Abstract
Purpose
In 1994, the technique of transdiscal screws fixation in spondylolisthesis was introduced but did not gained popularity as it failed to address problems with spinal sagittal imbalance, retroverted pelvis, pseudoarthrosis, implant failure and neural injury. Majority of problems were due to lack of clear indications; hence, in this study, with modification of traditional technique and use of O-arm navigation for selected group of patients, we have addressed the above problems and given good to excellent functional outcomes.
Methods
We did prospective study on 15 patients with osteoporotic high-grade spondylolisthesis Meyerding grade 3 & 4 admitted in period 2020–2021. Intraoperative assessment was done in form of blood loss, incision length, operative time and complications. The preoperative & postoperative assessment was done in the form of clinical and radiological parameters.
Results
The average follow-up was of 21.2 months (18–24 months). There was no significant difference between pre- & postoperative spinopelvic parameters. Intraoperative average blood loss was 100 ml (90–120 ml) with mean surgical time of 138 min (120–150 min). Incision length was about 5–6-cms-posterior midline with two paraspinal 1-cm incisions for transdiscal screws. Patients were mobilized on postoperative day-2. There was statistically significant improvement in mean ODI, COMI and VAS for LBP and radicular pain with no intra- or postoperative complication observed till latest follow-up with all patients showing solid monoblock fusion on 1-year follow-up CT scan.
Conclusions
LIMO delta technique is a newly modified version of conventional transdiscal screw technique. Minimal incision, decreased blood loss & operative time with in situ 3-column rigid fixation and solid fusion minimizing risk of complications makes this novel technique safer, simpler & effective in osteoporotic HGS.
Similar content being viewed by others
References
Koslosky E, Gendelberg D (2020) Classification in brief: the Meyerding classification system of spondylolisthesis. Clin Orthop Relat Res 478(5):1125–1130. https://doi.org/10.1097/CORR.0000000000001153
Labelle H, Roussouly P, Berthonnaud E, Transfeldt E, O’Brien M, Chopin D, Hresko T, Dimnet J (2004) Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine Phila Pa 1976 29(18):2049–2054. https://doi.org/10.1097/01.brs.0000138279.53439.cc
Gill GG, Manning JG, White HL (1955) Surgical treatment of spondylolisthesis without spine fusion; excision of the loose lamina with decompression of the nerve roots. J Bone Joint Surg 37(A3):493–520
König MA, Boszczyk BM (2012) Limited access surgery for 360 degrees in-situ fusion in a dysraphic patient with high-grade spondylolisthesis. Eur Spine J 21(3):390–395
Ani N, Keppler L, Biscup RS, Steffee AD (1991) Reduction of high-grade slips (grades III-V) with VSP instrumentation report of a series of 41 cases. Spine 16:S302–S310. https://doi.org/10.1097/00007632-199106001-00025
Bohlman HH, Cook SS (1982) One-stage decompression and posterolateral and interbody fusion for lumbosacral spondyloptosis through a posterior approach Report of two cases. J bone Joint Surg 64(3):415–418
Roca J, Ubierna MT, Cáceres E, Iborra M (1999) One-stage decompression and posterolateral and interbody fusion for severe spondylolisthesis an analysis of 14 patients. Spine 24(7):709–714. https://doi.org/10.1097/00007632-199904010-00019
Abdu WA, Wilber RG, Emery SE (1994) Pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis. A New Tech Stabilization Spine 19(6):710–715. https://doi.org/10.1097/00007632-199403001-00011
Kasliwal MK, Smith JS, Kanter A, Chen CJ, Mummaneni PV, Hart RA, Shaffrey CI (2013) Management of high-grade spondylolisthesis. Neurosurg Clin N Am 24(2):275–291. https://doi.org/10.1016/j.nec.2012.12.002
Palejwala A, Fridley J, Jea A (2016) Transsacral transdiscal L5–S1 screws for the management of high-grade spondylolisthesis in an adolescent. J Neurosurg Pediatr 17(6):645–650. https://doi.org/10.3171/2015.12.PEDS15535
Joaquim AF, Patel AA (2018) Posterior L5–S1 transdiscal screws for high grade spondylolisthesis - a systematic review. Revista da Associacao Medica Brasileira 1992 64(12):1147–1153. https://doi.org/10.1590/1806-9282.64.12.1147
Bouyer B, Bachy M, Courvoisier A, Dromzee E, Mary P, Vialle R (2014) High- grade lumbosacral spondylolisthesis reduction and fusion in children using transsacral rod fixation. Childs Nerv Syst 30(3):505–513
Lamberg T, Remes V, Helenius I, Schlenzka D, Seitsalo S, Poussa M (2007) Uninstrumented in situ fusion for high-grade childhood and adolescent isthmic spondylolisthesis: long-term outcome. J Bone Joint Surg Am 89(3):512–518. https://doi.org/10.2106/JBJS.G.01186
Lamartina C (2010) Posterior instrumentation, reduction and fusion in spondyloptosis. Eur Spine J 19(10):1799–1800. https://doi.org/10.1007/s00586-010-1570-z
Poussa M, Remes V, Lamberg T, Tervahartiala P, Schlenzka D, Yrjönen T, Osterman K, Seitsalo S, Helenius I (2006) Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine 31(5):583–592. https://doi.org/10.1097/01.brs.0000201401.17944.f7
Transfeldt EE, Mehbod AA (2007) Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips. Spine 32(19 Suppl):S126–S129. https://doi.org/10.1097/BRS.0b013e318145b353
Rodriguez-Olaverri JC, Zimick NC, Merola A, Vicente J, Rodriguez J, Tabuenca A, Loste A, Suñen E, Burgos J, Hevia E, Piza-Vallespir G (2008) Comparing the clinical and radiological outcomes of pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis versus unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior cages. Spine 33(18):1977–1981. https://doi.org/10.1097/BRS.0b013e31817ecc01
Collados-Maestre I, Lizaur-Utrilla A, Bas-Hermida T, Pastor-Fernandez E, Gil-Guillen V (2016) Transdiscal screw versus pedicle screw fixation for high-grade L5–S1 isthmic spondylolisthesis in patients younger than 60 years: a case-control study. European spine J 25(6):1806–1812. https://doi.org/10.1007/s00586-016-4550-0
Grob D, Humke T, Dvorak J (1996) Direct pediculo-body fixation in cases of spondylolisthesis with advanced intervertebral disc degeneration. European spine J 5(4):281–285. https://doi.org/10.1007/BF00301335
Weiser L, Huber G, Sellenschloh K, Viezens L, Püschel K, Morlock MM, Lehmann W (2017) Insufficient stability of pedicle screws in osteoporotic vertebrae: biomechanical correlation of bone mineral density and pedicle screw fixation strength. European Spine J 26(11):2891–2897. https://doi.org/10.1007/s00586-017-5091-x
Boachie-Adjei O, Do T, Rawlins BA (2002) Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: clinical and radiographic results in six patients. Spine 27(6):E161–E168. https://doi.org/10.1097/00007632-200203150-00019
Francois J, Lauweryns P, Fabry G (2005) Treatment of high- grade spondylolisthesis by posterior lumbosacral transfixation with transdiscal screws: surgical technique and preliminary results in four cases. Acta Orthop Belg 71:334–341
Ruland CM, McAfee PC, Warden KE, Cunningham BW (1991) Triangulation of pedicular instrumentation. A Biomech Anal Spine 16(6 Suppl):S270–S276. https://doi.org/10.1097/00007632-199106001-00019
Minamide A, Akamaru T, Yoon ST, Tamaki T, Rhee JM, Hutton WC (2003) Transdiscal L5–S1 screws for the fixation of isthmic spondylolisthesis: a biomechanical evaluation. J Spinal Disord Tech 16(2):144–149. https://doi.org/10.1097/00024720-200304000-00005
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no financial or non-financial disclosers directly or indirectly related to the work submitted for publication.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Hadgaonkar, S., Katkade, S.M., Bhilare, P. et al. Efficacy of less Invasive modified O-arm navigated delta fixation in osteoporotic high-grade spondylolisthesis: “a LIMO delta technique”. Eur Spine J 32, 1393–1400 (2023). https://doi.org/10.1007/s00586-023-07594-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-023-07594-8