Abstract
Introduction
Unstable isthmic spondylolisthesis is a common disease. Treatment of high-grade dysplastic spondylolisthesis remains challenging. According to the literature, decompressive laminectomy and posterolateral screws fusion is preferred by most surgeons. Surgical treatment of spondylolisthesis has been recommended in patients with pain refractory to conservative treatment, slippage progression, or severe slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. Moreover, some authors reported the incidence of L5 root palsy during the reduction procedure. We believe that satisfactory nerve root decompression may be achieved by complete anterior discectomy and restoration of disc height (Indirect Decompression), followed by ALIF graft and posterior pedicle screws
Material and Methods
We performed a prospective study of 23 cases of surgical treatment using intraoperative electrophysiological monitoring for patients with high-grade spondylolisthesis. Each patient received treatment consisting of anterior retroperitoneal approach and indirect nerve decompression with anterior sagittal progressive realignment maneuver, and circumferential fusion with ALIF cage and L5-S1 minimally invasive pedicle fixation with intraoperative neurological monitoring with transcranial electric motor evoked potentials and continuous spontaneous electromyography recording.
Results
Intraoperative monitoring did show different transitory patterns with no any final abnormal changes. The patients got well after surgery, and they showed no postoperative sensory changes and motor paralysis of the extremities. A postoperative X-rays films showed suitable reduction of the slippage.
Conclusion
This report describes 23 cases of surgical treatment using intraoperative electrophysiological monitoring with transcranial electric motor evoked potentials and continuous spontaneous electromyography for patients with high-grade dysplastic spondylolisthesis. We successfully perform anterior sagittal reduction maneuvers without any neurological deficit using intraoperative electrophysiological monitoring.