28(11):1135–1141PubMedGoogle Scholar
  18. 18.
    Meyerding HW (1932) Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet 54:371–377Google Scholar
  19. 19.
    Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66(8):271–273PubMedGoogle Scholar
  20. 20.
    Labelle H, Mac-Thiong J, Roussouly P (2011) Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J 20(5):641–646. doi: 10.1007/s00586-011-1932-1 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lamberg T, Remes V, Helenius I, Schlenzka D, Seitsalo S, Poussa M (2007) Uninstrumented in situ fusion for high-grade childhood and adolescent isthmic spondylolisthesis: long-term outcome. J Bone Joint Surg Am 89(3):512–518CrossRefPubMedGoogle Scholar
  22. 22.
    Umehara S, Zindrick MR, Patwardhan AG, Havey RM, Vrbos LA, Knight GW, Miyano S, Kirincic M, Kaneda K, Lorenz MA (2000) The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine 25(13):1617–1624. doi: 10.1097/00007632-200007010-00004 CrossRefPubMedGoogle Scholar
  23. 23.
    Akamaru T, Kawahara N, Yoon ST, Minamide A, Su Kim K, Tomita K, Hutton WC (2003) Adjacent segment motion after a simulated lumbar fusion in different sagittal alignments. Spine 28(14):1560–1566. doi: 10.1097/00007632-200307150-00016 PubMedGoogle Scholar
  24. 24.
    Sasso RC, Shively KD, Reilly TM (2008) Transvertebral transsacral strut grafting for high-grade isthmic spondylolisthesis L5-S1 with fibular allograft. J Spinal Disord Tech 21(5):328–233. doi: 10.1097/BSD.0b013e318149e7ea CrossRefPubMedGoogle Scholar
  25. 25.
    Bradford DS, Gotfried Y (1987) Staged salvage reconstruction of grade-IV and V spondylolisthesis. J Bone Joint Surg Am 69(2):191–202PubMedGoogle Scholar
  26. 26.
    Labelle H, Roussouly P, Chopin D, Berthonnaud E, Hresko T, O’Brien M (2008) Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J 17(9):1170–1176. doi: 10.1007/s00586-008-0713-y CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lamartina C, Zavatsky JM, Petruzzi M, Specchia N (2009) Novel concepts in the evaluation and treatment of high-dysplastic spondylolisthesis. Eur Spine J 18(1):133–142CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Vialle R, Miladi L, Wicart P, Dubousset J (2005) Surgical treatment of lumbosacral spondylolisthesis with major displacement in children and adolescents: a continuous series of 20 patients with mean 5-year follow-up. Rev Chir Orthop Reparatrice Appar Mot 91(1):5–14CrossRefPubMedGoogle Scholar
  29. 29.
    Hresko MT, Hirschfeld R, Buerk A, Zurakowski D (2009) The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop 29(2):157–162. doi: 10.1097/BPO.0b013e3181977de8 CrossRefPubMedGoogle Scholar
  30. 30.
    Shevtsov VI, Khudyaev AT, Lyulin SV, Rossik OS (2005) Treatment of spondylolisthesis with a device for external transpedicular spinal fixation. Spine Surg 3:97–100, Google Scholar
  31. 31.
    Doita M, Uno K, Maeno K, Shimomura T, Nishida K, Fujioka H, Kurosaka M (2008) Two-stage decompression, reduction, and interbody fusion for lumbosacral spondyloptosis through a posterior approach using Ilizarov external fixation. J Neurosurg Spine 8(2):186–192. doi: 10.3171/SPI/2008/8/2/186 CrossRefPubMedGoogle Scholar
  32. 32.
    Karampalis C, Grevitt M, Shafafy M, Webb J (2012) High-grade spondylolisthesis: gradual reduction using Magerl’s external fixator followed by circumferential fusion technique and long-term results. Eur Spine J 21(2):200–206. doi: 10.1007/s00586-012-2190-6 CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Abumi K, Panjabi MM, Duranceau J (1989) Biomechanical evaluation of spinal fixation devices. Part III Stability provided by six spinal fixation devices and interbody bone graft. Spine 14(11):1249–1255CrossRefPubMedGoogle Scholar
  34. 34.
    Hu S, Bradford DS, Transfeldt EE, Cohen V (1996) Reduction of high-grade spondylolisthesis using Edwards instrumentation. Spine 21(3):367–371CrossRefPubMedGoogle Scholar
  35. 35.
    Schollner D (1990) One stage reduction and fusion for spondylolisthesis. Int Orthop 14(2):145–150CrossRefPubMedGoogle Scholar
  36. 36.
    Johnson JR, Kirwan EO (1983) The long-term results of fusion in situ for severe spondylolisthesis. J Bone Joint Surg (Br) 65(1):43–46Google Scholar
  37. 37.
    Freeman BL 3rd, Donati NL (1989) Spinal arthrodesis for severe spondylolisthesis in children and adolescents. A long-term follow-up study. J Bone Joint Surg Am 71(4):594–598PubMedGoogle Scholar
  38. 38.
    Ogilvie JW (2005) Complications in spondylolisthesis surgery. Spine 30(6):97–101CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2016

Authors and Affiliations

  1. 1.Russian Ilizarov Scientific Center for Restorative Traumatology and OrthopaedicsKurganRussian Federation

Personalised recommendations