Presenter: Teresa Bas

Co-authors: Isabel Collado(*) , Alejandro Lizaur(*) , Paloma Bas, Silvia Perez, Pedro Rubio, Teresa Bas .

TRANSDISCAL SCREW VERSUS PEDICLE SCREW FIXATION FOR HIGH-GRADE L5-S1

SPONDYLOLISTHESIS IN PATIENTS YOUNGER THAN 60 YEARS.

A CASE-CONTROL STUDY. .

Hospital Universitario La Fe Spine Unit. Valencia. (*) Hospital General Universitario de Elda. Alicante.

INTRODUCTION

Surgical management of high-grade spondylolisthesis remains controversial. Today, there is still significant debate regarding the best operative technique for obtaining stabilization and arthrodesis in spondylolisthesis. Various techniques have been described, with a similarly variable rate of successes and complications. Transdiscal L5-S1 fixation has emerged as a treatment option based on a potential mechanical advantage but currently there are no comparative clinical studies..

INTRODUCTION

We have used a technique (Abdu) for partial reduction of the lumbosacral kyphosis, decompression of the nerve roots for radiculopathy, posterolateral fusion, and pedicle screw transvertebral fixation of the lumbosacral junction. This technique has the advantage of providing : •  Three-column stabilization •  Single posterior approach. •  Interbody grafting to be performed,

without a formal anterior procedure.

OBJECTIVES:

The objective of this study was to compare functional and radiological outcomes between transdiscal and posterolateral fusion with pedicle fixation in patients younger than sixty years with L5-S1 spondylolisthesis

Pedicular group Transdiscal group

Material-Methods

RETROSPECTIVE case-control study with patients prospectively followed. 56 PATIENTS WITH SPONDYLOLISTHESIS . Twenty-five consecutive patients (mean age, 36.7 years) who underwent transdiscal fixation, and thirty-one other patients(mean age , 42.0 years) underwent pedicle fixation were clinically and radiographically compared. Follow-up was 2.7 years (range, 2.0 to 5.3). STUDY PARAMETERS in the medical record were reviewed Clinical assessment was performed using Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), Short-Form 12 (SF-12), and pain visual analogue scale (VAS). Imaging Studies: Roentgenographic, CT scan and Magnetic Resonance imaging finding. Radiographic spinopelvic parameters were also evaluated.

.

Material-Methods

Inclusion Criteria 56 Patients

High grade slippage Level L5-S1 <60 years

old

Exclusion  Criteria

Spinal Stenosis

Previous Surgery

Between January 2007 and December 2012 were eligible for the study. In that time, fusion for spondylolisthesis was always instrumented at our department by either using a conventional posterolateral fusion with pedicle screws fixation or stabilization with transdiscal screwing.

Results Preoperative data of the two groups

Continuous data are presented as mean (standard deviation). Activities: sedentary, standing, effort

Results

Postoperative data

Continuous data are presented as mean (standard deviation). * p-value intragroup. ** p-value intergroups

Complications

Results

Continuous data are presented as mean (standard deviation). * Level fusion: L3-S1/L4-S1/L5-S1.

Postoperative

Discussion

•  THE GOALS OF TREATMENT SPONDYLOSTHESIS are to improve sagittal balance, neural decompression, and stable fixation with low risk of neurologic complications.

•  THE TWO TECHNIQUE OF FIXATION (Pedicular group and Transdiscal group) are effective for managing severe spondylolisthesis with low back pain and leg pain

•  On the ODI, the COMI, SF-12 and the VAS questionnaire, the patients in the transdiscal fusion group had better results than had those in the pedicular group.

Conclusions TRANSDISCAL FIXATION results in improved functional outcomes compared with posterolateral fusion and pedicle fixation. •  Based on our results, WE RECOMMEND TRANSDISCAL FIXATION for patients with high-grade balance with high SS\ low PT spondylolisthesis . However, it is suggested that these results be confirmed by future studies ( higher number of patients and longer follow-up). LIMITATIONS OF THIS STUDY INCLUDED : Retrospective comparative design Short follow-up of 2.7 years Small sample size STRENGTHS: Patients had been followed prospectively There was no loss of follow-up Outcomes were assessed by independent observers.

Bibliography 1. Lee GW, Lee SM, Ahn MW, Kim HJ, Yeom JS. Comparison of

posterolateral lumbar fusion and posterior lumbar interbody fusion for patients younger than 60 years with isthmic spondylolisthesis. Spine 2014;39:1475-80.

2. Boxall D, Bradford DS, Winter RB, Moe JH. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 1979;61:479-95.

3. Minamide A, Akamaru T, Yoon ST, Tamaki T, Rhee JM, Hutton WC. Transdiscal L5-S1 screws for the fixation of isthmic spondylolisthesis: A biomechanical evaluation. J Spinal Disord Tech 2003;16:144-49.

4. Abdu WA, Wilber RG, Emery SE. Pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis: A new technique for stabilization. Spine 1994;19:710-15.

5. Boachie-Adjei O, Do T, Rawlins BA.Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: Clinical and radiographic results in six patients. Spine 2002;27:161-68.

DISCLOUSURES •  None of the authors has any potential conflict of interest •  This clinical study presented in this Poster had been support by Grant from SECOT 2014