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A novel less invasive endoscopic-assisted procedure for complete reduction of low-and high-grade isthmic spondylolisthesis performed by anterior and posterior combined approach

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Abstract

Purpose

The optimal surgical management of low- and high-grade isthmic spondylolisthesis (LGS and HGS -IS) is debated as well as whether reduction is needed especially for high-grade spondylolisthesis.

Both anterior and posterior techniques can be associated with mechanical disadvantages as hardware failure with loss of reduction and L5 injury. We purpose a novel endoscopic-assisted technique (Sled technique, ST) to achieve a

complete reduction in two surgical steps: first anteriorly through a retroperitoneal approach to obtain the greatest part of correction and then posteriorly to complete reduction in the same operation.

Methods

ST efficacy and complications rate were evaluated through a retrospective functional and radiological analysis.

Results

Thirty-one patients, 12 male (38.7%) and 19 female (61.3%), average age: 45.4 years with single level IS underwent olisthesis reduction by ST. Twenty-three IS involved L5 (74.2%), 7 L4 (22.5%) and 1 L3 (3.3%). No intraoperative complications were recorded. One patient required repositioning of a pedicle screw.

A significant improvement of functional and radiological parameters (L4-S1 and L5-S1 lordosis) outcomes was recorded (p < 0.001).

Conclusion

ST provides a complete reduction in the slippage in LGS and HGS. The huge anterior release as well as the partial reduction in the slippage by the endoscopic-assisted anterior procedure, because of the cage is acting as a “guide rail”, facilitate the final posterior reduction, always complete in our series, minimizing mechanical stresses and neurological risks.

ClinicalTrials.gov Identifier: NCT03644407.

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Data availability

No data have been fabricated or manipulated (including images) to support our conclusions. No data, text, or theories by others are presented as if they were the author’s own (“plagiarism”).

Code availability

‘Not applicable’ for that section.

References

  1. Beck AW, Simpson AK (2019) High-grade lumbar spondylolisthesis. Neurosurg Clin N Am 30(3):291–298

    Article  PubMed  Google Scholar 

  2. Camino Willhuber G, Kido G (2020) Classifications in brief: the spinal deformity study group classification of lumbosacral spondylolisthesis. Clin Orthop Relat Res 478(3):681–684

    Article  PubMed  Google Scholar 

  3. Marchetti PG, Bartolozzi P (1997) Classification of spondylolisthesis as a guideline for treatment. In: Bridwell KH, Dewald RL, Hammerberg KW et al (eds) Textbook of spinal surgery, 2nd edn. Lippincott-Raven, Philadelphia, pp 1211–1254

    Google Scholar 

  4. Kreiner DS, Baisden J, Mazanec DJ et al (2016) Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis. Spine J Off J North Am Spine Soc 16(12):1478–1485

    Article  Google Scholar 

  5. Kunze KN, Lilly DT, Khan JM et al (2020) High-grade spondylolisthesis in adults: current concepts in evaluation and management. Int J Spine Surg 14(3):327–340

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rivollier M, Marlier B, Kleiber JC, Eap C et al (2020) Surgical treatment of high-grade spondylolisthesis: technique and results. J Orthop 22:383–389

    Article  PubMed  PubMed Central  Google Scholar 

  7. Meyerding H (1932) Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet 54:371–377

    Google Scholar 

  8. Hanson DS, Bridwell KH, Rhee JM et al (2002) Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis. Spine 27(18):2026–2029

    Article  PubMed  Google Scholar 

  9. Lamartina C (2001) A square to indicate the unstable zone in severe spondylolisthesis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sec Cerv Spine Res Soc 10(5):444–448

    Article  CAS  Google Scholar 

  10. Hresko MT, Labelle H, Roussouly P, Berthonnaud E (2007) Classification of high-grade spondylolistheses based on pelvic version and spine balance: possible rationale for reduction. Spine 32(20):2208–2213

    Article  PubMed  Google Scholar 

  11. Labelle H, Roussouly P, Chopin D, Berthonnaud E et al (2008) Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sec Cerv Spine Res Soc 17(9):1170–1176

    Article  Google Scholar 

  12. Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sec Cerv Spine Res Soc 23(6):1177–1189

    Article  Google Scholar 

  13. Alhammoud A, Schroeder G, Aldahamsheh O et al (2019) functional and radiological outcomes of combined anterior-posterior approach versus posterior alone in management of isthmic spondylolisthesis. A systematic review and meta-analysis. Int J Spine Surg 13(3):230–238

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kasliwal MK, Smith JS, Shaffrey CI et al (2012) Short-term complications associated with surgery for high-grade spondylolisthesis in adults and pediatric patients: a report from the scoliosis research society morbidity and mortality database. Neurosurgery 71(1):109–116

    Article  PubMed  Google Scholar 

  15. Passias PG, Poorman CE, Yang S et al (2015) Surgical treatment strategies for high-grade spondylolisthesis: a systematic review. Int J Spine Surg 9:50

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bassani R, Morselli C, Querenghi AM et al (2020) Functional and radiological outcome of anterior retroperitoneal versus posterior transforaminal interbody fusion in the management of single-level lumbar degenerative disease. Neurosurg Focus 49(3):E2

    Article  PubMed  Google Scholar 

  17. Schar RT, Sutter M, Mannion AF et al (2017) Outcome of l5 radiculopathy after reduction and instrumental transforaminal lumbar interbody fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative neurophysiological monitoring. Eur Spine J 26(3):679–690

    Article  PubMed  Google Scholar 

  18. Dowlati E, Alexander H, Voyadzis JM (2020) Whereas the vulnerability of the L5 nerve root during anterior lumbar interbody fusion at L5–S1: case series and review of the literature. Neurosurg Focus 49(3):E7

    Article  PubMed  Google Scholar 

  19. Dubousset J (1997) Treatment of spondylolysis and spondylolisthesis in children and adolescents. Clin Orthop Relat Res 337:77–85

    Article  Google Scholar 

  20. Bassani R, Morselli C, Baschiera R et al (2021) New trends in spinal surgery: less invasive anatomical approach to the spine. The advantages of the anterior approach in lumbar spinal fusion. Turk Neurosurg 31(4):484–492

    PubMed  Google Scholar 

  21. Bassani R, Gregori F, Peretti G (2019) Evolution of the anterior approach in lumbar spine fusion. World Neurosurg 131:391–398

    Article  PubMed  Google Scholar 

  22. Phan K, Xu J, Scherman DB, Rao PJ, Mobbs RJ (2017) Anterior lumbar interbody fusion with and without an “access surgeon”: a systematic review and meta-analysis. Spine (Phila Pa 1976) 42(10):E592–E601

    Article  PubMed  Google Scholar 

  23. Bassani R, Querenghi AM, Cecchinato R et al (2018) A new “keyhole” approach for multilevel anterior lumbar interbody fusion: the perinavel approach-technical note and literature review. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sec Cerv Spine Res Soc 27(8):1956–1963

    Article  CAS  Google Scholar 

  24. Poussa M, Schlenzka D, Seitsalo S et al (1993) Surgical treatment of severe isthmic spondylolisthesis in adolescents. Reduction or fusion in situ. Spine 18(7):894–901

    Article  CAS  PubMed  Google Scholar 

  25. Ishak B, Kikuta S, Scullen T et al (2021) Does the L5 spinal nerve move? Anatomical evaluation with implications for postoperative L5 nerve palsy. Surgi Radiol Anat: SRA 43(6):813–818

    Article  Google Scholar 

  26. Lin YT, Su KC, Chen KH et al (2021) Biomechanical analysis of reduction technique for lumbar spondylolisthesis: anterior lever versus posterior lever reduction method. BMC Musculoskelet Disord 22(1):879

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jaeger A, Giber D, Bastard C et al (2019) Risk factors of instrumentation failure and pseudarthrosis after stand-alone L5–S1 anterior lumbar interbody fusion: a retrospective cohort study. J Neurosurg Spine 31(3):338–346

    PubMed  Google Scholar 

  28. Bradford DS (1979) Treatment of severe spondylolisthesis. A combined approach for reduction and stabilization. Spine 4(5):423–429

    Article  CAS  PubMed  Google Scholar 

  29. Tu KC, Shih CM, Chen KH et al (2021) Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique-surgical technique note and preliminary results. BMC Musculoskelet Disord 22(1):559

    Article  PubMed  PubMed Central  Google Scholar 

  30. Yang J, Peng Z, Kong Q et al (2022) Stretch on the L5 nerve root in high-grade spondylolisthesis reduction. J Neurosurg Spine 1:1–9

    Google Scholar 

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Funding

The authors have no personal financial or institutional interest (financial or non-financial) in any of the drugs, materials, or devices described in this article.

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Authors and Affiliations

  1. Spine Surgery II, IRCCS Ospedale Galeazzi Sant’Ambrogio, Via Cristina Belgioioso, 173, 20157, Milan, Italy

    Roberto Bassani, Carlotta Morselli, Agostino Cirullo & Giuseppe Maria Peretti

  2. Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy

    Andrea Pezzi

  3. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Giuseppe Maria Peretti

Authors
  1. Roberto Bassani
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  2. Carlotta Morselli
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  3. Agostino Cirullo
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  4. Andrea Pezzi
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  5. Giuseppe Maria Peretti
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Correspondence to Carlotta Morselli.

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This research did not receive any specific grant from founding, agencies in the public, commercial, or not-for-profit sectors. Any acknowledgments for grants technical support or corporate support were necessary.

Ethical approval

Ethic Committee approval was not requested for this study. Clinical and Radiological de-identified registries were used to track patients care and outcome without a direct patient involvement even if all patients gave their written informed consent to publish their data for the Institutional Spine registry: (Galeazzi Spine Surgery Registry “SPINEREG”).

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Informed consent was obtained from each patient included in the study. Copyright to reproduce materials was not necessary.

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Bassani, R., Morselli, C., Cirullo, A. et al. A novel less invasive endoscopic-assisted procedure for complete reduction of low-and high-grade isthmic spondylolisthesis performed by anterior and posterior combined approach. Eur Spine J 32, 2819–2827 (2023). https://doi.org/10.1007/s00586-023-07666-9

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  • DOI: https://doi.org/10.1007/s00586-023-07666-9

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