Spinal fusion for paediatric lumbosacral spondylolisthesis
Background: Paediatric spondylolisthesis can range from a benign non-progressive asymptomatic condition to rapidly progressive slips with associated debilitating axial and radicular pain. We reviewed our experience as to the presentation, surgical management and outcomes following surgery of this relatively rare condition.
Methods: We identified 24 paediatric patients who underwent surgery for spondylolisthesis from 2006–2017. The cohort consisted of 17 females and seven males with a median age of 13 years (IQR 11–14) at the time of surgery. A case note and imaging review was conducted. Presenting history and examination, aetiology and degree of slip, surgical technique employed, complications and outcome were analysed.
Results: Most patients presented with a combination of lower back and radicular symptoms, with five having radiculopathy as a single complaint. Seventeen cases involved instrumentation and 18 interbody fusions, with interbody cages used in 14, and bone graft alone in four. All but the four uninstrumented interbody fusions were performed with an all-posterior approach. In 11 of grade 1 and 2 slip cases, the listhesis was completely reduced. Four patients were partially reduced and in six patients, including one spondyloptosis, fusion was in situ. All patients with radicular symptoms were decompressed surgically, along with those where the listhesis was reduced. All but one patient has complete resolution of presenting symptoms at latest follow-up. Four patients required re-operation for complications related to the surgery.
Conclusion: Paediatric spondylolisthesis can be successfully managed employing a variety of techniques. For low grade slips, reduction and interbody fusion is a safe and reliable method of improving spinal sagittal balance and relieving symptoms related to nerve root compression and spinal instability. For higher grade slips, reduction was associated with instrumentation failure in two patients and in-situ fusion via a combined anterior and posterior approach had a better outcome in our patients.
Level of evidence: Level 4 – Case series