Summary of Surgical Strategy
| AUTHOR | Approach | Fusion levels/ Instrumentation | Graft | Decompression | Reduction |
|---|---|---|---|---|---|
| 2002_Hanson | Posterior: n = 2 Ant/Post: n = 15 (performed in two separate stages, usu. 5 days later) | n = 2 none, n = 11 L4-S1, n = 1 L3-S1 + ilium, n = 1 L4-S1 + ilium, n = 1 L5-S1 + ilium, n = 1 T5-sacrum + ilium; Pedicle screws. | Fibular dowel graft (allograft n = 11, autograft n = 6) | Wide decompression of the L5-S1 root | n = 15: Grade 4/3 Pre-Op to Grade 1/3 Post-Op n = 2: no change |
| 2002_Molinari | n = 18 Posterior; n = 11 Group 1A | Group 1A = L4-sacrum No instrumentation | NA | Group 1A = No decompression | Group 1A = in situ |
| n = 7 Group 1B | Group 1B = L4-sacrum Posterior instrumentation | NA | Group 1B = Posterior decompression | Group 1B = 6/7 patients | |
| n = 19 Circumferential with anterior support (Group 2) n = 16 separate anterior approach, n = 3 PLIF in lieu of anterior approach | Circumferential with anterior structural support; n = 3 Structural graft and posterior fixation | Anterior structural graft | Group 2 = Posterior decompression | Group 2 = 19/19 patients | |
| 2005_DeWald | n = 10, Ant. interbody cage/ graft n = 9, Post. interbody cage/graft n = 2, Ant. Pedicle screws/graft | n = 1 NA, n = 11 L4-S1, n = 5 L5-S1, n = 3 L3-S1, n = 1 L4-L6 Interbody cages/strut graft; Pedicle screws | Bone on bone, fibermetal trans-sacral strut, fibular allo-graft trans-sacral strut, autograph cortical iliac trans-sacral strut | NA | n = 16/21 (14 partial reduction) |
| 2005_Shufflebarger | Posterior lumbar interbody fusion | n = 18 L5-S1; Harm's cage, posterior monosegmental compression instrumentation with pedicular fixation | Autogenous iliac crest graft | Gill decompression | n = 18 (% slip avg pre-op 77%- > post-op 13%) |
| 2006_Poussa | Anterior/ Posterolateral | L4-S1 n = 9, L5-S1 n = 2, transpedicular magerl/dick, anterior L5-S1 | NA | Laminectomy n = 11 (all) | Yes |
| Anterior/ Posterolateral without instrumentation | L4-S1 n = 7, L5-S1 n = 4, no instrumentation, anterior L5-S1 | NA | Laminectomy n = 7 | NO (some due to interbody grafts) | |
| 2006_Helenius | Group 1A: Posterolateral in situ | n = 4 L5-sacrum, n = 16 L4-sacrum, n = 1 L3-sacrum; No instrumentation | Autologous iliac crest bone graft | Not performed | None |
| Group 1B: Ant intercorporeal fusion, transperitoneal, resected ant/inf edge L5 for access if necessary | n = 23 L5-S1 No instrumentation | Autologous iliac crest bone graft; wedge interbody grafts | From patient's positioning on operating table and wedge-shaped grafts | ||
| Group 2: Circumferential: anterior/posterolateral, n = 17 one operation, n = 9 staged | n = 14 L4-S1, n = 12 L5-S1 No instrumentation | Autogenous bone graft | None | ||
| 2006_Vialle | Same-day, staged posterior-anterior approach | Anterior plate to S1, plates through S1 to iliac wings n = 40 Instrumentation in all patients | Posterior: No grafting Anterior: ICBG through anterior plate | Posterior decompression and removal of posterior arch of L5 | Complete reduction in all patients |
| 2008_Rodriguez-Olaverri | Group A: Unilateral TLIF Posterior with transforaminal lumbar interbody implants | L4, L5, S1, ilium Rods, screws and two titanium mesh cages | Posterolateral: autogenous local graft + allograft | L5 nerve root, L5 arch and pars interarticularis decompres | Partial reduction via interbody packed titanium cage and hip extension positioning |
| Group B: Transsacral Posterior only | Transsacral screws thru L5-S1, pedicle screws L4 | Posterolateral: autogenous local graft + allograft | L5 nerve root, L5 arch and pars interarticularis decompression | Partial reduction via hip extension positioning | |
| 2008_Sasso | n = 8 Posterior-only, n = 17 Anterior-posterior (paramedian rectus-sparing mini-open retroperitoneal) same-day surgery | L4-S1 Pedicle screws | Posterior: Fibular allograft Anterior: Fibular strut graft plus femoral ring allograft | S1 Gill laminectomy | Reduced with patient positioning, no additional attempts at reduction |
| 2009_Hresko | n = 21 Posterolateral, n = 5 Posterolateral + anterior discectomy/interbody fusion | L4-sacrum n = 13 Jackson intrasacral rods, n = 13 Luque box instrumentation | NA | Laminectomy and nerve root decompression on case-by-case basis | Partial reduction achieved by prone positioning and lumbar lordosis. Achieved 10° reduction in 10% of all patients |