One-stage posterior spinal shortening by L5 partial spondylectomy for spondyloptosis or L5-S1 high-grade spondylolisthesis management.

STUDY DESIGN: A case series of seven consecutive patients with L5-S1 spondyloptosis (SPP) and Meyerding IV spondylolisthesis (HGSPL) treated consecutively by a new surgical technique with partial reduction and fixation after spinal shortening.

OBJECTIVE: To report clinical and radiological outcomes of a spinal shortening procedure by a single posterior approach in seven patients with HGSPL and SPP.

BACKGROUND DATA: The surgical treatment of L5-S1 SPP and HGSPL remains challenging, and numbers of surgical treatment options have been described with several principles. We reported a new surgical technique achieving partial reduction and fixation of L5-S1 SPP and HGSPL and highlighted its clinical and radiological outcomes.

METHODS: Seven patients with Meyerding Grade IV (2), and Grade V (5) were operated consecutively between 2004 and 2011 for HGSPL and SPP. Surgery time, blood loss and complications were collected for all patients. The slip angle or Dubousset lumbo-sacral Angle (Dub-LSA), L5 slip percentage (%slip), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK) and C7-tilt were measured pre and postoperatively. All patients underwent posterior one-stage decompression with sacral dome osteotomy, L5 vertebrectomy with L5-S1 discectomy, and partial reduction and instrumented fusion in a single posterior approach.

RESULTS: The mean age and follow-up were, respectively, 20 years and 65 months. The mean preoperative %slip was 115 %, which improved to 63 % postoperatively. The mean preoperative Dub-LSA, PT, LL, TK, and C7-tilt were 37°, 31°, -74°, 30°, and 6°, respectively, which improved to 94°, 25°, -44°, 42° and -0.14° postoperatively. No implant failure or pseudarthrosis were reported at last follow-up.

CONCLUSION: This novel and efficient one-stage shortening technique offers the possibility to manage lumbosacral kyphosis and spinal local malalignment in L5-S1 SPP.