Shedid Daniel, Weil Alexander G, Lieberman Isidore
*Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, QC, Canada †Texas Health Resource Hospital, Plano, TX.
J Spinal Disord Tech. 2014 Apr;27(2):E41-8. doi: 10.1097/BSD.0b013e31829649fa.
Case report of 3 patients with high-grade isthmic spondylolisthesis treated using a novel minimally invasive technique using a posterior transsacral rod.
To assess the efficacy, safety, and advantages of this approach in the treatment of high-grade L5-S1 spondylolisthesis.
Surgical treatment of high-grade isthmic spondylolisthesis at the L5-S1 level is technically demanding. The most commonly used procedure is posterior spinal fusion. In this report, we present a new minimally invasive technique for the treatment high-grade isthmic spondylolisthesis in 3 patients with sagittally balanced spines.
Three patients with high-grade L5-S1 spondylolisthesis underwent L4-S1 fusion with percutaneous pedicle screw fixation supplemented with a transsacral rod implanted through a tubular retractor. We report technical details, clinical, and radiologic results at follow-up.
All 3 patients suffered from grade 3 or 4 L5-S1 spondylolisthesis. All patients had neutral sagittal balance on preoperative imaging. There were no postoperative complications and all 3 patients were discharged within 48 hours. At final follow-up (range, 13-18 mo), all patients were pain free off all narcotic pain medication and fusion was observed in all 3 patients.
We have shown the technical feasibility of anterior and posterior fusion for severe L5-S1 spondylolisthesis using a minimally invasive percutaneous technique through a transsacral approach. The main advantage of a posterior transsacral axial rod fixation is that it creates a structurally sound anterior column support, thus eliminating the problems related to bone grafts and eliminating the complications associated with an anterior approach. Our preliminary results suggest that this technique is feasible and seems to be associated with favorable outcome, although larger studies are warranted to verify these findings.
3例高位峡部裂型腰椎滑脱患者采用经骶后棒的新型微创技术治疗的病例报告。
评估该方法治疗高位L5-S1腰椎滑脱的疗效、安全性及优势。
L5-S1水平的高位峡部裂型腰椎滑脱的手术治疗技术要求高。最常用的手术是后路脊柱融合术。在本报告中，我们介绍一种治疗3例矢状面平衡脊柱的高位峡部裂型腰椎滑脱的新型微创技术。
3例高位L5-S1腰椎滑脱患者接受了L4-S1融合术，采用经皮椎弓根螺钉固定，并通过管状牵开器植入骶后棒。我们报告了随访时的技术细节、临床及影像学结果。
所有3例患者均为3级或4级L5-S1腰椎滑脱。所有患者术前影像学检查显示矢状面平衡。术后无并发症，所有3例患者均在48小时内出院。末次随访时（范围13 - 18个月），所有患者停用所有麻醉性镇痛药后均无疼痛，且3例患者均观察到融合。
我们已证明通过经骶入路的微创经皮技术对重度L5-S1腰椎滑脱进行前后路融合的技术可行性。经骶后轴向棒固定的主要优势在于它能形成结构稳固的前柱支撑，从而消除与植骨相关的问题以及与前路手术相关的并发症。我们的初步结果表明该技术可行，且似乎与良好的预后相关，尽管需要更大规模的研究来验证这些发现。
