Tactics of surgical treatment of patients with true (spondylolytic) spondylolisthesis

Purpose. To develop and introduce the algorithm of efficient diagnostics and surgical tactics into clinical practice on the basis of analyzing the results of surgical treatment of patients with true spondylolisthesis. The algorithm allows improving anatomic-and-functional results of treatment. Materials and Methods. The results of surgical treatment of 115 patients with true spondylolisthesis analyzed. 47 patients(Group I) operated using the technique of isolated anterior interbody spondylodesis, 68 patients (Group II) – using the systems of the spine transpedicular correction and fixation. The maximum periods of follow-up for Groups I and II patients were 25 and 14 years, respectively. Most of patients had L5 Degree II displacement and operated at the age of 20-40 years. Results. The factors identified which largely affected the outcomes of surgical treatment of patients with spondylolisthesis: compression of nerve roots; degree of vertebral body displacement; destabilization and abnormality of the spine profile line; intervertebral space height; degenerative changes in adjacent vertebral segments. The efficient tactics of surgical treatment proposed in view of the above mentioned factors, which contributed to reduce the incidence of unsatisfactory treatment outcomes from 25.5% (Group I) to 4.4% (Group II). Conclusion. The combination of pathological factors in each specific case allows to develop an individual program of surgical treatment including different variants of spinal cord root decompression, the spine instrumental correction (alignment) and osteoplastic stabilization. It’s rational to use transpedicular systems for the spine correction and fixation in case of spondylolisthesis. The alignment of the vertebra displaced indicated for Degree II-IV displacement and can be performed using special reduction screws or instruments.