Spontaneous resolution of scoliosis associated with lumbar spondylolisthesis: a case report.

By London Spine
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Spontaneous resolution of scoliosis associated with lumbar spondylolisthesis: a case report.

Spine J. 2013 Feb 12;

Authors: Zhou Z, Song Y, Cai Q, Kong Q

Abstract
BACKGROUND CONTEXT: Scoliosis in association with spondylolisthesis is a common phenomenon. According to the traditional opinion, scoliosis should be managed depending on its classification and flexibility. Recently, Crostelli and Mazza proposed a new opinion toward this topic. They advocate that spondylolisthesis-associated scoliosis, especially severe scoliosis, should be considered as idiopathic scoliosis and must be treated with the same principles used in the treatment of idiopathic scoliosis. According to their viewpoints, more scoliotic curves in association with spondylolisthesis need to be treated, either surgically or conservatively. PURPOSE: To describe the spontaneous correction of a severe case of scoliosis by internal fixation of the spondylolisthesis. STUDY DESIGN: Case report of a patient with scoliosis developing in association with high-grade lumbar spondylolisthesis. METHODS: A 12-year-old girl presented with a 2-year history of spinal curvature. She did not have low back or leg pain. The scoliotic deformity corrected readily in the supine position. Radiographs revealed 88% slippage of L5 on S1 in addition to a long section curve of the spine with the main 50° curve at the thoracic level. The spondylolisthesis was repaired with segmental instrumentation and circumferential fusion of L5 and S1. RESULTS: The scoliosis showed spontaneous resolution gradually after lumbosacral fusion and reached a complete correction 2 years after surgery. CONCLUSIONS: The relationship between scoliosis and spondylolisthesis is complex. If scoliosis is considered to be caused by spondylolisthesis, surgery for the latter condition might be the only required intervention for the patient. Unnecessary operation for scoliosis should be avoided.

PMID: 23415020 [PubMed – as supplied by publisher]

Long-Term Outcome After Monosegmental L4/5 Stabilization for Degenerative Spondylolisthesis With the Dynesys Device.

By London Spine
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Long-Term Outcome After Monosegmental L4/5 Stabilization for Degenerative Spondylolisthesis With the Dynesys Device.

J Spinal Disord Tech. 2012 Oct 16;

Authors: Hoppe S, Schwarzenbach O, Aghayev E, Bonel H, Berlemann U

Abstract
STUDY DESIGN:: retrospective analysis of prospectively collected clinical data. OBJECTIVE:: To assess the long-term outcome of patients with monosegmental L4/5 degenerative spondylolisthesis treated with the dynamic Dynesys device. SUMMARY OF BACKGROUND DATA:: The Dynesys® system has been used as a semirigid, lumbar dorsal pedicular stabilization device since 1994. Good short-term results have been reported, but little is known about the long-term outcome following treatment for degenerative spondylolisthesis at the L4/5 level. METHODS:: 39 consecutive patients with symptomatic degenerative lumbar spondylolisthesis at the L4/5 level were treated with bilateral decompression and Dynesys instrumentation. At a mean follow-up of 7.2 years (range 5.0-11.2▒y) they underwent clinical and radiographic evaluation and quality of life assessment. RESULTS:: At final follow-up back pain improved in 89% and leg pain improved in 86% of patients compared to preoperative status. 83% of patients reported global subjective improvement. 92% would undergo the surgery again. 8 patients (21%) required further surgery due to symptomatic adjacent segment disease (6 cases), late onset infection (1 case), and screw breakage (1 case). In 9 cases radiological progression of spondylolisthesis at the operated segment was found. 74% of operated segments showed limited flexion-extension range of less than 4°. Adjacent segment pathology, though without clinical correlation, was diagnosed at the L5/S1 (17.9%) and L3/4 (28.2%) segments. In 4 cases asymptomatic screw loosening was observed. CONCLUSION:: Monosegmental Dynesys instrumentation of degenerative spondylolisthesis at L4/5 shows good long-term results. The rate of secondary surgeries is comparable to other dorsal instrumentation devices. Residual range of motion in the stabilized segment is reduced, and the rate of radiological and symptomatic adjacent segment degeneration is low. Patient satisfaction is high. Dynesys stabilization of symptomatic L4/5 degenerative spondylolisthesis is a possible alternative to other stabilization devices.

PMID: 23075857 [PubMed – as supplied by publisher]

Operative management of a non-traumatic cervico-thoracic spondylolisthesis: a case report.

By London Spine
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Operative management of a non-traumatic cervico-thoracic spondylolisthesis: a case report.

J Med Case Rep. 2012;6(1):146

Authors: Zwingenberger S, Leimert M, Valladares RD, Betz VM, Seifert J

Abstract
INTRODUCTION: In contrast to spondylolisthesis of the lumbar spine, non-traumatic cervico-thoracic spondylolisthesis is a very rare lesion. Even minor changes in the displacement of the vertebrae or the cord can lead to cervical myelopathy and paralysis. Since only a few cases have been well-documented, there is currently no clear preference between operative techniques.
CASE PRESENTATION: We describe the case of a 63-year-old Caucasian man with a 13 mm spondylolisthesis between C7 and T1. Within a few months, a progressive cervical myelopathy developed as he began to suffer pain and loss of function of his digits and was no longer able to walk unassisted. In an interdisciplinary collaboration between neurological and orthopedic surgeons, a ventral-dorsal-ventral approach was performed on one vertebral section. The ventral removal of the intervertebral disc was followed by laminectomy and dorsal instrumentation. A new application technique was established by inserting bicortical screws into the transverse processes of T2 and T3. The structure was subsequently stabilized by the ventral insertion of a Harms basket. The procedure was successful as it halted progression of the myelopathy. The patient demonstrated improved sensitivity and recovered the ability to walk unassisted. He has now been able to walk unassisted for two years postoperatively.
CONCLUSION: This paper describes a successful treatment for a very rare case of cervico-thoracic spondylolisthesis. The technique of inserting bicortical screws into the transverse processes is a fast, safe and successful method that does not require the use of intraoperative radiographs for placement of the bicortical screws into the transverse processes.

PMID: 22686409 [PubMed]

Grade 2 spondylolisthesis at L4-5 treated by XLIF: safety and midterm results in the “worst case scenario”.

By London Spine
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Grade 2 spondylolisthesis at L4-5 treated by XLIF: safety and midterm results in the “worst case scenario”.

ScientificWorldJournal. 2012;2012:356712

Authors: Rodgers WB, Lehmen JA, Gerber EJ, Rodgers JA

Abstract
UNLABELLED: Spondylolisthesis is one of the most common indications for spinal surgery. However, no one approach has been proven to be more effective in treating spondylolisthesis. Recent advances in minimally invasive spine technology have allowed for different approaches to be applied to this indication, notably extreme lateral interbody fusion (XLIF). The risk, however, of using XLIF in treating grade II spondylolisthesis is the ventral position of the lumbar plexus, particularly at L4-5.
OBJECTIVE: This study reports the safety and midterm clinical and radiographic outcomes of patients with grade II lumbar spondylolisthesis treated with XLIF.
METHODS: 63 patients with grade II spondylolisthesis and spinal stenosis were treated with XLIF and were available for 12-month followup. Of those, 61 (97%) were treated at L4-5. Clinical (VAS, complications, and reoperation rate) and radiographic (anterolisthesis, disk height, and fusion) parameters were assessed.
STUDY DESIGN: Data were collected via a prospective registry and analyzed retrospectively.
RESULTS: Sixty-three patients were available for evaluations at least one year postoperatively. Average pain (visual analog scale) decreased from a score of 8.7 at baseline to 2.2 at 12 months postoperatively. Average anterior slippage was reduced by 73% and was well maintained. Average disk height (4.6 mm pre-op and 9.0 mm post-op) nearly doubled after surgery. Slight settling (average 1.3 mm) occurred over the twelve-month follow-up period. There were no neural injuries and no nonunions noted.
CONCLUSIONS: XLIF is a safe and effective minimally invasive treatment alternative for grade II spondylolisthesis. Real-time neurological monitoring and attention to technique are mandatory.

PMID: 23125555 [PubMed – in process]