Summary: Retrospective chart and Xray review to evaluate procedure associated fusion rates, complications, reoperations, and the risks and benefits of aggressive surgical reduction at a single center over a 50‐year period.
Introduction: The benefits of aggressive surgical reduction of high‐grade adolescent isthmic spondylolisthesis do not outweigh the risks.
Methods: 63 patients met the inclusion criteria of high‐grade (>50%) isthmic spondylolisthesis, patient less than 18 years old at surgery, surgical intervention performed between 1960 and 2008, and absence of a syndromic diagnosis.
Results: Of the 63 patients, 34 had slips of 51% ‐ 75%, 13 had slips of 76% 100%, and 10 had slips of > 101%. 39 patients had 2‐year radiographic follow‐up. 43 patients underwent either no or table assisted reduction. A posterior fusion was performed in 32 patients (25 uninstrumented and 7 instrumented), 10 with 360‐degree fusion (6 uninstrumented and 4 instrumented), and 1 with uninstrumented anterior fusion.
18 patients underwent aggressive active reduction. A posterior fusion was performed in 12 patients (1 uninstrumented and 10 instrumented), a 360‐degree fusion was performed in 6 patients (5 uninstrumented and 1 instrumented) and 1 had an uninstrumented anterior fusion.
There were 5 (11.6%) pseudoarthroses in the minimally reduced group, all of which were uninstrumented posterior fusions, and 3 (16.7%) pseudoarthroses in the aggressively reduced group (one each in the posterior instrumented, uninstrumented anterior, and uninstrumented 360 groups).
Overall there were 5 neurologic complications (7.9%), all occurring in patients that were actively reduced (26% of active reductions), of which 3 were permanent.
There were 8 reoperations in the actively reduced group, and 6 reoperations in the minimally reduced group.
Conclusion: We found that aggressive reduction did not improve fusion rate, increased neurologic complications, and resulted in a higher reoperation rate.
Significance: Excellent outcomes are obtained without significant morbidity and minimally reduced treatment of Adolescent High‐Grade Spondylolisthesis.