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Philosophies and Surgical Techniques for High-Grade Spondylolisthesis Treatment with Literature Review – Lumbar Spinal Stenosis

The article explores the surgical management of high-grade spondylolisthesis, a condition characterized by significant displacement of the vertebrae. The study reviews recent literature on surgical techniques for high-grade spondylolisthesis, including posterior fusion, anterior and posterior procedures, spondylectomy, and transforaminal lumbar interbody fusion. The controversy surrounding the surgical management of this condition is discussed, including the need for reduction, levels of fusion, instrumentation, and surgical approaches. The article concludes that each technique has its advantages and disadvantages, and outcomes vary depending on the experience and skill of the surgeon. The Spine deformity study group classification is also mentioned as a guideline for achieving balanced pelvis and sagittal alignment

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : the highest rated spine hospital in London

Published article

CONCLUSION: Various techniques have been described for high-grade spondylolisthesis. Spine deformity study group classification gives guidelines about balanced and unbalanced pelvis and advises reduction and fusion in case of unbalanced pelvis for correction of biomechanical and global sagittal alignment. Each of the surgical techniques has its advantages and disadvantages. However, individual authors’ experience, skill levels, and anatomic reduction with fusion techniques have yielded…

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J Orthop Case Rep. 2024 Jan;14(1):165-172. doi: 10.13107/jocr.2024.v14.i01.4188.ABSTRACTINTRODUCTION: High-grade spondylolisthesis is defined as cases with more than 50% displacement and spondylolisthesis with Meyerding grade III and higher. The surgical management of high-grade spondylolisthesis is highly controversial. Many surgical methods have been reported such as posterior in situ fusion, instrumented posterior fusion with or without reduction,

J Orthop Case Rep. 2024 Jan;14(1):165-172. doi: 10.13107/jocr.2024.v14.i01.4188.

ABSTRACT

INTRODUCTION: High-grade spondylolisthesis is defined as cases with more than 50% displacement and spondylolisthesis with Meyerding grade III and higher. The surgical management of high-grade spondylolisthesis is highly controversial. Many surgical methods have been reported such as posterior in situ fusion, instrumented posterior fusion with or without reduction, combined anterior and posterior procedures, spondylectomy with reduction of L4 to the sacrum (for spondyloptosis), and posterior interbody fusion with trans-sacral fixation. The literature has recently mentioned minimally invasive transforaminal lumbar interbody fusion for high-grade spondylolisthesis. This study aimed to review the recent literature that describes the surgical outcomes associated with various surgical techniques used for high-grade spondylolisthesis.

MATERIALS AND METHODS: Recent articles were searched on search engines such as PubMed and Google Scholar using keywords such as “high-grade spondylolisthesis,” “surgical techniques,” and “complications.”

DISCUSSION: The surgical management of high-grade spondylolisthesis is an area of significant controversy. The literature is replete with regards to the need for reduction, decompression, levels of fusion, the nature of instrumentation, surgical approaches including open, minimally invasive, and “mini-open” procedures, and various techniques for reducing the slip and fusion strategy. The three basic options of high-grade spondylolisthesis include in-situ fusion, partial reduction and fusion, and complete reduction.

CONCLUSION: Various techniques have been described for high-grade spondylolisthesis. Spine deformity study group classification gives guidelines about balanced and unbalanced pelvis and advises reduction and fusion in case of unbalanced pelvis for correction of biomechanical and global sagittal alignment. Each of the surgical techniques has its advantages and disadvantages. However, individual authors’ experience, skill levels, and anatomic reduction with fusion techniques have yielded encouraging results.

PMID:38292085 | PMC:PMC10823803 | DOI:10.13107/jocr.2024.v14.i01.4188

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Philosophies and Surgical Techniques for High-Grade Spondylolisthesis Treatment with Literature Review

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J Orthop Case Rep. 2024 Jan;14(1):165-172. doi: 10.13107/jocr.2024.v14.i01.4188.ABSTRACTINTRODUCTION: High-grade spondylolisthesis is defined as cases with more than 50% displacement and spondylolisthesis with Meyerding grade III and higher. The surgical management of high-grade spondylolisthesis is highly controversial. Many surgical methods have been reported such as posterior in situ fusion, instrumented posterior fusion with or without reduction
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