The several posts were on Low-Grade Slip/Spondylolisthesis
Fusion Surgery, which are done for Grade 1 and 2 severity slips.
We will now move onto High-Grade Slip/Spondylolisthesis
Fusion Surgery…..which if you recall are for Grade 3-5 severity slips
One of the best publications on the treatment of High-Grade
Spondylolistheses is shown in the below two figures:
The first type of High-Grade Spondylisthesis is the Type 4
(see above diagram)
The below case demonstrates a Type 4 surgical case, which means
the patient overall has good overall spine/body balance, called Sacropelvic
Balance. Since this patient has good
balance we do not have to alter the preoperative position of the slipped
vertebra, and can fix as it sits….called in-situ.
The loose posterior part of the spine is removed, called a
Gill laminectomy and the nerve roots of L5 and S1 are inspected and
decompressed, as needed.
Fixation is then placed at L4, L5 and S1. Since we don’t need to move L5 we can place
our S1 screws into the L5 body, to give additional fixation strength to the construct.
The below figure shows the patient before and after
surgery. As you see we haven’t altered
the slipped vertebra position nor the overall spinal balance.
Below the patient is now 3 years after surgery, having no
pain and the fusion has solidly healed.
In the next blog post we will demonstrate a Type 5
deformity.