Journal article
Spondylolysis and spondylolisthesis in children and adolescents: II. Surgical management
Journal of the American Academy of Orthopaedic Surgeons, v 14(8), pp 488-498
01 Aug 2006
PMID: 16885480
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Surgical management is indicated for children and adolescents with spondylolysis and low-grade spondylolisthesis (< or =50% slip) who fail to respond to nonsurgical measures. In situ posterolateral L5 to S1 fusion is the best option for those with a low-grade slip secondary to L5 pars defects or dysplastic spondylolisthesis at the lumbosacral junction. Pars repair is reserved for patients with symptomatic spondylolysis and low-grade, mobile spondylolisthesis with pars defects cephalad to L5 and for those with multiple-level defects. Screw repair of the pars defect, wiring transverse process to spinous process, and pedicle screw-laminar hook fixation are surgical options. The ideal surgical management of high-grade spondylolisthesis (>50% slip) is controversial. Spinal fusion has been indicated for children and adolescents with high-grade spondylolisthesis regardless of symptoms. In situ L4 to S1 fusion with cast immobilization is safe and effective for alleviating back pain and neurologic symptoms. Instrumented reduction and fusion techniques permit improved correction of sagittal spinal imbalance and more rapid rehabilitation but are associated with a higher risk of iatrogenic nerve root injuries than in situ techniques. Wide decompression of nerve roots combined with instrumented partial reduction may diminish the risk of neurologic complications. Pseudarthrosis and neurologic injury presenting as L5 radiculopathy and sacral root dysfunction are the most common complications associated with surgical management of high-grade spondylolisthesis.
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Details
- Title
- Spondylolysis and spondylolisthesis in children and adolescents: II. Surgical management
- Creators
- Emilie V Cheung - St. Christopher's Hospital for ChildrenMartin J Herman - St. Christopher's Hospital for ChildrenRalph Cavalier - St. Christopher's Hospital for ChildrenPeter D Pizzutillo - St. Christopher's Hospital for Children
- Publication Details
- Journal of the American Academy of Orthopaedic Surgeons, v 14(8), pp 488-498
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics; Medical Humanities; Orthopedic/Orthopaedic Surgery
- Web of Science ID
- WOS:000239707500006
- Scopus ID
- 2-s2.0-33845501609
- Other Identifier
- 991020836503204721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Orthopedics
- Surgery