30: Surgical Treatment of High-Grade Spondylolisthesis

Procedure 30 Surgical Treatment of High-Grade Spondylolisthesis



Frank L. Acosta, Jr. , Christopher P. Ames



Indications




• Severe, refractory low back pain


• Sagittal imbalance


• Radiculopathy


• Neurogenic claudication



Indications Pitfalls




• Asymptomatic deformity


• Well-controlled low back pain


• Radiculopathy from another source



Examination/Imaging




• Lumbar radiograph (Figure 30-1)


• Standing 36-inch scoliosis radiograph (Figure 30-2)


• Lumbar computed tomography (CT) scan (Figure 30-3)


• Lumbar magnetic resonance imaging (MRI) (Figure 30-4)


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FIGURE 30-1


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FIGURE 30-2


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FIGURE 30-3


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FIGURE 30-4



Treatment Options




• Direct reduction/transforaminal lumbar interbody fusion


• Gaines procedure


• Transsacral cage/screw


• Sacral dome osteotomy



Surgical Anatomy




• Thecal sac/lumbosacral nerve roots


• Listhesed vertebral body


• Ileum


• Pedicles



Positioning




• Prone on Jackson table



Positioning Pearls




• Adequate padding of pressure points


• Jackson pads at level of iliac crest


• Can use towels to increase chest elevation to augment lumbar lordosis



Positioning Pitfalls




• Avoid using Wilson frame: creates kyphosis



Positioning Equipment




• Jackson table


• Mayfield head frame (optional)



Portals/Exposures




• Open exposure of posterior spine and bilateral transverse processes


• Exposure of ileum



Portals/Exposures Pearls




• Wide exposure of lamina and transverse processes



Portals/Exposures Pitfalls




• Inadequate understanding of local anatomy of listhesed segment



Portals/Exposures Equipment




• C-arm


• Neuromonitoring leads (motor evoked potentials [MEPs] and somatosensory evoked potentials [SSEPs])


• Intraoperative CT scanner

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Aug 28, 2016 | Posted by in ORTHOPEDIC | Comments Off on 30: Surgical Treatment of High-Grade Spondylolisthesis

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