Case Reports
Reduction of High-Grade Isthmic and Dysplastic Spondylolisthesis in 5 Adolescents
Am J Orthop. 2007 July;36(7):367-373
Author and Disclosure Information
Baron S. Lonner, MD, Edward W. Song, MD, Carrie L. Scharf, BA, and Jeff Yao, MD
Dr. Lonner is Clinical Assistant Professor of Orthopaedic Surgery, and Dr. Song is Spine Fellow, Hospital for Joint Diseases–New York University Medical Center, New York, New York.
Ms. Scharf is Medical Student, New York University School of Medicine, New York, New York.
Dr. Yao is Resident, Long Island Jewish Medical Center, New Hyde Park, New York.
Treatment of high-grade isthmic and dysplastic spondylolisthesis in children and adolescents remains a challenge. Surgical treatment of spondylolisthesis has been recommended in adolescents with pain refractory to nonoperative modalities, slippage progression, or >50% slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. In this report, we describe 5 cases of high-grade isthmic and dysplastic spondylolisthesis in adolescents and review the literature on surgical treatment for this entity. Operative records, charts, x-rays, and Scoliosis Research Society outcome questionnaires (SRS-22) were retrospectively evaluated for 5 consecutive patients diagnosed with and treated for high-grade spondylolisthesis. Each patient received treatment consisting of decompression, reduction, and circumferential fusion with transpedicular and segmental fixation from a posterior approach. Two patients had transient L5 nerve root deficit, which resolved within 3 months. Reduction benefits include a decrease in shear stresses (and resulting decreased rates of postoperative pseudarthrosis and slip progression), restoration of sagittal alignment and lumbosacral spine balance, and improvement in clinical deformity.