Abstract

VLOK, AJ  and  DUNN, RN. Spondylolytic spondylolisthesis: surgical management of adult presentation. SA orthop. j. [online]. 2011, vol.10, n.3, pp.85-89. ISSN 2309-8309.

Retrospective review of 27 patients presenting as adults with spondylolytic spondylolisthesis. The average age at surgery was 42.9 years. Most patients (21/27) had long standing tolerable axial back pain with symptoms present for up to 156 months. It was however the radicular pain that brought them to surgery. Posterior transforaminal lumbar inter-body fusion (TLIF) was performed in all patients with a median surgical time of 183 minutes and 650 ml blood loss. There were two complications, one a large blood loss of 4 000 ml due to uncontrollable epidural bleeding and another transient cauda equina syndrome after a delayed secondary bleed. Following haematoma evacuation, the latter patient returned to normal neurological status. There was maintenance of a normal segmental lordosis with increased disc height. The fusion rate was 90% by 2 years with a significant improvement in all pain and functional scores (EQ 5D, ODI, Roland-Morris, Health Slider and VAS). CONCLUSION: Although lumbar lysis is largely a benign condition, a subgroup of patients will develop disc degeneration and present with debilitating radicular pain from foraminal stenosis despite minimal listhesis. These patients are well managed with a posterior-based decompression and fusion with the TLIF technique as it provides high radiographic fusion rates with excellent patient outcome.

Keywords : spondylolysis; listhesis; lysis; TLIF; adult.

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