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Research ArticleLumbar Spine

Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young

Pramod K Sudarshan, Hardik R Suthar, Vamsi K Varma, Appaji Krishnan and Sajan K Hegde
International Journal of Spine Surgery June 2018, 5047; DOI: https://doi.org/10.14444/5047
Pramod K Sudarshan
1Apollo Hospitals, Chennai, India
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Hardik R Suthar
1Apollo Hospitals, Chennai, India
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Vamsi K Varma
1Apollo Hospitals, Chennai, India
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Appaji Krishnan
2SIMS Hospitals, Chennai, India
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Sajan K Hegde
1Apollo Hospitals, Chennai, India
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ABSTRACT

Background Surgical management of high-grade spondylolisthesis in the young is not only challenging but also controversial, from in-situ fusion to complete reduction. It is fraught with dangers such as neurological injury, pseudoarthrosis, and progressive deformity with subsequent global sagittal imbalance. We describe our experience of progressive reduction technique and restoration of lumbosacral alignment.

Methods This study is a retrospective review of patients who underwent surgery between 1998 and 2012. The surgical technique involved positioning the hips in extension with traction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, and gradual reduction of the deformity and maintenance of reduction with interbody fusion. All patients were serially assessed at 1, 3, and 6 months and yearly thereafter with clinical, radiological, and Oswestry Disability Index and Visual Analogue Scale outcome measures.

Results Twenty-seven patients with high-grade spondylolisthesis at L5-S1 (3 cases grade 3, 7 grade 4, 17 grade 5) with an average age of 13.9 years were reviewed. Mean follow-up was 120 months (range 24–192). All patients presented a solid fusion at the 6-month visit; mean slip percentage was reduced from 89% to 23%, with all cases reduced to grade 2 or less. The slip angle improved from 45° to 3° postoperatively, with improvement in sacral slope from 13° to 35°. Four spondyloptosis patients had concomitant scoliosis which corrected spontaneously after the surgery and did not need further intervention. All but one patient (96.2%) had good functional outcomes and returned to their full normal activities One patient developed a deep infection necessitating implant removal, with eventual deformity progression leading to a poor outcome. Three patients (11.1%) suffered partial drop foot that resolved in full by 12 weeks.

Conclusion Our technique demonstrated a significant reduction of high grade spondylolisthesis, with restoration of global sagittal balance via correction of the lumbosacral kyphosis. Though surgically demanding, it is safe and reproducible.

Level of Evidence IV

  • high-grade spondylolisthesis
  • reduction
  • instrumentation
  • sagittal balance
  • lumbosacral kyphosis

Footnotes

  • Disclosures and COI: The authors received no funding for this study and report no conflicts of interest. The Institutional Review Board of the Apollo Hospital Education and Research Foundation approved this study.

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young
Pramod K Sudarshan, Hardik R Suthar, Vamsi K Varma, Appaji Krishnan, Sajan K Hegde
International Journal of Spine Surgery Jun 2018, 5047; DOI: 10.14444/5047

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Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young
Pramod K Sudarshan, Hardik R Suthar, Vamsi K Varma, Appaji Krishnan, Sajan K Hegde
International Journal of Spine Surgery Jun 2018, 5047; DOI: 10.14444/5047
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Keywords

  • high-grade spondylolisthesis
  • reduction
  • instrumentation
  • sagittal balance
  • lumbosacral kyphosis

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