Case ReportSacrum fracture following L5–S1 stand-alone interbody fusion for isthmic spondylolisthesis
Introduction
Isthmic spondylolisthesis is characterized by subluxation of one vertebral body over another, causing spinal instability which is usually initially attributed to lytic defects in the pars interarticularis [1]. A pars defect disconnects the anterior column segment from its posterior support, which may produce excessive loading, leading to disc degeneration, subluxation and nerve impingement.
Surgical treatment of isthmic spondylolisthesis remains controversial. At the L5–S1 level, decompression and instrumented fusion can be achieved using several techniques, including a posterior and/or anterior approach, or non-instrumented technique. Traditionally, a posterior lumbar interbody fusion or transforaminal lumbar interbody fusion is commonly performed for direct nerve decompression and stabilization [2]. However, these posterior approaches may be associated with increased operative duration, blood loss and longer hospitalization. For low grade isthmic spondylolisthesis with radicular symptoms, multiple studies have reported excellent results with the anterior lumbar interbody fusion (ALIF). The anterior approach offers the advantages of minimal tissue and neural disruption, with restoration of disc height, sagittal alignment and indirect nerve decompression [3]. To provide fixation, the ALIF cage design has evolved over the years to a stand-alone construct with an integrated distraction cage and fixation plate.
We report a man with a delayed sacral fracture complication of ALIF for isthmic spondylolisthesis, who was managed with the minimally invasive strategy of posterior percutaneous pedicle fixation and partial reduction of the deformity.
Section snippets
Case report
A 72-year-old man presented with Grade I isthmic spondylolisthesis, with several years of progressive lower back pain and predominant bilateral L5 radiculopathy (Fig. 1A). Following some unsuccessful conservative treatment options, the decision was made to proceed with surgical intervention. The senior author adopted a strategy of stand-alone ALIF (ANCHOR-L Implant; Stryker, Kalamazoo, MI, USA) to restore the foraminal height and stabilize the spondylolisthesis (Fig. 1B).
The surgery was
Discussion
For lumbar spondylolisthesis, in situ ALIF provides results that are comparable to those obtained by other stabilization techniques. In a recent study [4] of 65 patients with isthmic spondylolisthesis who underwent ALIF, a fusion rate of 91% was maintained at an average of 6.6 years. Additionally, slippage decreased by 30%, disc height increased by 177%, and there were significant reductions in lumbar and radicular pain, according to the visual analogue scale scores. In comparison, a recent
Conclusion
We described a man with L5–S1 isthmic spondylolisthesis who experienced a follow-up sacral fracture. This was successfully managed using a minimally invasive percutaneous posterior fixation strategy. This man confirms the essential role of fusion in achieving good functional results for isthmic spondylolisthesis with neurological symptoms.
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
References (10)
- et al.
Indirect foraminal decompression after anterior lumbar interbody fusion: a prospective radiographic study using a new pedicle-to-pedicle technique
Spine J
(2015) - et al.
Outcomes of anterior lumbar interbody fusion in low-grade isthmic spondylolisthesis in adults: a continuous series of 65 cases with an average follow-up of 6.6 years
Orthop Traumatol Surg Res
(2013) - et al.
Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation
J Neurosurg Spine
(2014) - et al.
Terminology and measurement of spondylolisthesis
J Bone Joint Surg Am Vol
(1983) - et al.
Fusion techniques for adult isthmic spondylolisthesis: a systematic review
Arch Orthop Trauma Surg
(2014)
Cited by (10)
Minimally invasive decompression in patients with degenerative spondylolisthesis associated with lumbar spinal stenosis. Report of a surgical series and review of the literature
2018, Neurologia i Neurochirurgia PolskaCitation Excerpt :This technique has been demonstrated to significantly improve clinical outcome in patients with DS [6–10]. Nonetheless, spinal fusion has been associated with some complications such as fracture of the vertebral body and the pedicle [11–19], pedicle screw loosening and adjacent segment degeneration [20], requiring secondary spine surgery for lumbar adjacent instability [21]. In the last few years minimally invasive spinal decompression (MISD) procedures have been described [22–27] to overcome the problems, such as iatrogenic instability [28], associated with laminectomy.
Evaluation of Anterior Lumbar Interbody Fusion Performed Using a Stand-Alone, Integrated Fusion Cage
2023, International Journal of Spine SurgeryLumbar interbody fusion: recent advances in surgical techniques and bone healing strategies
2021, European Spine Journal