What is the role of transfixation decompression and transsacral interbody fusion using a fibula graft in the treatment of highgrade spondylolisthesis

Decompression, partial reduction, transvertebral screw fixation, and placement of a transsacral fibula graft are an attractive treatment option for patients with high-grade spondylolisthesis. This technique permits reduction of the slip angle, which is the major component of the deformity. It minimizes the risks associated with attempting complete correction of vertebral translation (spondylolisthesis reduction) and provides a circumferential fusion through a singlestage posterior approach (Fig. 38-6).

Figure 38-6. Decompression, transfixation, and transsacral interbody fusion. A, A fibula graft is placed across the sacrum, L5-S1 disc and into the L5 vertebral body. B, Pedicle screws are subsequently placed via the S1 pedicle from S1 into L5. (A from Winter RB, Lonstein JW, Denis F, Smith MD, editors. Atlas of Spine Surgery. Philadelphia: Saunders; 1995. p. 461, with permission.)

Figure 38-6. Decompression, transfixation, and transsacral interbody fusion. A, A fibula graft is placed across the sacrum, L5-S1 disc and into the L5 vertebral body. B, Pedicle screws are subsequently placed via the S1 pedicle from S1 into L5. (A from Winter RB, Lonstein JW, Denis F, Smith MD, editors. Atlas of Spine Surgery. Philadelphia: Saunders; 1995. p. 461, with permission.)

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