Reduction of Adolescent Grade IV L5-S1 Spondylolisthesis with Anterior Joystick Manipulation During a Combined Anterior and Posterior Surgical Approach: A Case Report

Overview

Journal N Am Spine Soc J

Date 2023 Sep 15

PMID 37711284

Authors

Manjot Singh

Mariah Balmaceno-Criss

Daniel Alsoof

M Benjamin Burch

Itala Sakr

Bassel G Diebo

Christopher McDonald

Bryce Basques

Eren O Kuris

Alan H Daniels

Affiliations

Soon will be listed here.

Abstract

Background: High-grade isthmic spondylolisthesis poses a clinical challenge in the pediatric and adolescent population. Current surgical management using posterior-based approaches may lead to incomplete reduction and restoration of listhesis, disc height, and lordosis. Combined anterior and posterior approach addresses these issues but has been infrequently reported, mainly in the treatment of low-grade isthmic spondylolisthesis. Neither offers good disc space visualization and control of spinal alignment during reduction.

Case Description: A healthy 17-year-old female presented with 9 months of progressively worsening lower back pain radiating down the left lower extremity and 3 inches of height loss. Diagnosis of grade IV L5-S1 spondylolisthesis was made using plain radiographs, CT, and MRI. Management with combined anterior and posterior fusion, involving the manual manipulation of segments using an anterior pedicle screw joystick, was pursued.

Outcome: Satisfactory alignment, solid arthrodesis, no complications, and improved patient reported outcomes.

Conclusions: Combined anterior and posterior fusion with anterior joystick manipulation allowed for full reduction of grade IV spondylolisthesis and restoration of disc/foraminal height and L5-S1 segmental lordosis without neurological complication. Although less commonly performed in children and adolescents, this surgical approach can assist in restoring optimal alignment in isthmic spondylolisthesis.

References

Lightsey 4th H, Pisano A, Striano B, Crawford A, Xiong G, Hershman S . ALIF Versus TLIF for L5-S1 Isthmic Spondylolisthesis: ALIF Demonstrates Superior Segmental and Regional Radiographic Outcomes and Clinical Improvements Across More Patient-reported Outcome Measures Domains. Spine (Phila Pa 1976). 2022; 47(11):808-816. DOI: 10.1097/BRS.0000000000004333. View

Lafage R, Obeid I, Liabaud B, Bess S, Burton D, Smith J . Location of correction within the lumbar spine impacts acute adjacent-segment kyphosis. J Neurosurg Spine. 2018; 30(1):69-77. DOI: 10.3171/2018.6.SPINE161468. View

Rothenfluh D, Mueller D, Rothenfluh E, Min K . Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J. 2014; 24(6):1251-8. DOI: 10.1007/s00586-014-3454-0. View

Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A . Spondylolisthesis. Orthop Rev (Pavia). 2022; 14(3):36917. PMC: 9329062. DOI: 10.52965/001c.36917. View

Bunmaprasert T, Luangkittikong S, Tosinthiti M, Nivescharoenpisan S, Raphitphan R, Sugandhavesa N . The aiming device for cervical distractor pin insertion: a proof-of-concept, feasibility study. BMC Musculoskelet Disord. 2021; 22(1):648. PMC: 8325237. DOI: 10.1186/s12891-021-04533-w. View

Alhammoud A, Schroeder G, Aldahamsheh O, Alkhalili K, Lendner M, Moghamis I . Functional and Radiological Outcomes of Combined Anterior-Posterior Approach Versus Posterior Alone in Management of Isthmic Spondylolisthesis. A Systematic Review and Meta-Analysis. Int J Spine Surg. 2019; 13(3):230-238. PMC: 6625719. DOI: 10.14444/6031. View

Koslosky E, Gendelberg D . Classification in Brief: The Meyerding Classification System of Spondylolisthesis. Clin Orthop Relat Res. 2020; 478(5):1125-1130. PMC: 7170696. DOI: 10.1097/CORR.0000000000001153. View

Alonso F, Rustagi T, Schmidt C, Norvell D, Tubbs R, Oskouian R . Failure Patterns in Standalone Anterior Cervical Discectomy and Fusion Implants. World Neurosurg. 2017; 108:676-682. DOI: 10.1016/j.wneu.2017.09.071. View

Harrison D, HARRISON D, Cailliet R, Janik T, Holland B . Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine (Phila Pa 1976). 2001; 26(11):E235-42. DOI: 10.1097/00007632-200106010-00003. View

10.

Fransen P . A simplified technique for anterior cervical discectomy and fusion using a screw-plate implanted over the Caspar distractor pins. Acta Orthop Belg. 2010; 76(4):546-8. View

11.

Endler P, Ekman P, Ljungqvist H, Brismar T, Gerdhem P, Moller H . Long-term outcome after spinal fusion for isthmic spondylolisthesis in adults. Spine J. 2018; 19(3):501-508. DOI: 10.1016/j.spinee.2018.08.008. View

12.

Rivollier M, Marlier B, Kleiber J, Eap C, Litre C . Surgical treatment of high-grade spondylolisthesis: Technique and results. J Orthop. 2020; 22:383-389. PMC: 7486580. DOI: 10.1016/j.jor.2020.08.015. View

13.

Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N . Spondylolysis and spondylolisthesis: A review of the literature. J Orthop. 2018; 15(2):404-407. PMC: 5990218. DOI: 10.1016/j.jor.2018.03.008. View

14.

Tsirikos A, Garrido E . Spondylolysis and spondylolisthesis in children and adolescents. J Bone Joint Surg Br. 2010; 92(6):751-9. DOI: 10.1302/0301-620X.92B6.23014. View

15.

Lafage V, Schwab F, Patel A, Hawkinson N, Farcy J . Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009; 34(17):E599-606. DOI: 10.1097/BRS.0b013e3181aad219. View

16.

Foreman P, Griessenauer C, Watanabe K, Conklin M, Shoja M, Rozzelle C . L5 spondylolysis/spondylolisthesis: a comprehensive review with an anatomic focus. Childs Nerv Syst. 2012; 29(2):209-16. DOI: 10.1007/s00381-012-1942-2. View

17.

Gelb D, Lenke L, Bridwell K, Blanke K, McEnery K . An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976). 1995; 20(12):1351-8. View