Presacral fusion for adult spondylolisthesis

Abstract

Low-grade spondylolisthesis has been traditionally treated with decompressive laminectomy and posterolateral, interbody fusion, or a combination of both. The combination of an axial presacral approach combined with percutaneous pedicle screw fixation for lumbosacral discectomy and fusion offers a minimally invasive alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. This chapter elucidates the anatomy of the presacral space, the biomechanics of presacral axial fusion, and the technique of the axial presacral approach in treating low-grade spondylolisthesis. In addition, we have also highlighted the possible pitfalls and steps to avoid complications at each step of the procedure.