Long-term outcome of posterior S1 osteotomy and reduction surgery on adolescent high-grade spondylolisthesis

English Keywords:Adolescent lumbar spondylolisthesis  High-grade  S1 osteotomy  Long-term outcome

English Abstract:

  【Abstract】 Objectives: To analyze the long-term outcome and radiographic parameter changes of posterior S1 osteotomy and reduction surgery on adolescent high-grade L5 spondylolisthesis. Methods: 21 cases of adolescent high-grade L5 spondylolisthesis who received posterior S1 osteotomy and reduction surgery between January 2008 and January 2015 in our medical center were retrospectively analyzed. There were a total of 13 males and 8 females with an average age of 14.4±5.2 years old and average BMI of 23.4±6.5kg/m2. The average follow up period was 73.7±11.3 months. The Meyerding classification status were as follows: 13 cases of grade Ⅲ, 5 cases of grade Ⅳ, and 3 cases of grade Ⅴ. General epidemiological data includinglumbar-VAS, leg-VAS, ODI, JOA score, SRS-22 score and radiologic parameters of slippage rate, SVA, TK, LL, PI, PT, SS, and LSA at preoperation, 6 months postoperatively and final follow-up were collected. Chi square test and independent sample T-test were used for statistical analysis of imaging parameters and SRS-22 questionnaire scores. Results: At final follow-up, the superior rate of JOA was 80.95%, the fusion rate was 95.23%. Amelioration of lumbar spondylolisthesis was 71.22%. One case developed screw breakage and received revision surgery. Comparing between parameters at 6 months follow-up and before surgery: PT(24.7°±7.6° vs 34.3°±10.7°), SS(48.2°±6.7° vs 38.4°±16.4°), LL(-42.3°±9.4° vs -63.4°±12.4°), LSA(-7.3°±5.4° vs 18.3°±6.4°), TK(18.6°±12.7° vs 9.4°±22.6°) and SVA(1.4±2.7cm vs 3.1±2.7cm) improved significantly(P<0.05); while PI(73.2°±10.8° vs 73.6°±11.3°, P>0.05) presented no significant change. Comparing between parameters at final follow-up and at 6 months follow-up: PI(81.6°±13.7° vs 73.2°±10.8°), PT(28.3°±8.6° vs 24.7°±7.6°), SS(52.2°±13.3° vs 48.2°±6.7°) and LL(-56.4°±15.3° vs -42.3°±9.4°) improved significantly(P<0.05): whiles LSA (-7.1°±5.8° vs -7.3°±5.4°), TK(15.4°±12.4° vs 18.6°±12.7°) and SVA(1.2±3.1cm vs 1.4±2.7cm) presented no significant change. Lumbar-VAS(1.8±1.4 vs 6.8±2.1), leg-VAS(1.5±1.1 vs 5.4±1.3), JOA(22.5±5.7 vs 8.5±3.4), ODI[(15.2±5.5)% vs (42.6±7.5)%], SRS-22 pain score(4.2±0.8 vs 2.8±0.8), self-image score(4.6±0.5 vs 3.1±0.6), activity score(4.3±0.6 vs 3.4±0.6), mental score(4.2±0.6 vs 3.3±0.7) and total score(4.3±0.5 vs 3.2±0.4) at the 6 months follow-up showed various dimensions changes compared with that preoperatively(P<0.05). Lumbar-VAS (3.6±1.2 vs 1.8±1.4) and SRS-22 pain score(3.7±0.6 vs 4.2±0.8) deteriorated at final follow-up(P<0.05). Conclusions: Posterior S1 osteotomy and reduction surgeryon adolescent high-grade spondylolisthesis could achieve satisfying clinical symptoms and sagittal alignment improvement at more than five years follow-up.