Improved Pain and Quality of Life with Corrected Thoracic and Lumbosacral Spondylolisthesis Subluxations Using CBP®: A Case Study and 1-Year Follow-Up.

Objective: Discuss non-surgical spinal rehabilitation for a 27-year-old male with thoracic and lumbosacral spondylolistheses. A selective literature review and discussion are provided. Clinical Features: A 27-year-old male presented with severe, 8/10 mid and low back pain. Initial lateral thoracic and lumbar x-rays revealed grade 1 spondylolistheses at T9-T10 and L5-S1 measuring -5.3 mm and -6.8 mm. Interventions and Outcomes: The patient completed 60 sessions of Mirror Image® spinal adjustments, exercises, and traction over 30 weeks. Post-treatment x-rays showed correction in translations at T9-T10 and L5-S1 from -5.3 mm to 0.0 mm and -6.8 mm to -1.0 mm, within normal limits. 1-year follow-up x-rays showed maintained correction. Conclusions: This case is the first documented evidence of non-surgical or chiropractic treatment for thoracic and lumbosacral spondylolistheses where spinal alignment was corrected. More research is needed to investigate the clinical implications and applications.

Traumatic Bilateral L3-4 Facet Dislocation With Open Decompression and Short Segment Fusion.

Traumatic lumbar facet dislocations are exceedingly rare, with reported cases primarily involving the lumbosacral junction. This injury arises from very high flexion distraction forces imparted on the lumbar spine. Herein we describe a bilateral L3-4 facet dislocation, a particularly rare injury pattern, using a short-segment posterior decompression and fusion followed by an interbody fusion through a lateral approach. Our case involves a 24-year-old man who presented to the emergency department after a high-speed, head-on motor vehicle collision. He was a restrained passenger with no prior significant medical history. He was found to have multisystem injuries, the most notable a L3-4 bilateral lumbar facet dislocation. The patient was neurologically intact upon his presentation but developed radiculopathy several hours into his hospital admission. He was treated operatively through a posterior decompression and instrumented short-segment fusion as well as a subsequent interbody fusion through a lateral approach at the same level. Pure lumbar spine facet dislocations outside the lumbosacral junction, especially bilateral dislocations, are exceedingly rare and often result in neurological deficits. A literature review reveals only a few cases outside of Asia, all of which were treated with decompression and either short- or long-segment fusion. No accepted treatment algorithm for this injury has been established. Open treatment is almost always indicated. Decompression and short-segment fusion is a valid treatment option, but patient and injury characteristics must be considered on an individualized basis.Level of Evidence: 5.

Correlation Between Lumbopelvic and Sagittal Parameters and Health-Related Quality of Life in Adults With Lumbosacral Spondylolisthesis.

STUDY DESIGN: Secondary analysis of prospective, multicenter data. OBJECTIVE: To evaluate impact of sagittal parameters on health-related quality of life (HRQoL) in adults with lumbosacral spondylolisthesis. METHODS: Adults with unoperated lumbosacral spondylolisthesis were identified in the Spinal Deformity Study Group database. Pearson's correlations were calculated between SF-12 (Short Form-12)/Scoliosis Research Society-30 (SRS-30) scores and radiographic parameters (C7 sagittal vertical axis [SVA] deviation, T1 pelvic angle, pelvic tilt [PT], pelvic incidence, sacral slope, slip angle, Meyerding slip grade, Labelle classification). Main effects linear regression models measured association between individual health status measures and individual radiographic predictor variables. RESULTS: Forty-five patients were analyzed (male, 15; female, 30; average age 40.5 ± 18.7 years; 14 low-grade, 31 high-grade). For low-grade slips, SVA had strong negative correlations with SF-12 mental component score (MCS), SRS-30 appearance, mental, and satisfaction domains (r = -0.57, r = -0.60, r = -0.58, r = -0.53, respectively; P < .05). For high-grade slips, slip angle had a moderate negative correlation with SF-12 MCS (r = -0.36; P = .05) and SVA had strong negative correlations with SF-12 physical component score (PCS), SRS-30 appearance and activity domains (r = -0.48, r = -0.48, r = -0.45; P < .05) and a moderate negative correlation with SRS-30 total (r = -0.37; P < .05). T1 pelvic angle had a moderate negative correlation with SF-12 PCS and SRS-30 appearance (r = -0.37, r = -0.36; P ≤ .05). For every 1° increase in PT, there was a 0.04-point decrease in SRS appearance, 0.05-point decrease in SRS activity, 0.06-point decrease in SRS satisfaction, and 0.04-point decrease in SRS total score (P < .05). CONCLUSION: Lumbosacral spondylolisthesis in adults negatively affects HRQoL. Multiple radiographic sagittal parameters negatively affect HRQoLs for patients with low- and high-grade slips. Improvement of sagittal parameters is an important goal of surgery for adults with lumbosacral spondylolisthesis.

Traumatic Lumbosacral Spondylolisthesis: A Case Report.

INTRODUCTION: Traumatic lumbar spondylolisthesis is rare disease and in the literature, different surgical approaches, including anterior, posterior, or combined approaches (posterior and anterior) are used to treat the lesion. CASE PRESENTATION: We treated a case of traumatic lumbosacral spondylolisthesis using posterior approach and the patient showed a satisfactory outcome. At the final follow-up, he was completely asymptomatic, and radiographic images revealed normal lumbar alignment and a solid interbody fusion. CONCLUSIONS: Traumatic lumbosacral spondylolisthesis can be treated using posterior approach alone to obtain reduction, decompression, and solid fusion.

Mini posterior lumbar interbody fusion with presacral screw stabilization in early lumbosacral instability.

BACKGROUND: Surgical options for the management of early lumbosacral spondylolisthesis and degenerative disc disease with instability vary from open lumbar interbody fusion with transpedicular fixation to a variety of minimal access fusion and fixation procedures. We have used a combination of micro discectomy and axial lumbosacral interbody fusion with presacral screw fixation to treat symptomatic patients with lumbosacral spondylolisthesis or lumbosacral degenerative disc disease, which needed surgical stabilization. This study describes the above technique along with analysis of results. MATERIALS AND METHODS: Twelve patients with symptomatic lumbosacral (L5-S1) instability and degenerative lumbosacral disc disease were treated by micro discectomy and interbody fusion using presacral screw stabilization. Patients with history of bowel, bladder dysfunction and local anorectal diseases were excluded from this study. Postoperatively all patients were evaluated neurologically and radiologically for screw position, fusion and stability. Oswestry disability index was used to evaluate results. RESULTS: We had nine females and three males with a mean age of 47.33 years (range 26-68 years). Postoperative assessment revealed three patients to have screw placed in anterior 1/4(th) of the 1(st) sacral body, in rest nine the screws were placed in the posterior 3/4(th) of sacral body. At 2 years followup, eight patients (67%) showed evidence of bridging trabeculae at bone graft site and none of the patients showed evidence of instability or implant failure. CONCLUSION: Presacral screw fixation along with micro discectomy is an effective procedure to manage early symptomatic lumbosacral spondylolisthesis and degenerative disc disease with instability.

Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity.

OBJECT: Spinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS. METHODS: The records of 15 patients with HDDS who underwent surgery between 2005 and 2010 were reviewed. The treatment consisted of L4-sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position. Radiographic measurements included pelvic incidence, sacral slope, lumbar lordosis, and thoracic kyphosis. The degree of lumbosacral kyphosis was evaluated by the lumbosacral angle. Because of the small number of patients, nonparametric tests were considered for data analysis. RESULTS: Preoperative lumbosacral kyphosis and L-5 anterior slip were corrected by instrumentation. Transient neurological complications were noted in 5 patients. Statistical analysis showed a significant increase of thoracic kyphosis on 6-month postoperative and final follow-up radiographs (p < 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p < 0.001) and between preoperative and final follow-up radiographs (p < 0.001). CONCLUSIONS: Based on the authors' observations, this technique resulted in an effective reduction of L-5 anterior slip and significant reduction of lumbosacral kyphosis (from 69.8° to 105.13°). Due to complete reduction of lumbosacral kyphosis and anterior trunk displacement associated with L-5 anterior slipping, lumbar lordosis progressively decreased and thoracic kyphosis progressively increased postoperatively. Adjusting the sagittal trunk balance produced not only pelvic anteversion, but also reciprocal adjustment of lumbar lordosis and thoracic kyphosis, creating a satisfactory level of compensated global sagittal balance.

Treating Traumatic Lumbosacral Spondylolisthesis Using Posterior Lumbar Interbody Fusion with three years follow up.

OBJECTIVE: To analyze the surgical outcome of traumatic lumbosacral spondylolisthesis treated using posterior lumbar interbody fusion, and help spine surgeons to determine the treatment strategy. METHODS: We reviewed retrospectively five cases of traumatic lumbosacral spondylolisthesis treated in our hospital from May 2005 to May 2010. There were four male and one female patient, treated surgically using posterior lumbar interbody fusion. The patients' data including age, neurological status, operation time, blood loss, follow-up periods, X- radiographs and fusion status were collected. RESULTS: All the cases were treated using posterior lumbar interbody fusion to realize decompression, reduction and fusion. Solid arthrodesis was found at the 12-month follow-up. No shift or breakage of the instrumentation was found, and all the patients were symptom-free at the last follow-up. CONCLUSION: Traumatic lumbosacral spondylolisthesis can be treated using posterior lumbar interbody fusion to realize the perfect reduction, decompression, fixation and fusion.