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Abstract from the 2006 SRS Annual Meeting
Introduction: Twenty-two pediatric patients with high grade
spondylolisthesis underwent posterior decompression and posterolateral fusion
and fibular dowel placement without aggressive attempt at deformity correction.
Method: Average age was 13.5 years (range 11-17 years). All
patients had both back and bilateral leg pain. 5 patients had Meyerding grade
III spondylolisthesis, 12 had grade IV, and 5 had spondyloptosis. No patient
had undergone prior surgery. All patients had posterolateral fusion with iliac
crest grafting; 8 patients had pedicle screw instrumentation. Allograft fibular
dowels were placed via a posterior approach from the sacrum to L5. Average follow-up
was 8.6 years (range 3-17 years).
Results: Clinical outcome was assessed with a specific questionnaire
addressing relief of back and leg pain, improvement in quality of life, and
achievement of pre-operative expectations. Parameters measured were Meyerding
grade, slip angle, sacral inclination, lumbar lordosis, and pelvic incidence.
Radiographs evaluated posterolateral fusion mass, integrity of the fibular dowel,
and hardware failure if present. 86% of patients had good or excellent relief
of back pain, while 91% had good or excellent relief of leg pain. 95% of patients
reported improvement in quality of life and 91% felt their pre-operative expectations
had been achieved. 91% of patients had solid posterolateral fusion by 6 months.
Fracture of a fibular dowel occurred in one case. Hardware failure occurred
in one case. Pedicle screw instrumentation did not affect clinical or radiographic
outcome. 3 patients (14%) required further surgery; two with a symptomatic pseudarthrosis
underwent supplemental posterolateral fusion and a third had elective removal
of painful, loose hardware.
Conclusion: Transient L5 neuropraxia occurred in 4 cases but
no persistent neurologic deficits were noted. Lumbar lordosis improved an average
of 6 degrees. Slip angle, sacral inclination, slip grade and pelvic incidence
were not found to significantly affect clinical outcome.
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