The Evolution of the Surgical Treatment of High-Grade Adolescent Isthmic Spondylolisthesis: Successes and Failures. A Single Center 50 Year Experience: PAPER #74 : Spine Journal Meeting Abstracts

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00152232-201100002-00074AbstractSpine: Affiliated Society Meeting AbstractsSpine: Affiliated Society Meeting Abstracts© 2011 Lippincott Williams & Wilkins, Inc. p 93The Evolution of the Surgical Treatment of High-Grade Adolescent Isthmic Spondylolisthesis: Successes and Failures. A Single Center 50 Year ExperiencePAPER #74PODIUM PRESENTATION ABSTRACTSGuillaume, Tenner J. MD; Perra, Joseph H. MD; Lonstein, John; Winter, Robert B. MDUSASummary: 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.<strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">The Evolution of the Surgical Treatment of High-Grade Adolescent Isthmic Spondylolisthesis: Successes and Failures. A Single Center 50 Year Experience</strong>: <strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">PAPER #74</strong>Guillaume Tenner J. MD; Perra, Joseph H. MD; Lonstein, John; Winter, Robert B. MDPODIUM PRESENTATION ABSTRACTSPODIUM PRESENTATION ABSTRACTSp 93