Procedure Fusion Rate

Posterior fusion without spinal implants 55

Posterior fusion with posterior spinal implants 71

Circumferential fusion with posterior implants 100

In the circumferential fusion group, bilateral S1 and iliac screw fixation and interbody fusion using anterior structural grafts or cages were utilized. Interbody fusion via a transforaminal lumbar interbody (TLIF) approach has been documented as an alternative approach for achieving circumferential fusion in this setting (Fig. 38-5).

Figure 38-5. Treatment of high-grade isthmic spondylolisthesis with reduction and circumferential fusion from a posterior approach. A, Lateral radiograph. B, Magnetic resonance imaging show grade 4 developmental spondylolisthesis. Treatment included reduction of the spondylolisthesis utilizing bilateral S1 and iliac screws, reduction screws in L3, L4, and L5, sacral dome osteotomy and posterior lumbar interbody fusion with cortical bone interbody spacers and iliac crest autograft. C, Postoperative anteroposterior radiograph. D, Lateral radiograph. (From O'Brien MF, Kuklo TR, Mardjetko SJ, et al. The sacropelvic unit: creative solutions to complex fixation and reconstruction problems. Semin Spine Surg 2004;16:134-49.)

Figure 38-5. Treatment of high-grade isthmic spondylolisthesis with reduction and circumferential fusion from a posterior approach. A, Lateral radiograph. B, Magnetic resonance imaging show grade 4 developmental spondylolisthesis. Treatment included reduction of the spondylolisthesis utilizing bilateral S1 and iliac screws, reduction screws in L3, L4, and L5, sacral dome osteotomy and posterior lumbar interbody fusion with cortical bone interbody spacers and iliac crest autograft. C, Postoperative anteroposterior radiograph. D, Lateral radiograph. (From O'Brien MF, Kuklo TR, Mardjetko SJ, et al. The sacropelvic unit: creative solutions to complex fixation and reconstruction problems. Semin Spine Surg 2004;16:134-49.)

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