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Eur Spine J (2012) 21 (Suppl 6):S785S791 DOI 10.1007/s00586-011-1949-5
ORIGINAL ARTICLE
Sacral dome resection and single-stage posterior reductionin the treatment of high-grade high dysplastic spondylolisthesis in adolescents and young adults
Kan Min Thomas Liebscher Dominique Rothenuh
Received: 13 July 2011 / Accepted: 13 July 2011 / Published online: 29 July 2011 Springer-Verlag 2011
AbstractObjective The description of the operation technique and retrospective review of 15 consecutive patients who were treated by posterior sacral dome resection and single-stage reduction with pedicle screw xation for high-grade, high-dysplastic spondylolisthesis.
Materials and methods All the patients had high-grade, high-dysplatic spondylolisthesis L5 and were treated by posterior sacral dome resection and posterior single-stage reduction from L4S1. The average age at the time of surgery was 17.3 (1128) years. The average follow-up time is 5.5 (211.6) years. Clinical and radiologica data were retrospectively reviewed.
Results Spondylolisthesis was reduced from average 99% preoperative to 29% at the last follow-up. L5 incidence improved from 74 to 56, the lumbosacral angle improved from 15 kyphosis to 6 lordosis, lumbar lordosis decreased from 69 to 53 from preoperative to the last follow-up. While pelvic incidence of 77 remained unchanged, sacral slope decreased from 51 to 46 and pelvic tilt increased from 25 to 30. Clinical outcome was subjectively rated to be much better than before surgery by 14 out of 15 patients. Four out of 15 patients had temporary sensory impairment of the L5 nerve root which resolved completely within 12 weeks. There were no permanent neurological complications or no pseudarthrosis.
Conclusion The sacral dome resection is a shortening osteotomy of the lumbosacral spine which allows a single-stage reduction of L5 without lengthening of lumbosacral region in high-grade spondylolisthesis, which helps to
avoid neurological complications. This is a safe surgical technique resulting in a good multidimensional deformity correction and restoration of spino-pelvic alignment towards normal values with a satisfactory clinical outcome.
Keywords High-grade spondylolisthesis Sacral dome
resection Posterior reduction Spino-pelvic alignment
Introduction
The treatment of high-grade spondylolisthesis remains controversial in terms of in situ fusion versus reduction. While satisfactory clinical outcome has been reported after in situ fusion [6, 14], this procedure is associated with higher rates of pseudarthrosis and slip progression [2]. Without reduction the lumbosacral alignment does not improve and the sagittal spinal...