The Journal of Bone and Joint Surgery, Vol 63, Issue 4 619-626, Copyright © 1981 by Journal of Bone and Joint Surgery, Inc
Severe lumbosacral spondylolisthesis in adolescents and children. Reduction and staged circumferential fusion
RL DeWald, MM Faut, RF Taddonio and MG Neuwirth
Using a new surgical regimen, fourteen patients with lumbosacral
spondylolisthesis and more than 50 per cent slipping were treated by
reduction of the slip with two Harrington distraction rods extending from
the first lumbar laminae to the sacral alae and bilateral posterolateral
fusion from the fourth lumbar to the second sacral segment. Then, at a
second procedure, thirteen had an anterior lumbosacral fusion using two
bicortical wedge-shaped iliac grafts. The distraction rods were removed six
to twelve months later. At follow-up, correction of the slips ranged from
70 to 100 per cent. In four of the thirteen patients the reduction was
improved by 10 to 13 per cent during the anterior procedure. In one
patient, a twenty-one-year-old women with a slip of more than 100 per cent,
a cauda equina syndrome developed after the reduction and posterolateral
fusion, and this necessitated removal of th rods and cancellation of the
anterior fusion. This patient recovered completely and her final result was
a solid posterolateral fusion in situ, with her abnormal posture and gait
unchanged. The other thirteen patients, after follow-up ranging from two
years to six years and seven months, had solid fusion, normal spinal
alignment, normal anatomy of the spinal canal, and normal posture and gait.
Only one patient had loss of correction during follow-up, which amounted to
7 per cent. We concluded that correction of severe spondylolisthesis (50
per cent or more) in properly selected patients can be accomplished by this
two-stage procedure without risk of further slipping, pseudarthrosis,
persistent deformity, or recurrence of the slip due to late remodeling.
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