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Spondylolisthesis Surgery for Children

Will Surgery Improve Your Child's Posture and Walk?

Question: My fourteen-year-old daughter was just diagnosed with grade 4 spondylolisthesis and needs surgery to fuse her spine. After surgery, will her walk and posture improve?
—Valencia, CA

Answer: Before I discuss what your daughter should expect after surgery, it's important to have a basic understanding of her condition. Spondylolisthesis refers to a forward slippage of one vertebra on the vertebra below. The most common types of spondylolisthesis that present in childhood typically occur at the L5-S1 level (the lowest level of the spine). Isthmic spondylolisthesis is the result of a fracture through the portion of the vertebra called the pars interarticularis. This fracture is called spondylolysis, and it may allow for increased motion to occur between the vertebral bodies in some patients.

Young patients with spondylolisthesis may have very few symptoms associated with the forward slippage. Some patients may complain of back and/or leg pain or troubles with urinary incontinence or frequency. Spondylolisthesis can be classified as either a low-grade or a high-grade slip based on the amount of forward slippage of one vertebral body on another. High-grade slips (Grades 3-5), such as your daughter's, are defined as having more than 50% forward slippage of one vertebral body on another.

Treatment of spondylolisthesis is based on the severity of the patient's symptoms and the amount of slippage that is present. For most patients, non-surgical treatment is successful. For patients with high-grade spondylolisthesis that has failed to respond to non-surgical treatments, a fusion operation is usually recommended.

For growing patients with grade 4 spondylolisthesis, surgery typically involves decompression of the nerves, placement of metal implants (rods and screws), reduction of the spondylolisthesis, and spinal fusion. This may be performed either through one incision in the back or in some cases through an additional incision in the abdomen to allow access to the front of the spine.

For patients with weakness, leg pain, or other nerve-related problems prior to surgery, appropriate decompression of nerves may improve difficulties with limping or walking after surgery. In addition, muscle stiffness and tightness may improve once the nerves are decompressed.

When surgery is performed for high-grade spondylolisthesis, partial or complete reduction of the spondylolisthesis is typically recommended in order to restore the normal alignment of the lumbar spine (low back) and to improve the patient's posture. The amount of reduction that is performed depends on the amount of slippage that is present, as well as the neurologic status of the patient. Reduction may be associated with some neurologic risk (most commonly weakness in the toes or feet), although this is almost always temporary.

Spinal fusion plays an important role in the surgical treatment of high-grade spondylolisthesis. Fusion is necessary in order to treat the instability that exists between the vertebrae. When a fusion is performed, the bones that are fused grow together to become one solid piece of bone. The addition of instrumentation has been shown to increase spinal fusion rates and also improve patient outcomes following surgery. The use of spinal implants may also eliminate the need for bracing after surgery for the majority of young patients.

The goal of surgery is to fully relieve pinched nerves, restore appropriate spinal alignment, and achieve a solid fusion. A successful surgery should help your daughter's walk and posture improve.

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