Abstract
Spondyloptosis is a condition characterized by complete slip of one vertebral body over another, more commonly seen at the L5 on S1. High-grade slips and spondyloptosis have been associated with high pelvic incidence which increases the shear forces across the lumbosacral junction which further aggravates the slip angle. Additionally, posterior element defects have been noted in a high percentage of patients. Spondyloptosis is often associated with back pain and symptoms of spinal canal stenosis along with sagittal plan deformity with or without compensatory coronal plane deformity. While conservative management is usually the first line of treatment, surgical intervention is often required to control patient symptoms. The surgical management for high-grade slips including spondyloptosis is controversial and ranges from neural decompression, In situ fusion, partial or complete reduction of slip with or without vertebral resection. In this chapter, we will review the different approaches to this problem described in the literature. The surgeon should tailor the best management for the patient based on symptoms and magnitude of deformity.
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References
Meyerding HW. Low backache and sciatic pain associated with spondylolisthesis and protruded intervertebral disc: incidence, significance and treatment. J Bone Joint Surg. 1941;23:461–70.
Wiltse L, Newman PH, Macnab I. Classification of spondylolysis and spondylolisthesis. Clin Orthop. 1976;117:23.
Curylo LJ, Edwards C, Dewald RW. Radiographic markers in spondyloptosis implications for spondylolisthesis progression. Spine. 2002;27(18):2021–5.
Taillard W. Les Spondylolisthesis chez l'enfant et l'adolescent. Acta Orthop Scand. 1955;24:115.
Boisaubert B, Montigny JP, Duval-Beaupere G, et al. Incidence, sacrum, spondylolisthesis. Rachis. 1997;9:187–92.
Labelle H, Roussouly P, Berthonnaud E, et al. The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine. 2005;30:S27–34.
Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study. J Neurosurg. 2000;93:194–8.
Seitsalo S. Operative and conservative treatment of moderate spondylolisthesis in young patients. J Bone Joint Surg Br. 1990;72:908–13.
Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66:699–707.
Floman Y. Progression of lumbosacral ishtmic spondylolisthesis in adults. Spine. 2000;25:342.
Smith JA, Deviren V, Berven S, et al. Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade l5-s1 spondylolisthesis. Spine. 2001;26:2227–34.
Bradford DS, Boachie-Adjei O. Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long-term follow-up study. J Bone Joint Surg Am. 1990;72:1060–6.
Bradford D. Treatment of severe spondylolisthesis: a combined approach for reduction and stabilization. Spine. 1979;4:423–9.
Bradford D, Gotfried Y. Staged salvage reconstruction of grade IV and V spondylolisthesis. J Bone Joint Surg Am. 1987;69:191–202.
Gaines RW, Nichols WK. Treatment of spondyloptosis by two stage L5 vertebrectomy and reduction of L4 onto S1. Spine. 1985;10:680–6.
Kalra K, et al. A modified Gaines procedure for spondyloptosis. J Bone Joint Surg Br. 2010;92:1589–91.
Vaz G, Roussouly P, Berthonnaud E, et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002;11:80–7.
Di Martino A, et al. Spontaneous fusion of L5 spondyloptosis: should we learn from nature? Spine J. 2012;12(6):529.
Kawahara N, Tomita K, Kobayashi T, et al. Influence of acute shortening on the spinal cord: an experimental study. Spine. 2005;30:613–20.
Bohlman HH, Cook SS. One-stage decompression and posterolateral and interbody fusion for lumbosacral spondyloptosis through a posterior approach. Report of two cases. J Bone Joint Surg Am. 1982;64:415–8.
Laursen M, Thomsen K, Eiskjaer SP, et al. Functional outcome after partial reduction and 360 degree fusion in grade III-V spondylolisthesis in adolescent and adult patients. J Spinal Disord. 1999;12:300–6.
Molinari RW, Bridwell KH, Lenke LG, et al. Anterior column support in surgery for high-grade, isthmic spondylolisthesis. Clin Orthop Relat Res. 2002;394:109–20.
Boxall D, Bradford DS, Winter RB, Moe JH. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg. 1979;61A:479–95.
Ishikawa S, Kumar SJ, Torres BC. Surgical treatment of dysplastic spondylolisthesis. Results after in situ fusion. Spine. 1994;19:1691–6.
Hanson DS, Bridwell KH, Rhee JM, et al. Dowel fibular strut grafts for high-grade dysplastic isthmic spondylolisthesis. Spine. 2002;27:1982–8.
Schoenecker PL, Cole HO, Herring JA, et al. Cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction. J Bone Joint Surg Am. 1990;72:369–77.
Sailhan F, Gollogly S, Roussouly P. The radiographic results and neurologic complications of instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements: a retrospective review of 44 patients. Spine. 2006;31(2):161–9.
Petraco DM, Spivak JM, Cappadona JG, et al. An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction. Spine. 1996;21:1133.
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Maziad, A.M., Boachie-Adjei, O. (2015). Management of Spondyloptosis. In: Wollowick, A., Sarwahi, V. (eds) Spondylolisthesis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7575-1_19
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DOI: https://doi.org/10.1007/978-1-4899-7575-1_19
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