The radiographic results and neurologic complications of instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements: a retrospective review of 44 patients.

Abstract

A retrospective review of all cases of high-grade spondylolisthesis treated by 1 surgeon between the years 1991 and 2003. To report the radiographic results and neurologic complications following instrumented posterior reduction and fusion without decompression of the neural elements. Despite a large number of published reviews of the clinical results of operative intervention, controversy remains about the surgical treatment of high-grade spondylolisthesis. A retrospective review of the clinical charts and radiographs of all patients with L5-S1 spondylolisthesis and more than 50% anterior displacement of L5 on S1 who were treated by the same surgical team at 1 institution. With this technique, an average reduction in the displacement of L5 on S1 from 64% to 38% was achieved. At a minimum 2-year follow-up (41 patients), we have detected 5 cases with evidence of pseudarthrosis or loss of reduction (11.4%). Overall, a neurologic complication rate of 9.1% occurred in this series, with a 2.3% chance of a persistent motor deficit. We did not detect any loss of bowel or bladder function after surgery. At last follow-up, and after revision procedures, we were able to achieve good or fair clinical results in 40 (90.9%) of 44 patients. These data suggest that a posterior instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements can be accomplished with acceptable radiographic and clinical results.