Surgical Outcome, Complications and Clinical Recommendations Per Author.
| AUTHOR | Approach/Study Groups | Radiography, fusion status postop | Neuro/clinical deficit | Change in clinical evaluation (e.g. ODI, SF-12, others) | Complications | Clinical Recommendations |
|---|---|---|---|---|---|---|
| 2002_Hanson | Posterior: n = 2 Ant/Post: n = 15 | Posterior: Grade 1 (n = 15), grade 2 (n = 1), no fusion (n = 1) Anterior: Grade 1 (n = 16), broken strut (n = 1). | NA | Post-op ODI= 11.4, SRS= 37.3, SRS satisfaction= 14.1 | 1 broken strut graft (in situ anterior only), no neurological deficits, no infection | Partial reduction of high-grade isthmic spondylolisthesis with fibular strut grafting is a safe, effective procedure. No difference between allograft and autograft |
| 2002_Molinari | Group 1A (n = 11) | Group 1A = 45% pseudarthrosis | No neurologic deficit in patients treated with in situ; Transient neurologic deficits (n = 4/26); Failed intra-op wake-up test (n = 1) that resolved immediately after releasing the reduction, foot drops (n = 2) and bilateral extensor hallucis longus weakness (n = 1) | Pain score: 3/10 Function score: NA Satisfaction score: 8.4/11 | 36% had progression | Anterior structural grafting combined with posterior instrumentation and fusion is effective in achieving fusion in HGS patients. Outcomes for function, pain, and satisfaction are excellent in those patients who obtain solid fusion regardless of the surgical procedure |
| Group 1B (n = 7) | Group 1B = 29% pseudarthrosis | Pain score: 3.6/10 Function score: 12.6/15 Satisfaction score: 9.4/11 | 29% instrumentation failure and partial loss of reduction | |||
| Group 2: Circumferential (n = 19) | Group 2 = 0% pseudarthrosis | Pain score: 2.5/10 Function score: 13.7/15 Satisfaction score: 9.7/11 | 11% implant complications and partial loss of reduction | |||
| 2005_DeWald | Ant. interbody cage/graft (n = 10), post. interbody cage/graft (n = 9), anterior pedicle screws/graft (n = 2) | 0% pseudarthrosis | Hypesthesias or dysesthesias on the dorsum of one or both feet (n = 8); extensor hallus longus weakness (n = 2); cauda equina syndrome (n = 1) | Used an unofficial clinical evaluation format: 12 excellent, 7 good, 1 fair, and 1 poor clinical outcome | Instrumentation failure (n = 1), Iliac vein thrombosis, pulmonary embolus, pancreatitis, and temporary retrograde ejaculation (n = 1 each) | Pediatric patients can be treated successfully by non-instrumented posterior in situ fusion, but instrumentation should be used in adults. Recommends use of adjunctive fixation for adults. |
| 2005_Shufflebarger | Posterior lumbar interbody fusion | All patients achieved arthrodesis | No neurologic complications | NA | Urinary tract infections (n = 3), ileus (n = 2), cholelithiasis (n = 1), no infectious or instrumentation complications | Reducing slip and lumbosacral kyphosis will provide ideal biomechanical environment. Structural anterior column support and posterior transpedicular instrumentation provide more resistance to shear forces than posterior instrumentation alone. |
| 2006_Helenius | Posterolateral in situ | Nonunion (n = 3)Progression (n = 4) | General back pain (BP) (n = 9)BP radiating down leg (n = 5)Neuro deficiencies/ hamstring tightness (n = 14) | SRS = 89.7. ODI = 9.7: severely disabled (n = 1), moderately disabled (n = 2)VAS = 22.6 | Nonunion (n = 3)Re-operation (n = 1) | Circumferential fusion provided significantly better long-term clinical, radiographic, and SRS total score than posterolateral or anterior fusion for HGIS |
| Anterior intercorporeal fusion, trans-peritoneal | Progression (n = 1) | SRS = 93.2, ODI = 8.9: moderately disabled (n = 4), VAS = 24.1; scored best on SRS self-image | Post-op peroneal palsy (n = 1), L5 /S1 radicular pain (n = 3), spondyloptosis (n = 1) | |||
| Circumferential | Nonunion (n = 1) Progression (n = 3) Least lumbosacral kyphosis progression | SRS = 100, ODI = 3.0, VAS = 5.5. Scored best on SRS pain and function | Nonunion (n = 1), wound infection (n = 1), scoliosis and gait difficulties (n = 1) | |||
| 2006_Poussa | Reduction (n = 11) | 18% pseudarthrosis (n = 2) | L5 nerve root injury during decompression (n = 1) | ODI = 7.2, SRS = 90 | Mild muscle atrophy: iliopsoas (n = 7), back L3 (n = 4)/L5 (n = 6); Severe atrophy: back L5 (n = 3) | Fusion in situ should be considered as a method of choice in severe L5 isthmic spondylolisthesis |
| In situ (n = 11) | All fusions healed appropriately | Immediate post-op peroneal palsy 18% (n = 2) | ODI = 1.6, SRS = 103.9, better SRS pain and post-op function | Mild muscle atrophy: iliopsoas (n = 2), back L3 (n = 2)/L5 (n = 4) Severe atrophy: iliopsoas (n = 1) | ||
| 2006_Vialle | Same-day, staged posterior-anterior approach | Fusion achieved in all patients | BP (n = 12), BP/bilateral leg pain (n = 11), BP/unilateral leg pain (n = 9), radicular (n = 6), neuro complications (n = 12): L5 incomplete deficit (n = 5), unilateral L incomplete deficit (n = 6), unilateral L5 hypoesthesia (n = 1); 10/12 recovered neurologically within 18months. | Beaujon functional score: Pre-op mean 14.2 (5-20); Post-op 20+ in n = 35; 15-19 in n = 5 from BP/leg pain. JOA Pre-op mean 10 (2-15); Post-op 15 in n = 35; 12-14 for n = 5. | Intra-op complications: iliac vein lesion and technical difficulty with plate (n = 2). Implant complications: Kyphosis due to plate hitting L4-5 (n = 2), broken screws (n = 2), late infections (n = 5) | This technique proved to provide an excellent fusion rate and satisfactory final functional outcomes, but due to the unusually high rate of late infections that may be related to the surgical approach, we do not recommend this technique for HGIS treatment. |
| 2008_Rodriguez-Olaverri | Group A: Unilateral TLIF Posterior with transforaminal lumbar interbody implants | 100% fusion | Back/leg pain resolved in 90%, no neurologic deficits | SRS pre-op: pain 4.8, self-image 3.8, fxn 4.8; SRS pos-opt: pain 4.6, self-image 3.6, fxn 4.5 | Durotomy (n = 7), infections (n = 3) | Both procedure A and B appear to be safe and effective surgically and radiographically, but we must note that the average operation time was longer in procedure A (4.45 hrs) than in procedure B (3.25 hrs) |
| Group B: Transsacral Posterior only | Solid fusion in 19/ 20 subjects | Back/leg pain resolved in 80%, no neurologic deficits | SRS pre-op: pain 4.7, self-image 4.1, fxn 4.7; SRS post-op: pain 4.3, self-image 4.4, fxn 4.3 | Durotomy (n = 1), pseudarthrosis (n = 1), implant failure (n = 1) | ||
| 2008_Sasso | Posterior-only (n = 8), Anterior-posterior same-day surgery (n = 17) | 100% fusion, no increase in slip grade or angle. | No permanent neurologic deficits or deterioration; transient radiculitis 1-month post-op (n = 1) | SRS: Extremely or somewhat satisfied (n = 24). Pain: 8.2 pre-op, 3.4 post-op | Hardware removal due to prominence after fusion achieved (n = 1); equivalent EBL | This technique offers excellent fusion results, good clinical outcomes, and prevents further sagittal translation and lumbosacral kyphosis progression. |
| 2009_Hresko | Posterolateral (n = 21), Posterolateral + anterior discectomy/interbody fusion (n = 5) | Grade A (definite solid fusion) (n = 22); Grade B (probable solid fusion) (n = 4) | NA | NA | Re-operation (n = 5), loss of L4-L5 motor strength (n = 1), removal prominence (n = 1), revision due to instrument failure (n = 3), transient neurapraxia (n = 6), permanent unilateral L5 weakness (n = 1) | No correlation between improvement in pelvic version and amount of reduction. Other factors, such as achievement of solid arthrodesis, may be more important than reduction of spondylolisthesis in determining spinopelvic sagittal balance. |
| 2010_Sansur | N = 10,242; No fusion/ decompression (n = 532), combined ant/post (n = 893), ant only (n = 286), post fusion w/o instrument (n = 491), post fusion w/ instrument (n = 4117), TLIF/PLIF (n = 3860) | NA | The rate of neurological complications was highest in the decompression/no fusion group, but it was not significantly different from other groups (p = 0.10) | NA | 9.2% complications rate Most common complications = dural tear (2%), infection (2%), neurologic (1.2%), implantrelated (0.7%) | Grade level and age but not surgical approach and history of previous surgery significantly correlated with increased complication rates. |
| 2011_Jalanko | HGS in children (<12.5 years old for females; <14.5 years old for males) | Non-unions but no effect on long-term outcome (n = 5) | Posture/gait abnormality (n = 10), SRA positive (n = 14), scoliosis (n = 8) | At final follow-up: SRS-24 = 92, ODI = 4.5%, VAS = 9mm | Revision due to nonunion (n = 3), Transient L5 paresis (n = 1) | Recommend circumferential in situ fusion for high-grade slips; spinal fusion can be carried out at an early age for HGS with good long-term clinical, functional, radiographic and health-related quality-of-life outcomes. |
| HGS in adolescents | Non-unions but no effect on long-term outcome (n = 3) | Posture/gait abnormality (n = 1), SRA positive (n = 5), scoliosis (n = 4) | At final follow-up: SRS-24 = 94, ODI = 8.7%, VAS = 25.1mm | Revision due to nonunion (n = 1), S1 root decompression (n = 2), wound infection (n-1) | ||
| 2012_Kasliwal | Pediatric (≤18 years old) | NA | Nerve root (n = 9), cauda equina (n = 2), lumbar nerve palsy (n = 2), peroneal n. palsy (n = 2) | NA | 24% of total patients had a complication | Osteotomy was the only surgical predictor of neurologic deficit; new neurologic deficit post-op did not correlate to decompression, reduction or revision surgery |
| Adults (>18 years old) | NA | Nerve root (n = 8), cauda equina (n = 0), lumbar nerve. palsy (n = 1), peroneal nerve. palsy (n = 0) | NA | 26% of total patients had a complication |