Sakhrekar Rajendra, Ha Ji Soo, Kim Do-Hyoung, Kim Chang Wook, Kulkarni Shreenidhi, Han Hee-Don
Department of Spine Surgery, Yonsei Okay Hospital, Seoul, South Korea.
J Orthop Case Rep. 2024 Jan;14(1):165-172. doi: 10.13107/jocr.2024.v14.i01.4188.
High-grade spondylolisthesis is defined as cases with more than 50% displacement and spondylolisthesis with Meyerding grade III and higher. The surgical management of high-grade spondylolisthesis is highly controversial. Many surgical methods have been reported such as posterior in situ fusion, instrumented posterior fusion with or without reduction, combined anterior and posterior procedures, spondylectomy with reduction of L4 to the sacrum (for spondyloptosis), and posterior interbody fusion with trans-sacral fixation. The literature has recently mentioned minimally invasive transforaminal lumbar interbody fusion for high-grade spondylolisthesis. This study aimed to review the recent literature that describes the surgical outcomes associated with various surgical techniques used for high-grade spondylolisthesis.
Recent articles were searched on search engines such as PubMed and Google Scholar using keywords such as "high-grade spondylolisthesis," "surgical techniques," and "complications."
The surgical management of high-grade spondylolisthesis is an area of significant controversy. The literature is replete with regards to the need for reduction, decompression, levels of fusion, the nature of instrumentation, surgical approaches including open, minimally invasive, and "mini-open" procedures, and various techniques for reducing the slip and fusion strategy. The three basic options of high-grade spondylolisthesis include in-situ fusion, partial reduction and fusion, and complete reduction.
Various techniques have been described for high-grade spondylolisthesis. Spine deformity study group classification gives guidelines about balanced and unbalanced pelvis and advises reduction and fusion in case of unbalanced pelvis for correction of biomechanical and global sagittal alignment. Each of the surgical techniques has its advantages and disadvantages. However, individual authors' experience, skill levels, and anatomic reduction with fusion techniques have yielded encouraging results.
重度腰椎滑脱被定义为移位超过50%的病例以及迈耶丁分级为III级及以上的腰椎滑脱。重度腰椎滑脱的手术治疗极具争议性。已报道了许多手术方法，如后路原位融合、带或不带复位的器械辅助后路融合、前后联合手术、L4至骶骨复位的椎体切除术（用于椎体滑脱）以及经骶骨固定的后路椎间融合术。最近文献提及了用于重度腰椎滑脱的微创经椎间孔腰椎椎间融合术。本研究旨在回顾近期描述用于重度腰椎滑脱的各种手术技术相关手术结果的文献。
在PubMed和谷歌学术等搜索引擎上使用“重度腰椎滑脱”“手术技术”和“并发症”等关键词搜索近期文章。
重度腰椎滑脱的手术治疗是一个存在重大争议的领域。关于复位的必要性、减压、融合节段、内固定的性质、包括开放、微创和“迷你开放”手术的手术入路以及各种减少滑脱和融合策略的技术，文献中都有大量记载。重度腰椎滑脱的三种基本选择包括原位融合、部分复位和融合以及完全复位。
已描述了用于重度腰椎滑脱的各种技术。脊柱畸形研究组分类给出了关于骨盆平衡和不平衡的指导原则，并建议在骨盆不平衡时进行复位和融合以纠正生物力学和整体矢状位对线。每种手术技术都有其优缺点。然而，个别作者的经验、技术水平以及融合技术的解剖复位已取得了令人鼓舞的结果。
