Performing 2-Stage Circumferential Fusion in an Adolescent With High-Grade Spondylolisthesis: A Surgical Technique.

The surgical approach to high-grade spondylolisthesis at the lumbosacral junction remains controversial. Appropriate surgical techniques can be challenging with the potential for high complication rates, particularly with reduction. Multiple techniques have been described including posterior only reduction and instrumentation, posterior only instrumentation with in situ arthrodesis, and anterior-posterior reduction and instrumentation. Regardless of technique, the operative goals are to provide sufficient stability and biological support to promote bony fusion, maintain global balance, and decompress the neural elements while avoiding neurological complications. During instrumentation of a high-grade spondylolisthesis at the lumbosacral junction, it can be difficult to obtain access to the L5-S1 disc space for interbody insertion. We present a novel technique for improving access to the L5-S1 disc space through an osteotomy of the anterior-inferior aspect of the L5 vertebral body as part of a 2-stage circumferential fusion in the treatment of high-grade spondylolisthesis in an adolescent.
Competing Interests: A.S.S. receives royalties from CTL Amedica and Jaypee Publishers, and is a paid consultant for Depuy. A.N. receives research support from Pfizer, AO Spine and Premia Spine, and is a board or committee member of the American Orthopaedic Association, Cervical Spine Research Society, Lumbar Spine Research Society, Scoliosis Research Society. A.N. is on the editorial or governing board for Techniques in Orthopedics. For the remaining authors declare no conflict of interest.
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