Spondylolisthesis : Diagnosis, Non-Surgical Management, and Surgical Techniques

Now in a fully revised and expanded second edition, this comprehensive text remains the definitive source for information related to the care of adult and pediatric patients with spondylolisthesis. It presents a complete analysis of this common yet intricate spinal condition, including basic science, diagnosis, non-surgical management, surgical techniques (including minimally invasive options and biologics) and outcomes. The management of the various types of spondylolisthesis requires a thorough understanding of both fundamental principles and subtle nuances, which are highlighted here in three sections. Part I details the basic principles, diagnosis and non-surgical management of spondylolisthesis, including anatomy and biomechanics, clinical evaluation of both adult and pediatric patients, and imaging and classification. Part II covers surgical management with a step-by-step discussion of strategies, techniques and tips that are necessary to apply standard procedures to this specific disorder. Procedures that are covered here include decompression, spinal fusion from various approaches, and the latest minimally invasive and endoscopic techniques. Part III discusses the outcomes and complications of surgical treatment, as well as interoperative neuro-monitoring and value considerations. Written and edited by top clinicians in the field, Spondylolisthesis remains an invaluable resource for orthopedic and neurological spine surgeons, rehabilitation physicians, residents, fellows, and any caregiver who treats the spine. Preface Contents Contributors Part I: Basic Principles, Diagnosis, and Non-surgical Management 1: Spondylolisthesis: A Historical Perspective on Etiology, Diagnosis, and Treatment Introduction Etiology Diagnosis Treatment References 2: Anatomy and Biomechanics Relevant to Spondylolisthesis Introduction Biomechanics Spinal Balance Sacropelvic Alignment Lumbosacral Dysplasia Conclusions References 3: Pain Generators in Spondylolisthesis Introduction Discogenic Pain Facet Joints Neurologic Compression Pars Interarticularis Axial Pain from Sagittal Imbalance The Clinical Scenario References 4: Clinical Evaluation of Pediatric Patient with Spondylolisthesis Introduction History Evaluation Palpation Range of Motion Gait Neurologic Exam Special Tests Conclusion References 5: Clinical Evaluation of Adult Patient with Spondylolisthesis Introduction Isthmic Spondylolisthesis Introduction Patient History Low Back Pain Neurologic Symptoms Physical Exam Imaging Diagnosis Lumbosacral Analysis Level and Degree of Slip Lumbosacral Angle Lumbar Index Sacral Inclination Sacral Rounding Spina Bifida Occulta Spinopelvic Analysis and Sagittal Balance Pelvic Incidence, Sacral Slope, and Pelvic Tilt Pedicle Morphology Global Sagittal Balance Degenerative Spondylolisthesis Introduction Patient History Low Back Pain Neurogenic Claudication and Radiculopathy Physical Exam Radiographic Exam Radiographic Diagnosis Advanced Imaging Clinical Correlation References 6: Imaging Techniques for the Diagnosis of Spondylolisthesis Introduction Radiography Radiographic Examinations Frontal Radiographs Lateral Radiographs Oblique Radiographs Radiographic Anatomy Frontal Radiographs Lateral Radiographs Oblique Radiographs Radiographic Diagnosis and Grading of Spondylolisthesis Additional Radiographic Observations in Spondylolisthesis Spondylolysis Dysplastic or Dystrophic Changes Degenerative Intervertebral Disc Disease and Facet Arthropathy Spondylolisthesis in Patients with Scoliosis “Inverted Napoleon’s Hat” Sign Spinous Process Tilt or Rotation Radiographic Measurements Radiographic Assessment of Instability Magnetic Resonance Imaging MRI Scanning Sequences and Anatomy MRI Findings in Spondylolisthesis Limitations of MRI Computed Tomography CT Anatomy and Findings in Spondylolisthesis CT Myelography Nuclear Medicine Studies Bone Scintigraphy with Single-Photon Emission Computed Tomography Positron-Emission Tomography Bone Scintigraphy Imaging Findings in Spondylolisthesis According to Etiology Dysplastic Spondylolisthesis Isthmic Spondylolisthesis Degenerative Spondylolisthesis Traumatic Spondylolisthesis Pathological Spondylolisthesis Post-operative Spondylolisthesis Radiation Safety Patient Radiation Dose Effective Dose Radiography Computed Tomography Nuclear Medicine Imaging Intraoperative Imaging Radiation Risk Factors Summary References 7: Classification of Spondylolisthesis Introduction Meyerding Classification Wiltse Classification Marchetti and Bartolozzi Classification Developmental Spondylolisthesis Acquired Spondylolisthesis Herman Classification Mac-Thiong Classification SDSG Classification Other Classification Systems Conclusion References 8: Role of the Pelvis in the Diagnosis and Management of L5–S1 Spondylolisthesis The Pelvis: From Quadrupeds to Humans Spino-Pelvic Measures and Their Variations in Normal Humans The Pelvis in L5–S1 Spondylolisthesis L5–S1 Spondylisthesis Classification Based on Sagittal Posture and Its Clinical Relevance References 9: Nonsurgical Treatment of Spondylolisthesis in Pediatric Patients Introduction Natural History Risk Factors for Progression Treatment Options Medical Treatment Modalities Physical Therapy Bracing Treatment Protocols Author’s Recommendations Conclusion References 10: Nonsurgical Management of Spondylolisthesis in Adult Patients Introduction Treatment Pharmacologic Treatment Physical Therapy Interventional Treatment Options Bracing Alternative Therapy Authors’ Approach Conclusion References 11: Biologics and Advanced Materials for Spondylolisthesis Introduction Bone Grafts Synthetic Bone Grafts Ceramics Synthetic Polymers Composite Graft rhBMP-2, Bone Marrow Aspirate, and HA rhBMP-2, Local Bone Graft, and Iliac Crest Bone Graft Calcium Phosphate and rhBMP-2 Bioactive Glass and Autologous Bone Graft PMMA and Spine Fusion Conclusion References Part II: Surgical Techniques 12: Spondylolysis Repair Introduction Diagnostic Imaging Treatment Nonoperative Management Surgical Management Surgical Techniques: Pars Repair Positioning Direct Pars Repair with Navigated Cannulated Lag Screw Fixation Indirect Repair: Pedicle Screw, Rod, and Laminar Hook Construct Postoperative Care Surgical Outcomes References 13: Decompression and Spinal Fusion in Low-Grade Spondylolisthesis Introduction Indications for Surgical Treatment Surgical Techniques Decompression Decompression with Fusion Without Instrumentation Decompression with Fusion and Instrumentation Decompression, Instrumentation with Interbody Fusion Techniques Summary References 14: Posterior Lumbar Interbody Fusion in Spondylolisthesis Introduction Indications for PLIF Interbody Fusion Versus Posterolateral Fusion Alone Contraindications to PLIF PLIF Versus Other Forms of Interbody Fusion vs. ALIF vs. LLIF vs. TLIF Surgical Technique Reduction of Spondylolisthesis and Deformity Correction Using the PLIF Depth Unilateral Versus Bilateral PLIF Cage Selection and the Use of RhBMP2 Complications: Prevention and Management Great Vessel Injury Adjacent Segment Degeneration Neurologic Injury Durotomy Interbody Migration Pseudarthrosis/Failure of Fusion Infection Conclusion References 15: Anterior Lumbar Interbody Fusion in Spondylolisthesis History Preoperative Evaluation Surgical Technique Lumbar and Lumbosacral Retroperitoneal Approach Lumbar Transperitoneal Approach Interbody Graft Outcomes Complications References 16: Minimally Invasive TLIF for Adult Spondylolisthesis Introduction Contraindications Obesity Revision Surgery High-Grade Listhesis (Grade 3 or 4) Three (or More) Level Fusions Deformity Correction Equipment Required Procedure Anesthesia and Position Procedure Special Situations High-Grade Adult Spondylolisthesis Two-Level Fusion Revision Decompression and Fusion Pitfalls Incidental Durotomy Poor Visualization Due to Muscle Creep Summary References 17: Lateral Interbody Fusion for Adult Spondylolisthesis Including Single Position Techniques Background Surgical Procedure Technique Screw Fixation Published Results LLIF for DS Comparison of LLIF and Posterior Procedures Single Position LLIF Conclusion References 18: Anterior to Psoas/OLIF Approach for Adult Spondylolisthesis Introduction Surgical Technique Discussion References 19: Prone Transpsoas Approach for Adult Spondylolisthesis Introduction Surgical Technique Positioning and Draping Approach Side Neuromonitoring Intraoperative Imaging Operative Procedure Application in Spondylolisthesis Advantages Disadvantages Complications Patient Selection Conclusion References 20: Pedicle Screw Placement in Adult and Pediatric Spondylolisthesis: Free Hand, Navigation, and Robotic Assisted Introduction Pedicle Screws: Advent and Advances Pedicle Screw Placement in Spondylolisthesis Pedicle Screw Placement Techniques, Considerations, and Freehand Results Navigation-Assisted Pedicle Screw Placement Robot-Assisted Pedicle Screw Placement: Introduction and Results Robotic-Assisted Spondylolisthesis: Case Presentation Case Description Surgical Planning Operating Room Setup Incision, Exposure, and Robot Registration Mounting and Registration Instrumentation, Decompression, and Interbody Spondylolisthesis Reduction References 21: Endoscopic Techniques for Treatment of Spondylolisthesis Introduction Endoscopic Decompression Endoscopic Advantages Endoscopic Fusion Techniques for Low-Grade Spondylolisthesis Surgical Technique High Grade: Grade 3 and Grade 4 Potential Pitfalls Conclusion References 22: Management of High-Grade Spondylolisthesis Including Reduction Techniques Introduction Pathomechanics of High-Grade Spondylolisthesis Classification of Spondylolisthesis Treatment Algorithm: High-Grade Spondylolisthesis Controversies Described Surgical Techniques Open Procedure Positioning and Approach Open Reduction Minimally Invasive Procedure Positioning and Approach Reduction Interbody Fusion Authors’ Preferred Management Preoperative Planning Surgical Technique Complications Conclusions References 23: Diagnosis and Management of Spondyloptosis Introduction and Etiology Clinical Presentation Diagnostic Imaging Nonoperative Management Operative Management Case Presentation References 24: Management of Traumatic Spondylolisthesis: Cervical and Lumbar Introduction Cervical Spine: Anatomic Considerations in Injury Patterns Traumatic Spondylolisthesis of the Axis Management of TSA Traumatic Spondylolisthesis of the Subaxial Cervical Spine Lumbar Spine: Anatomic Considerations and Traumatic Spondylolisthesis Conclusion References 25: Spondylolisthesis Associated with Scoliosis Scoliosis: Definition and Classification Causation and Association of Scoliosis and Spondylolisthesis Spondylolisthesis Presenting with Scoliosis Spondylolisthesis Developing After Scoliosis Diagnosis and Symptoms Surgical Techniques and Considerations Clinical Cases 36-Year-Old Female 45-Year-Old Male 12-Year-Old Female References Part III: Results of Treatment and Complications 26: Results of Surgical Treatment of Adult Degenerative Spondylolisthesis Surgical Options Decompression Without Fusion Decompression with Uninstrumented Fusion Posterolateral Fusion with Instrumentation Anterior Column Support Minimally Invasive Surgical Options for Fusion Role of Biologics Dynamic Stabilization Role of Spinopelvic Alignment Conclusions References 27: Results of Surgical Treatment of Low-Grade Adult Isthmic Spondylolisthesis Introduction Pars Repair Decompression and Fusion for Low-Grade Isthmic Spondylolisthesis Conclusions References 28: Results of Surgical Treatment of Pediatric Spondylolysis and Spondylolisthesis Results of Management of Low-Grade Pediatric Spondylolysis and Spondylolisthesis Fusion as an Alternative to Direct Repair Combining Anterior and Posterior Column Support Results of Management of High-Grade Pediatric Spondylolisthesis Nerve Root Decompression In Situ Fusion Reduction of Slip Spondyloptosis Summary References 29: Complications Associated with Surgical Treatment of Pediatric and Adult Spondylolisthesis Introduction Neurologic Pseudarthrosis Adjacent Level Disease Slip Progression Other Complications Conclusion References 30: Intraoperative Neuro-monitoring During Spondylolisthesis Surgery Monitoring Modalities Stagnara Wake-Up Test Somatosensory Evoked Potentials Motor Evoked Potentials Spontaneous EMG Triggered EMG Multimodality Monitoring Lumbosacral Spine Surgery and Spondylolisthesis Reduction Spondylolisthesis Reduction Conclusions References 31: Value Considerations in the Surgical Management of Spondylolisthesis Introduction An Evidence-Based Approach to the Management of Spondylolisthesis Evidence for the Role of Operative Versus Nonoperative Care: Degenerative Spondylolisthesis Evidence for the Role of Operative Versus Nonoperative Care: Isthmic Spondylolisthesis Evidence for Specific Surgical Strategies in the Management of Spondylolisthesis Decompression and Fusion Instrumentation Circumferential Fusion Value Considerations in the Management of Spondylolisthesis Value Assessment in Health Care Interventions Evidence for the Cost-Effectiveness of Surgery for Spondylolisthesis Value of Operative Versus Nonoperative Care Value of Decompression with Fusion Versus Decompression Alone Value of Instrumented Versus Non-instrumented Fusion Value of Circumferential Versus Posterolateral Fusion Conclusion References Index