Eur Spine J (2017) 26 (Suppl 5):S557–S559
OPEN OPERATING THEATRE (OOT)
Single‑stage posterior reduction and instrumented fusion
of high‑grade L5–S1 spondylolisthesis
· Luigi Aurelio Nasto
© Springer-Verlag GmbH Germany 2017
Dysplastic spondylolisthesis is due to developmental
abnormalities of the lumbosacral junction, whereas isthmic
spondylolisthesis involves a defect or elongation of the pars
interarticularis (i.e. spondylolysis). Meyerding grading sys-
tem is commonly used to measure the degree of slippage, the
term spondyloptosis refers to the complete dislocation of the
L5 vertebral body in front of the sacrum .
Most patients with spondylolisthesis are asymptomatic.
When symptoms arise, they include low back pain (worse
with activity and hyperextension), tightness of the ham-
strings (increased popliteal angle), and in some patients
neurological deﬁcits (e.g. L5 radiculopathy, or cauda equina
compression). Indications for surgery include: (1) patients
with neurological deficits, (2) progressive deformity in
growing children (> 50% slippage), (3) symptomatic adults
non responsive to conservative management.
Routine pre-operative studies include whole spine antero-
posterior and lateral standing X-rays with ﬂexion and exten-
sion views of the lumbar spine. MRI scan of the whole spine
is useful to evaluate soft tissue pathology (i.e. intervertebral
discs) and neural structures.
Surgical treatment of high-grade spondylolisthesis is
highly debated. Most of the debate revolves around whether
a partial or complete reduction of the deformity should be
attempted. A novel classiﬁcation system has been proposed
by the Spinal Deformity Study Group (SDSG) aimed at
guiding surgical treatment of dysplastic and isthmic spon-
When considering reduction of spondylolisthesis,
improvement of the slip and lumbosacral angles rather than
Keywords High-grade L5–S1 spondylolisthesis · Sacral
dome osteotomy · Spondylolisthesis correction · Single-
stage posterior approach
Surgical technique for single-stage posterior reduction
and instrumented fusion of high-grade L5–S1 spon-
dylolisthesis in adolescents.
How to perform a posterior sacral dome osteotomy for
anterior column shortening.
The term spondylolisthesis encompasses a group of condi-
tions resulting in an anterior translation in the sagittal plane
of a vertebral body relative to its immediately adjacent level.
Leon L. Wiltse is credited for the broadly adopted classiﬁ-
cation of spondylolisthesis in ﬁve main groups.  Dysplas-
tic (15% of cases) and isthmic (85% of cases) spondylolis-
thesis represents the two most common types in paediatric
and young adult patients. Both types share a strong genetic
predisposition with signiﬁcant ethnic variability [2, 3].
Electronic supplementary material The online version of
this article (https://doi.org/10.1007/s00586-017-5345-7) contains
supplementary material, which is available to authorized users.
* Hossein Mehdian
Queen’s Medical Centre, Nottingham University Hospitals
NHS Trust, Derby Road, Nottingham NG7 2UH, UK
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