High-grade spondylolisthesis: gradual reduction using Magerl’s external fixator followed by circumferential fusion technique and long-term results

摘要

PurposeTo report the results of a cohort of patients treated with this technique high lighting radiological and functional outcomes, discussing also benefits arising from a gradual reduction procedure compared with other techniques.MethodsWe evaluated nine patients who have undergone high-grade listhesis reduction and circumferential fusion at our institution from 1988 to 2006. Average length of follow-up was 11?years (5–19). Functional outcomes and radiological measurements were recorded and reported.ResultsSlip magnitude was reduced by an average of 2.9 grades (Meyerding classification). Slip angle improved by an average of 66% (p?=?0.0001), lumbosacral angle by 47% (p?=?0.0002), sacral rotation by 51% (p?=?0.0068) and sacral inclination by 47% (p?=?0.0055). At the latest follow-up 88.9% had achieved solid fusion. Post-operative 10-point Visual Analogue Score (VAS) for back pain had improved by 70% (p??0.001) and that for leg pain by 76% (p??0.001) compared with pre-operative score. Average postoperative Oswestry Disability Index for all patients was 8% (range 0–16%) and that for Low Back Outcome Scores was 56.6 (range 44–70). All components of Short Form 36 Health Survey were greater than 80%. Overall patients’ expectations were met in 100%.ConclusionsThis is an effective and safe technique which addresses the lumbosacral kyphosis and cosmetic deformity without the neurological complications which accompany other reduction and fusion techniques for high-grade spondylolisthesis...