One-stage decompression and posterolateral and interbody fusion for severespondylolisthesis - An analysis of 14 patients

Study Design. A retrospective study of 14 patients with high-grade L5-S1 sp ondylolisthesis surgically treated with one-stage decompression and postero lateral and interbody fusion (technique of Bohlman and Cook). Objective. To determine the efficacy of this technique in managing severe l umbosacral spondylolisthesis, Summary of Background Data, Controversy exists most appropriate method for managing high-grade spondylolisthesis. Circumferential in situ fusion from a single-stage posterior approach was described in 1982, but to the current authors' knowledge, there are not many reports on clinical results in the literature. The current authors studied 14 patients (mean age, 21 years) wi th L5-S1 spondylolisthesis. The percentage of slipping averaged 77% slip an gle averaged 36 degrees. The average follow-up period was 30 months. All pa tients had severe back or radicular symptoms. Two patients had foot drop, a nd four had minor neurologic dysfunction. Four patients had extremely tight hamstrings. Methods. Pre- and postoperative radiographic films and computed tomography scans were reviewed. Magnetic resonance imaging was carried out in 11 patie nts before surgery and at follow-up examination. Patients were evaluated fo r fusion rate, clinical outcome, and complications. Results. All six patients with motor deficit of the nerve showed complete s trength recovery at follow-up examination. None of the patients had tightne ss of hamstrings. Twelve patients demonstrated incorporation of the graft w ith solid fusion, one patient had a fracture of the fibular graft; and one had graft resorption. All patients but one rated the surgical result as exc ellent. One patient was not satisfied with the cosmetic result. Transient p aresthesias in the leg of the donor graft were documented in two patients. Conclusion. Posterior decompression of the spinal canal combined with anter ior and posterior arthrodesis performed at one stage through a posterior ap proach is a safe and effective technique for managing severe spondylolisthe sis.