Ugo Nena

Traumatic L5-S1 spondylolisthesis: report of three cases and a review of the literature.

Abstract The literature reports that traumatic spondylolisthesis of L5 is an uncommon lesion. The authors report their experience of three cases of this particular fracture-dislocation of the lumbosacral spine. They stress the importance of certain radiographic signs in the diagnosis: namely, the presence of unilateral multiple fracture of the transverse lumbar apophysis. As far as the treatment is concerned, they state the need for an open reduction and an internal segmental fixation by posterior approach. A preoperative MRI study appears mandatory in order to evaluate the integrity of the L5-S1 disc. In the event of a traumatic disruption of the disc, they state the importance of posterior interbody fusion by means of a strut graft carved from the ilium or, in case of iliac wing fracture (which is not uncommon in these patients), by means of interbody cages.

Surgical treatment of severe L5-S1 spondylolisthesis in children and adolescents. Results of intraoperative reduction, posterior interbody fusion, and segmental pedicle fixation.

Study Design A retrospective study was done in 12 teenagers with severe L5‐S1 spondylolisthesis surgically treated with a single‐stage posterior procedure for reduction, posterior interbody fusion, and segmental instrumentation. Objective To evaluate the effectiveness and reliability of intraoperative reduction and posterior interbody fusion in severe lumbosacral spondylolisthesis in children. Summary of Background Data Twelve young patients (age, 13‐18 years; mean = 16 ± 1.5) with severe L5‐S1 spondylolisthesis (slip, 59%‐85%; mean = 70.4 ± 8.8%) were available for follow‐up evaluation (6‐24 months after surgery). All presented with serious preoperative clinical signs (tight hamstrings, waddling gait, lumbosacral pain, radiated leg pain). Methods The patients underwent surgery using a single posterior surgical procedure. After removal of the loosened arch and complete discectomy, a temporary device placed bilaterally between L1 and the sacral wings was used to achieve reduction by distraction. This was followed by a posterior interbody strut graft and pedicle segmental fixation. No postoperative casting was used. Clinical examination was done, and radiographic measurements were taken after surgery and at follow‐up evaluation. Patients were evaluated for fusion, rate, stability of reduction, clinical outcome, and possible complications. Results All patients underwent solid fusion without loss of reduction. No intraoperative or postoperative complications were observed. Mean correction of the initial slipping was 79.5 ± 7% of the initial deformity. No clinical signs were present at follow‐up evaluation. Conclusions Intraoperative distraction appears to be truly effective in reducing severe lumbosacral olyshtesis in children. Posterior interbody fusion (and eventual sacral dome osteotomy) successfully combines the goals of solid fusion with the requirements of root decompression. No neurologic problems were seen as a consequence of distraction. The solidity of the posterior segmental pedicle instrumentation combined with the anterior strut graft eliminate the need for postoperative casting.

Treatment of kyphotic deformities in adults: our experience

PurposeMany degenerative phenomena frequently result into kyphotic lumbar and thoracic deformities or cause their progression combined with deformities on the frontal plane of the spine. In these patients, the progression of the sagittal imbalance may lead to a series of disabling functional and painful consequences. The analysis of the spinopelvic parameters biases the choice of the correction surgical strategy aimed at restoring a good tri-dimensional and sagittal balance of the spine.Materials and methodsSample included 62 patients treated in our Operation Unit that were enrolled for evaluation; they were affected with prevailing sagittal deformities.ResultsClinical results were evaluated through the administration of SF-36, Oswestry Disability Index (ODI), Roland Morris (RM), and visual analogical scale (VAS).ConclusionsIn our experience, patients with sagittal imbalance and short fusion areas show a higher risk of correction loss; the arthrodesis area must include the thoracolumbar junction, and it is often necessary to include the whole thoracic spine in the arthrodesis area. This is to avoid any loss of correction, implants mobilization, and proximal hyperkyphosis.