Download PDF
Z Orthop Ihre Grenzgeb 2006; 144(1): 33-39
DOI: 10.1055/s-2005-918189
Wirbelsäule

© Georg Thieme Verlag Stuttgart · New York

Anatomische Reposition und monosegmentale Fusion bei hochgradiger dysplastischer Spondylolisthese L5/S1

Anatomic Reduction and Monosegmental Fusion for High-Grade Developmental Spondylolisthesis L5/S1M. Ruf1 , R. Melcher1 , H. Merk2 , J. Harms1
  • 1Orthopädie und Traumatologie, Wirbelsäulenchirurgie, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
  • 2Klinik für Orthopädische Chirurgie, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
Further Information

Publication History

Publication Date:
23 February 2006 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Einleitung: Die dysplastische Spondylolisthese führt zu einer segmentalen lumbosakralen Kyphosierung mit Retroversion des Sakrums, Hyperlordose der LWS und damit zu einer Beeinträchtigung des gesamten sagittalen Profils. Die Fehlstellung ist während des Wachstums progredient. Die vorliegende retrospektive Studie beschreibt eine operative Technik zur vollständigen Reposition und dokumentiert Ergebnisse. Patienten: 34 Patienten (Durchschnittsalter 16 J 3 M, 10 Männer, 24 Frauen) mit hochgradiger dysplastischer Spondylolisthese L5/S1 (Meyerding 3-5) wurden zwischen Februar 1997 und Juli 2002 operiert. Methode: Die Reposition wurde über eine temporäre transpedikuläre Instrumentation von L4 erzielt, die Schrauben bei L4 am Ende der Operation oder nach 12 Wochen entfernt. Ergebnisse: Der Gleitgrad wurde von durchschnittlich 76 % auf 10 % korrigiert, die segmentale Kyphose L5/S1 von + 21° auf - 7°. Die Sakruminklination betrug präoperativ 34°, postoperativ 43° und 47° bei der letzten Nachuntersuchung. 76 % der Patienten wurden vollständig beschwerdefrei. Bei 4 Patienten musste bei späterer Dekompensation eine Fusion L4/5 durchgeführt werden. Schlussfolgerung: Die beschriebene Operationstechnik ermöglicht eine nahezu anatomische Reposition mit Korrektur sowohl des Ventralgleitens als auch der segmentalen Kyphose. Die Korrektur der lokalen Fehlstellung mit nur monosegmentaler Fusion L5/S1 normalisiert die Gesamtstatik der Wirbelsäule. Das primär gesunde Segment L4/5 kann meist erhalten werden.

Abstract

Introduction: Developmental spondylolisthesis leads to lumbosacral kyphosis with retroversion of the sacrum and lumbar hyperlordosis. The overall sagittal profile of the spine is affected. The deformity is progressive during growth. This retrospective study describes a technique for complete reduction with clinical and radiological evaluation. Patients: Thirty-four patients (mean age 16 years 3 months, 10 males, 24 females) with severe developmental spondylolisthesis L5/S1 (Meyerding grades 3 to 5) were operated on between February 1997 and July 2002. Method: Reduction was achieved by temporary transpedicular instrumentation of L4. These screws were removed at the end of the operation or 12 weeks later. Results: Mean slippage was corrected from 76 % preoperatively to 10 % postoperatively. Segmental kyphosis L5/S1 improved from + 21° preoperatively to - 7° postoperatively. Sacral inclination was 34° preoperatively, 43° postoperatively, and 47° at latest follow-up. 76 % of the patients were pain free at the latest follow-up. In 4 patients a fusion at L4/5 was performed due to subsequent decompensation. Conclusion: The technique described allows for a nearly anatomic reduction with correction of slippage as well as segmental kyphosis. Correction of the local deformity with monosegmental fusion L5/S1 improves dramatically the overall sagittal profile of the spine. Fusion of the primarily healthy segment L4/5 can be avoided.

Schlüsselwörter

Spondylolisthese - Spondyloptose - dysplastische Spondylolisthese - kongenitale Spondylolisthesis - temporäre Instrumentation

Key words

spondylolisthesis - spondyloptosis - developmental spondylolisthesis - congenital spondylolisthesis - temporary instrumentation

Literatur

  • 1 Wiltse L L, Newman P H, Macnab I. Classification of spondylolisis and spondylolisthesis.  Clin Orthop. 1976;  117 23-29
    PubMedSearch in Google Scholar
  • 2 Marchetti P G, Bartolozzi P B. Classification of spondylolisthesis as a guideline for treatment. In: Bridwell KH, DeWald RL (eds). The textbook of spinal surgery, 2nd ed. Lippincott-Raven Publishers, Philadelphia 1997; 1211-1254
  • 3 Boos N, Marchesi D, Zuber K, Aebi M. Treatment of severe spondylolisthesis by reduction and pedicular fixation. A 4-6-year follow-up study.  Spine. 1993;  18 1655-1661
    PubMedSearch in Google Scholar
  • 4 Boxall D, Bradford D S, Winter R B, Moe J H. Management of severe spondylolisthesis in children and adolescents.  J Bone Joint Surg [Am]. 1979;  61 479-495
    PubMedSearch in Google Scholar
  • 5 Peek R D, Wiltse L L, Reynolds J B, Thomas J C, Guyer D W, Widell E H. In situ arthrodesis without decompression for Grade-III or IV isthmic spondylolisthesis in adults who have severe sciatica.  J Bone Joint Surg [Am]. 1989;  71 62-68
    PubMedSearch in Google Scholar
  • 6 Poussa M, Schlenzka D, Seitsalo S, Ylikoski M, Hurri H, Osterman K. Surgical treatment of severe isthmic spondylolisthesis in adolescents. Reduction or fusion in situ.  Spine. 1993;  18 894-901
    PubMedSearch in Google Scholar
  • 7 Roca J, Ubierna M T, Caceres E, Iborra M. One-stage decompression and posterolateral and interbody fusion for severe spondylolisthesis. An analysis of 14 patients.  Spine. 1999;  24 709-714
    Search in Google Scholar
  • 8 Seitsalo S, Osterman K, Hyvarinen H, Schlenzka D, Poussa M. Severe spondylolisthesis in children and adolescents. A long-term review of fusion in situ.  J Bone Joint Surg [Br]. 1990;  72 259-265
    PubMedSearch in Google Scholar
  • 9 Wiltse L L, Jackson D W. Treatment of spondylolisthesis and spondylolysis in children.  Clin Orthop.. 1976;  117 92-100
    PubMedSearch in Google Scholar
  • 10 Gaines R W, Nichols W K. Treatment of spondyloptosis by two stage L5 vertebrectomy and reduction of L4 onto S1.  Spine. 1985;  10 680-686
    PubMedSearch in Google Scholar
  • 11 Lehmer S M, Steffee A D, Gaines R W. Treatment of L5-S1 spondyloptosis by staged L5 resection with reduction and fusion of L4 onto S1 (Gaines procedure).  Spine. 1994;  19 1916-1925
    PubMedSearch in Google Scholar
  • 12 Hanson D S, Bridwell K H, Rhee J M, Lenke L G. Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis.  Spine. 2002;  27 2026-2029
    CrossrefPubMedSearch in Google Scholar
  • 13 Marty C, Boisaubert B, Descamps H, Montigny J P, Hecquet J, Legaye J, Duval-Beaupere G. The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients.  Eur Spine J. 2002;  11 119-125
    CrossrefPubMedSearch in Google Scholar
  • 14 Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O'Brien M. The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements.  Spine. 2005;  30 (Suppl 6) S 27-S 34
    PubMedSearch in Google Scholar
  • 15 Hensinger R N. Spondylolysis and spondylolisthesis in children and adolescents.  J Bone Joint Surg [Am]. 1989;  71 1098-1107
    PubMedSearch in Google Scholar
  • 16 Logroscino G, Mazza O, Aulisa G, Pitta L, Pola E, Aulisa L. Spondylolysis and spondylolisthesis in the pediatric and adolescent population.  Childs Nerv Syst. 2001;  17 644-655
    CrossrefPubMedSearch in Google Scholar
  • 17 Lonstein J E. Spondylolisthesis in children. Cause, natural history, and management.  Spine. 1999;  24 2640-2648
    CrossrefPubMedSearch in Google Scholar
  • 18 Molinari R W, Bridwell K H, Lenke L G, Ungacta F F, Riew K D. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches.  Spine. 1999;  24 1701-1711
    CrossrefPubMedSearch in Google Scholar
  • 19 Molinari R W, Bridwell K H, Lenke L G, Baldus C. Anterior column support in surgery for high-grade, isthmic spondylolisthesis.  Clin Orthop. 2002;  394 109-120
    CrossrefPubMedSearch in Google Scholar
  • 20 Seitsalo S, Osterman K, Hyvarinen H, Tallroth K, Schlenzka D, Poussa M. Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients.  Spine. 1991;  16 417-421
    CrossrefPubMedSearch in Google Scholar
  • 21 Maurice H D, Morley T R. Cauda equina lesions following fusion in situ and decompressive laminectomy for severe spondylolisthesis. Four case reports.  Spine. 1989;  14 214-216
    PubMedSearch in Google Scholar
  • 22 Schoenecker P L, Cole H O, Herring J A, Capelli A M, Bradford D S. Cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction.  J Bone Joint Surg [Am]. 1990;  72 369-377
    PubMedSearch in Google Scholar
  • 23 Petraco D M, Spivak J M, Cappadona J G, Kummer F J, Neuwirth M G. An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction.  Spine. 1996;  21 1133-1138
    CrossrefPubMedSearch in Google Scholar
  • 24 Albrecht S, Kleihues H, Gill C, Reinhardt A, Noack W. Repositioning injuries of nerve root L5 after surgical treatment of high degree spondylolistheses and spondyloptosis.  Z Orthop Ihre Grenzgeb. 1998;  136 182-191
    PubMedSearch in Google Scholar
  • 25 Ani N, Keppler L, Biscup R S, Steffee A D. Reduction of high-grade slips (grades III-V) with VSP instrumentation. Report of a series of 41 cases.  Spine. 1991;  16 (Suppl 6) S 302-S 310
    PubMedSearch in Google Scholar
  • 26 Bartolozzi P, Sandri A, Cassini M, Ricci M. One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5-S1 spondylolisthesis.  Spine. 2003;  28 1135-1141
    CrossrefPubMedSearch in Google Scholar
  • 27 Boachie-Adjei O, Do T, Rawlins B A. Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: clinical and radiographic results in six patients.  Spine. 2002;  27 E 161-E 168
    PubMedSearch in Google Scholar
  • 28 Bradford D S, 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 1060-1066
    PubMedSearch in Google Scholar
  • 29 Edwards C C, Bradford D S. Instrumented reduction of spondylolisthesis.  Spine. 1994;  19 1535-1537
    PubMedSearch in Google Scholar
  • 30 Schwend R M, Waters P M, Hey L A, Hall J E, Emans J B. Treatment of severe spondylolisthesis in children by reduction and L4-S4 posterior segmental hyperextension fixation.  J Pediatr Orthop.. 1992;  12 703-711
    PubMedSearch in Google Scholar
  • 31 Smith J A, Deviren V, Berven S, Kleinstueck F, Bradford D S. Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade L5-S1 spondylolisthesis.  Spine. 2001;  26 2227-2234
    CrossrefPubMedSearch in Google Scholar
  • 32 Edwards C C. Reduction of spondylolisthesis. In: Bridwell KH, DeWald RL (eds). The textbook of spinal surgery. Vol. 1. Lippincott-Raven Publishers, Philadelphia 1991; 605-634
  • 33 Steffee A D, Sitkowski D J. Reduction and stabilization of grade IV spondylolisthesis.  Clin Orthop Relat Res. 1988;  227 82-89
    PubMedSearch in Google Scholar
  • 34 Kumar M N, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion.  Eur Spine J. 2001;  10 314-319
    CrossrefPubMedSearch in Google Scholar
  • 35 Ruf M, Melcher R P, Harms J. Anatomic Reduction and Monosegmental Fusion in High-grade Developmental Spondylolisthesis. Presented at SRS Annual Meeting, Buenos Aires 2004
  • 36 Fabris D A, Costantini S, Nena U. Surgical treatment of severe L5-S1 spondylolisthesis in children and adolescents. Results of intraoperative reduction, posterior interbody fusion, and segmental pedicle fixation.  Spine. 1996;  21 728-733
    CrossrefPubMedSearch in Google Scholar
  • 37 Harms J, Jeszensky D, Stoltze D, Boehm H. True spondylolisthesis reduction and monosegmental fusion in spondylolisthesis. In: Bridwell KH, DeWald RL (eds). The textbook of spinal surgery. 2nd ed. Lippincott-Raven Publishers, Philadelphia 1997; 1337-1347
  • 38 Shufflebarger H L, Geck M J. High-grade isthmic dysplastic spondylolisthesis: monosegmental surgical treatment.  Spine. 2005;  30 (Suppl 6) S 42-S 48
    PubMedSearch in Google Scholar

Michael Ruf

Klinikum Karlsbad-Langensteinbach

Guttmannstr. 1

76307 Karlsbad

Germany

Phone: (+49) 72 02-6 10

Fax: (+49) 72 02-61 61 66

Email: michael.ruf@kkl.srh.de