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Results of Surgical Treatment of Pediatric Spondylolysis and Spondylolisthesis

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Spondylolisthesis

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Abstract

Patients with low-grade spondylolysis or spondylolisthesis rarely require surgery, as a majority respond to activity modification, NSAIDs, or physical therapy. For symptomatic patients who do not respond to conservative measures, surgical management is indicated. This may be accomplished with direct pars interarticularis repair by compression screw, wiring technique, sublaminar-hook-screw construct, or modifications thereof. Additionally, posterolateral fusion with or without instrumentation offers similar subjective, clinical, and functional long-term outcomes to direct repair with a trade-off of longer surgical time with greater exposure needed. Overall, both procedures offer good and excellent outcomes. The use of instrumentation has not been shown to improve posterolateral fusion rates or clinical outcomes in patients with low-grade disease. For patients with high-grade slip, in situ fusion or reduction and fusion are both valid options and depend upon surgeon experience and underlying patient function and neurologic status. For patients undergoing reduction, wide decompression and instrumentation with circumferential fusion provide stable long-term results. Interbody fusion techniques show greater long-term fusion rates, achieve greater reduction, and appear to have higher functional outcome compared to posterior-only fusion. Reduction carries increased risk of neurologic injury, but the majority of these resolve. Long-term follow-up comparing in situ fusion to reduction with fusion of high-grade spondylolisthesis has shown improved ODI and SRS scores with fusion in situ. Grade V spondylolisthesis presents several unique challenges for surgical repair and may be fused in situ from an anterior or posterior approach, with partial reduction, or Gaines procedure.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Arjun Gupta

  2. Department of Orthopaedic Surgery, John Hopkins Bloomberg Children’s Hospital, Baltimore, MD, USA

    Paul D. Sponseller

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  1. Stryker Spine, Brookfield, CT, USA

    Adam L. Wollowick

  2. Department of Orthopedic Surgery, Northwell Health, New Hyde Park, NY, USA

    Vishal Sarwahi

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Gupta, A., Sponseller, P.D. (2023). Results of Surgical Treatment of Pediatric Spondylolysis and Spondylolisthesis. In: Wollowick, A.L., Sarwahi, V. (eds) Spondylolisthesis. Springer, Cham. https://doi.org/10.1007/978-3-031-27253-0_28

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