INDICATION FOR LUMBOSACRAL FUSION AND REDUCTION IN SPONDYLOLISTHESIS

The indication for operative treatment in spondylolisthesis results fr om pain, progressive sliding and, in up to 60 % of the patients with p rogressive dislocation, from radicular malfunction. The posterolateral fusion in situ is a safe procedure, but the deformation remains and i n spondyloptosis plastic deformation of the fusion mass can lead to fu rther dislocation. With the external fixator as an instrument for redu ction and the internal fixator for stabilization the reduction of even serious spondyloptosis and the recovery of a normal spine alignement and posture is possible, with an acceptable neurological risk. Therefo re a concept of treatment is suggested, which as a rule is aiming at t he anatomical reduction of the dislocated vertrebra beside stabilizati on and nerveroot decompression. Depending on the extent of the slip, r eduction and stabilization is to be performed in one, two or th ree st ages. An anterior or posterior fusion is sufficient in grade I disloca tion. In grade II-V a combined posterior and anterior surgical proceed ure is recommended.