Espondilolistesis: En este artículo se presenta una publicación en la que se not related to lumbar pain, 12 a pars articularis defect was detected, respectively, . De un total de pacientes intervenidos quirúrgicamente de patología lumbar en los últimos 6 años, los autores estudian 19 pacientes con espondilolistesis.

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High-grade spondylolisthesis HGShowever, is much less frequent, which makes it difficult to develop a general recommendation for its treatment. Posterior transdiscal fixation was proposed in for Espondilplistesis, and the use of spine navigation could esponndilolistesis this technique more accessible and reduce the morbidity associated with the procedure.

The purpose of this study was to present a case series involving adult patients with HGS and correct spinal alignment who were treated with transdiscal pedicle screw lymbar guided with neuronavigation and compare the results to those achieved previously without image guidance.

METHODS The authors reviewed all cases in which adult patients with correct spinal alignment were treated for HGS with posterior transdiscal instrumentation placement guided with navigation between and at their institution. The authors compared preoperative and postoperative spinopelvic parameters on standing radiographs as well as Oswestry Disability Index ODI scores and visual analog scale VAS scores for low-back pain.

Follow-up CT and MRI studies and postoperative radiographs were evaluated to identify any screw malplacement or eespondilolistesis failure. Any other intraoperative or postoperative complications were also recorded. RESULTS Eight patients underwent posterior transdiscal navigated instrumentation placement during this period, with a mean duration of follow-up espondilolistsis 16 months range 9 —24 months.

In 5 cases, L4 —S1 instrumentation was placed, while in the other 3 cases, surgery consisted of transdiscal L5 —S1 fixation. There was no significant difference between preoperative and postoperative spinopelvic parameters. However, there was a statistically significant improvement in the mean VAS score for low-back pain 6.


Six patients reduced their use of pain medication. There were no intraoperative or postoperative complications during the hospital stay, and as of the most recent follow-up, no complications related to pseudarthrosis or hardware failure had been observed.

The use of navigation and image guidance was associated with improved results in this technique, including a reduction in postoperative and intraoperative complications related to screw malplacement, pseudarthrosis, and instrumentation failure. Neurosurg Focus 44 1: The prevalence of this condition is not well defined. A classic study by Roche and Rowe showed that the prevalence was about 4. The main objective of surgical treatment of spondylolisthesis is to decompress and fuse the vertebrae, with or without reduction of the slipped vertebra.

Many approaches have been described, including anterior and posterior approaches, with or without interbody fusion; posterolateral fusion without decompression; L-5 vertebrectomy Gaines procedure ; and circumferential fusion and reduction. This risk was reduced with posterior fixation and also with the use lumbsr interbody esondilolistesis and circumferential approaches.

More recently, the implementation of 3D image—guidance spine systems has improved the accuracy of instrumentation placement and decreased its morbidity. Moreover, new approaches and techniques are easier thanks to its application. This study is a retrospective review of HGS cases in which patients underwent surgery with transdiscal L5—S1 fixation between and at our institution. Some patients also had lower-extremity symptoms attributable to radiculopathy. Only cases involving patients older than 18 years with no upper limit were included in the study.

We analyzed demographic and clinical parameters, including age, sex, symptoms, preoperative pain level, and daily activities. The Oswestry Disability Index ODI score was the primary outcome measure, with lower scores indicating less severe symptoms. Postoperative follow-up included, at a minimum, assessment during the 1st month and at 3, 6, and 12 months after surgery.


In addition, standing anteroposterior and lateral lumbosacral radiographs and lateral flexion-extension images, together with full spine standing lateral radiographs for spinal and pelvic alignment, were obtained in every case.

Standing radiographs were obtained in the event of complications and during the first follow-up visit, 1 month after surgery. CT and MR images were assessed by an independent radiologist not involved in the surgical procedure. Fusion was evaluated according to the Ray criteria 21 on CT images. Grading of slippage was assessed according to the classification of Meyerding. Surgery was performed on a Jackson radiolucent surgical table with image guidance.

A midline incision was made at the level of the spondylolisthesis, and subperiosteal dissection was performed until exposure of transverse process espkndilolistesis every level to be treated. Once the reference array was attached to the lower spinous process of the sacrum at S-2 or S-3, images were obtained with intraoperative 3D fluoroscopy Siemens Medical Solutions and 3D reconstruction was performed by the Brainlab system for spine navigation.

After calibration of the probe, tap, and screwdriver Fig. The technique of transdiscal fixation has previously been described espondlolistesis Abdu et al.

Afterward, a previously calibrated screw 7. In this technique, pedicle screws are inserted obliquely through the pedicle of S-1 in an anteromedial direction to the sacral promontory. Then with continued image guidance, using the calibrated screwdriver, the screws are directed across the L5—S1 espondiloliistesis disc to the L-5 body.

In the upper levels, screws were also placed with image guidance in a standard fashion. Once the instrumentation was finished, another fluoroscopic 3D scan is performed to check that all screws were correctly positioned Fig.

In patients with radiculopathy, a hemilaminectomy and foraminotomy of the affected root were performed. Finally, in all cases, posterolateral and isthmic fusion with autologous iliac crest bone and heterologous bone graft substitute was performed. After surgery, a lumbosacral orthosis was prescribed for 3 months. Preoperative and postoperative data were compared by means of the Wilcoxon signed-rank test. Because the study was a retrospective review of patients, no informed consent was required for enrollment.

Intraoperative photographs showing the calibration of the awl-tap A and drill guide B.


During the period analyzed in our study, 8 patients all female underwent surgery for HGS. Their mean age was No reduction of espondiloolistesis listhesis was performed in any case, as there was no spinal imbalance. The median surgical time was minutes range — minutes.

There were no intraoperative complications. Photograph of the navigation screen showing the correct position of the transdiscal L5 —S1 screw. Intraoperative photograph of navigation-guided drilling for transdiscal screw placement.

Espondilolistesis: técnicas quirúrgicas avanzadas

Intraoperative photograph showing the use of a navigated awl-tap for transdiscal screw placement. Espondilollistesis of the navigation lujbar showing screw placement along the correct trajectory. Intraoperative axial CT image showing correctly positioned transdiscal screws. The intraoperative CT performed at the end of the procedure showed correct position of the instrumentation in all cases, with no need for repositioning of the screws.

Also, none of the patients required a transfusion after the procedure. Low-back pain lasting longer than 2 years was the main symptom in all the cases, radiating to the lower extremities mainly at the pelvic girdle. The mean preoperative VAS score was 6. However, in 3 of the cases low-back pain was accompanied by radiculopathy to the feet. The mean duration of follow-up was 16 months range 9—24 monthsand no complication was observed during this period.

Also, none of the patients have returned to our pain unit because of back pain, and all but 2 patients have reduced their intake of pain medication.

None of the patients had increased their analgesic dosage at the last follow-up. Six patients were starting exercise and 2 had returned to their jobs. There was no significant difference between preoperative and postoperative values for any of the spinopelvic parameters Table 1. Review of follow-up images by the independent radiologist showed no pseudarthrosis or implant breakage or malplacement, and fusion was obtained in all cases Fig.


HGS is a low-incidence pathology, which makes it difficult to standardize an approach for its treatment.

Many techniques have been described for HGS treatment, including anterior, posterior, and circumferential approaches. These authors cited 4 main advantages to this approach: Subsequent studies of biomechanical properties of the transdiscal approach have demonstrated improvement in resistance against shear forces at the displaced level compared with posterolateral fusion, 4,8 stiffness 1.

As Collados-Maestre et al. Summary of clinical and radiological data in 8 adult patients with HGS. Reduction of listhesis is one of espondiloljstesis most controversial topics in HGS management. The aim of reduction is to restore spinal anatomy, mainly recommended in patients with sagittal imbalance, and to lower the risk of pseudarthrosis.

In our series, we did not perform a reduction, as there was no sagittal imbalance in expondilolistesis patient. Again, a lack of studies on HGS with a substantial proportion of adult patients makes it difficult to generate a reliable standard recommendation.

Spondylolisthesis – Wikipedia

One ezpondilolistesis the largest series, published by Collados-Maestre et al. In their study, 25 patients age range 14 —60 years were treated with transdiscal fixation. The authors did not find any case of pseudarthrosis in the patients treated with transdiscal fixation, despite the fact that pseudarthrosis is one of the most frequent complications associated with in situ fusion and fixation procedures. Lateral standing radiograph showing correct positioning of the instrumentation without signs of malplacement or pseudarthrosis.

Axial CT images showing the proper placement of screws from the S-1 insertion point through the L-5 vertebral body. Complications described in published series of transdiscal pedicle screw fixation for HGS in adults. In previously published studies, the incidence of reported complications related to transdiscal fixation for the treatment of HGS is generally quite low; with the exception of 1 study, in which the incidence was The most frequent intraoperative complication described lkmbar dural tear, accounting for Malplacement of hardware and its failure are both common complications of transdiscal fixation for the treatment of spondylolisthesis.

In these cases, online 3D image guidance offers a better approach, improving security in the moment of the implant position and decreasing the incidence of complications, as we have shown in our series.

To our knowledge, the use of image guidance for transdiscal screws luumbar only been previously reported in the literature a single time—by Beringer et al. Our results presented here further demonstrate that screw malplacement and hardware breakage are greatly reduced with the use of online 3D image guidance compared with the results from previous reports. Nonetheless, the main limitation in our study is a short mean duration of followup, and this may have led to underestimation of implant failure and the presence of pseudarthrosis as well as the fusion rate in the most recent cases.

The use of transdiscal pedicle screws with in situ fusion is a good option for treating HGS in patients with good sagittal balance. This technique has some advantages compared with other approaches, including the increased familiarity of espondilolistssis surgical field for spine surgeons and the relatively low frequency of complications, which could be reduced using image-guidance systems, commonly used in most of the spine centers treating this kind of pathology.

Pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis. A new technique for stabilization.

Spine Phila Pa Operative management of adult high-grade lumbosacral spondylolisthesis.