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Single-level fusion without decompression for high-grade spondylolithesis in adolescents: a novel surgical strategy

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Abstract

Purpose

There is no consensus on the optimal surgical treatment for high-grade spondylolisthesis (HGS) in adolescents. The purpose of this study was to assess the radiographic and clinical outcomes of a novel surgical approach to HGS consisting of a single-level anterior reduction, placement of a lordotic cage, and circumferential fixation without decompression.

Methods

This was a retrospective consecutive case series of 11 adolescents who underwent anterior reduction through placement of a lordotic cage followed by posterior fusion using pedicle screws and rods confined to L5–S1. Radiographic data included slip percentage, slip angle, lumbar lordosis, and pelvic sagittal parameters assessed at clinical visits preoperatively and at 2 years postoperatively. A telephone survey was conducted to obtain current information about function, activity level, work status, and retrograde ejaculation.

Results

Patients were followed for an average of 7.8 years (range 2–16). Mean age was 15.5 years (range 12–19). The mean percent slip corrected from 55 to 18%. The average slip angle was + 17.1° preoperatively and − 14.1° at final assessment (average correction of 20.7°). Thirty-six percent (4/11) of patients improved by three Meyerding grades and an additional 55% (6/11) improved by two grades. Complications included one instance each of superficial infection, wound dehiscence, and transient neuralgia. There were no cases of instrumentation failure, cage subsidence, pseudoarthrosis, or retrograde ejaculation. Radiographic evidence of fusion was observed in all cases.

Conclusion

Single-level anterior reduction and circumferential fusion without decompression appears to be a safe and effective alternative for the surgical treatment of pediatric HGS.

Level of evidence

IV.

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Data availability

The original/raw data for main outcomes presented in the paper can be found in Table 2.

Code availability

Not applicable.

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Acknowledgements

The authors thank Amy Bronstone, PhD, for assistance with editing the manuscript, Jarrod Brown and Austin Wheeler for assistance with data collection, and Darlene Guillot for creating the medical illustrations.

Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Children’s Hospital, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Box T6-7, New Orleans, LA, 70112, USA

    Michael J. Heffernan & Andrew G. S. King

  2. Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch (UTMB), 301 University Blvd. 2.336 Rebecca Sealy, Galveston, TX, 77555, USA

    Pouya Alijanipour

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  1. Pouya Alijanipour
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Contributions

A, H, K: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. A, H, K: Drafted the work or revised it critically for important intellectual content. A, H, K: Approved the version to be published. A, H, K: Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Andrew G. S. King.

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Conflict of interest

Dr. King reports having received payment from by Medicrea to attend a meeting outside the scope of this work. All other authors have nothing to disclose.

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. Approval was granted by the Institutional Review Board of the University of Louisiana Health Sciences Center (FWA 00002762).

Informed consent

In view of the retrospective nature of the study, the fact that all the procedures and measures being performed were part of routine care, and that data were de-identified, the IRB did not require informed consent.

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The authors affirm that the human research participant provided signed consent for publication of the images in Figs. 2,  3.

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Alijanipour, P., Heffernan, M.J. & King, A.G.S. Single-level fusion without decompression for high-grade spondylolithesis in adolescents: a novel surgical strategy. Spine Deform 9, 1457–1464 (2021). https://doi.org/10.1007/s43390-021-00352-0

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