59: Posterior Instrumented Reduction and Fusion for Spondylolisthesis



Posterior Instrumented Reduction and Fusion for Spondylolisthesis


Eric W. Tan and Paul D. Sponseller



Indications





Pitfalls





Controversies




• Risk of neurologic injury and disk degeneration with surgical correction


• Risk of slip progression with posterior fusion secondary to shear forces on the fusion mass


• Risk of disk degeneration in adjacent segments


• Risk of pseudoarthrosis


• Need for reduction of spondylolisthesis. Alternatives to in situ fusion/fixation include open/closed reduction plus fusion, combined anterior-posterior approaches or posterior plus anterior interbody fusion, and fixation with pedicle screw constructs. In situ fusion without reduction is a time-honored procedure that works for many patients. It does require fusion to L4 in grade III and higher slips, and does leave the patient with some residual deformity. This can be done with posterior, anterior, or posterior interbody grafts. The Bohlman procedure is one that has a high rate of success with minimal incision.


• The patient may choose in situ fusion with a higher rate of pseudarthrosis and progression and residual deformity, but lower L5 nerve root risk; versus reduction and fusion of the slip with more correction of deformity, avoidance of fusion to L4, higher fusion rate, and higher risk of L5 nerve palsy.






Portals/Exposures





Pearls



Tags:
Jun 7, 2016 | Posted by in ORTHOPEDIC | Comments Off on 59: Posterior Instrumented Reduction and Fusion for Spondylolisthesis

Full access? Get Clinical Tree
Get Clinical Tree app for offline access