1/4. Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report.STUDY DESIGN: A case report of iatrogenic spondylolysis as a complication of microdiscectomy leading to contralateral pedicular stress fracture and unstable spondylolisthesis. OBJECTIVE: To improve understanding of this condition by presenting a case history and roentgenographic findings of a patient that differ from those already reported and to propose an effective method of surgical management. methods: A 67-year-old woman with no history of spondylolysis or spondylolisthesis underwent an L4-L5 microdiscectomy for a left herniated nucleus pulposus 1 year before the current consultation. For the preceding 8 months, she had been experiencing low back and bilateral leg pain. Imaging studies revealed a left L4 spondylolytic defect and a right L4 pedicular stress fracture with an unstable Grade I spondylolisthesis. RESULTS: The patient was treated with posterior spinal fusion, which resulted in complete resolution of her clinical and neurologic symptoms. CONCLUSIONS: Iatrogenic spondylolysis after microdiscectomy is an uncommon entity. However, it can lead to contralateral pedicular stress fracture and spondylolisthesis, and thus can be a source of persistent back pain after disc surgery. Surgeons caring for these patients should be aware of this potential complication.- - - - - - - - - - ranking = 1keywords = spondylolisthesis (Clic here for more details about this article) |
2/4. Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: case report.OBJECTIVE AND IMPORTANCE: Early sacral fracture is an extremely rare complication of instrumented lumbosacral fusion seen in older, osteopenic women. Previous reports have attributed the problem to the use of multisegmental (three or more levels) fixation, with the transfer of stress forces from rigid spinal implants to the sacrum. We report the only case, to the best of our knowledge, of early sacral fracture after a two-level lumbosacral fusion and the only case of early sacral fracture after reduction of spondylolisthesis. CLINICAL PRESENTATION: A patient presented with a sudden recurrence of low back and buttock pain a few days after lumbosacral decompression, reduction of L5-S1 Grade II spondylolisthesis, and instrumented L5-S1 fusion, including posterior lumbar interbody fusion. A transverse sacral fracture was found on plain x-rays 4 weeks later. INTERVENTION: Symptoms improved with brace therapy and medical treatment for osteoporosis. CONCLUSION: Early sacral fracture is a rare cause of pain after instrumented lumbosacral fusion. Although the transfer of loads from rigid spinal implants to adjacent segments is particularly problematic for multisegmental fusions, patients with short-segment constructs may also be affected. Active reduction of spondylolisthesis may provide additional adjacent segment stress contributing to this complication.- - - - - - - - - - ranking = 0.875keywords = spondylolisthesis (Clic here for more details about this article) |
3/4. Fracture of S1-2 after L4-S1 decompression and fusion. Case report and review of the literature.The author describes a woman in whom an S1-2 fracture developed after L4-S1 decompression and fusion. osteoporosis was not present, but the lesion failed to respond to conservative therapy, necessitating surgical extension of the spinal fusion. Although biomechanical complications of lumbosacral fusion are uncommon, pseudarthrosis, degenerative spondylolisthesis, and stress fractures have been reported. To date, only four cases of sacral stress fracture appear in the literature, all involving female patients and reportedly associated with osteoporosis. Unlike the present case, the fracture resolved satisfactorily in all cases with conservative treatment.- - - - - - - - - - ranking = 0.125keywords = spondylolisthesis (Clic here for more details about this article) |
4/4. Utilization of iliac screws and structural interbody grafting for revision spondylolisthesis surgery.STUDY DESIGN: Retrospective case analysis and presentation. OBJECTIVES: The purpose of this article is to discuss the spectrum of failed spondylolisthesis cases for which either anterior column support or iliac screw fixation or both are useful in salvaging failed spondylolisthesis surgeries. SUMMARY OF BACKGROUND DATA: Past studies and experience have suggested that there is a relatively high rate of sacral screw failure both in long constructs to the sacrum in the adult population and also with treatment of both high-grade and adult spondylolisthesis at L5-S1. It has been noted that anterior column support at L5-S1 and additional fixation points in the sacropelvic unit provide some protection to the sacral screws. methods: This article details the author's personal and institutional experience with sacropelvic fixation and anterior column support at L5-S1 to salvage failed spondylolisthesis cases. RESULTS: To some extent, each case needs to be individualized. It is not always necessary to provide both anterior column support at L5-S1 and protection of the sacral screws with iliac screws. However, in the most complex problems using both seems to provide the greatest chance for an acceptable radiographic and clinical outcome. Most biomechanical studies have supported the use of anterior column support and iliac fixation to protect sacral screws, suggesting, of the two, that the iliac screws are more valuable. CONCLUSIONS: For many of these cases of both high-grade dysplastic spondylolisthesis and low-grade adult isthmic spondylolisthesis, a reasonable combination of anterior column support and/or iliac screw fixation may be logical to reduce the incidence of failure and need for revision. The biggest concern with using iliac screw fixation is that these screws are prominent in a percentage of patients and the ultimate impact on the sacroiliac joint is not fully investigated. However, at our institution with 5- to 10-year follow-up, the impact on the sacroiliac joint has been minimal.- - - - - - - - - - ranking = 1.25keywords = spondylolisthesis (Clic here for more details about this article) |