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BACKGROUND: The ideal surgical treatment for adult low-grade isthmic spondylolisthesis (ALIS) remains unknown. Isolated anterior and posterior procedures are popular but have resulted in equivocal outcomes, while combined anterior and posterior procedures are associated with higher complication rates despite improved outcome.

OBJECTIVE: To evaluate the clinical and radiographic outcomes following the treatment of ALIS using a one stage posterior approach with posterior decompression and posterolateral arthrodesis combined with an interbody fibular allograft strut.

METHODS: Fifteen patients underwent fusion by a single surgeon using our modified technique. Seven patients were female and eight were male, with a mean age of 48 years. All patients were classified as Meyerding grade II slips and underwent a posterior approach only, a decompressive laminectomy, and a circumferential fusion using a trans-sacral fibular allograft and a posterolateral instrumented fusion. Post-operative clinical and radiographic evaluations were performed at 3, 6, 12 months and then on an annual basis.

RESULTS: The average follow-up interval was 61 months. Three complications were seen: a single dural tear, an L5 radiculopathy secondary to a malpositioned pedicle screw, and one patient with urinary retention. All patients were determined to be fused by their 6 month post-operative visit. All patients returned to their normal activities of daily living. Significant improvements in the VAS score were seen at all follow-up intervals.

CONCLUSION: Trans-sacral interbody fibular allograft can be used successfully to supplement a posterolateral instrumented fusion in selected low-grade ALIS patients.

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.