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High-grade lumbosacral spondylolisthesis reduction and fusion in children using transsacral rod fixation

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Abstract

Purpose

There is no consensus on how to treat surgically high-dysplastic developmental spondylolisthesis in children and adolescents. Although reducing spinal deformity seems mandatory, the issue of surgical reduction versus in situ fusion remains controversial.

Methods

The files of 12 consecutive patients surgically treated for a grade 3 or 4 spondylolisthesis were reviewed. The treatment consisted in L4 to sacrum reduction and fusion by posterior approach. The reduction of lumbopelvic imbalance was made intraoperatively using a trans-sacral rod fixation technique.

Results

Mean preoperative L5 anterior slippage was 72.3 % (60 to 95 %). The mean preoperative lumbosacral tilt angle was 70.5° (43 to 92°). Mean final lumbosacral tilt angle was 102° (91 to 114°). Mean final L5 anterior slippage was 19 % (7 to 63 %). Neurological complications (radicular L5 or S1 deficits) were noted in five patients. At final follow-up L4 to S1 fusion was achieved in all patients. No patient had persistent deficit or radicular pain.

Conclusions

The fusion rate in our series proved to be optimal. Thanks to the trans-sacral rod fixation, lumbosacral kyphosis correction was very good. The intrasacral positioning of the screws reduces the risk of implant prominence especially in such pediatric patients. We stress the importance to avoid complete slip reduction in such patients to minimize stretching on L5 and S1 roots. No additional immobilization is needed due to solid posterior instrumentation. Doing such procedure only by posterior approach avoids anterior approach-related complications.

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Conflicts of interest

The authors confirm that there are no known conflicts of interest associated with this work.

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Authors and Affiliations

  1. Université Pierre et Marie Curie Paris6, Department of Pediatric Orthopedics, Armand Trousseau Hospital, 26 avenue du Dr Arnold Netter, Cedex 12, 75571, Paris, France

    Benjamin Bouyer, Manon Bachy, Eric Dromzee, Pierre Mary & Raphaël Vialle

  2. Department of Pediatric Orthopaedics, Grenoble University Hospital, BP 217 Cedex, Grenoble, France

    Aurélien Courvoisier

Authors
  1. Benjamin Bouyer
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  2. Manon Bachy
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  3. Aurélien Courvoisier
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  4. Eric Dromzee
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  6. Raphaël Vialle
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Correspondence to Raphaël Vialle.

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Bouyer, B., Bachy, M., Courvoisier, A. et al. High-grade lumbosacral spondylolisthesis reduction and fusion in children using transsacral rod fixation. Childs Nerv Syst 30, 505–513 (2014). https://doi.org/10.1007/s00381-013-2260-z

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  • DOI: https://doi.org/10.1007/s00381-013-2260-z

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