Surgical Techniques for Adolescent Lumbar Spondylolisthesis

Abstract

Lumbar spondylolisthesis in adolescents is a common cause of back pain. Low-grade spondylolisthesis usually responds to non-surgical treatment. High-grade spondylolisthesis often requires surgery for the relief of symptoms. The primary goals in the surgical treatment of adolescent lumbar spondylolisthesis (L5-S1) are relief of back and radicular pain, relief of any motor weakness from nerve compression, and to achieve a stable spinal fusion. Optimal surgical strategy is debated with questions regarding the need for reduction of deformity, choice of spinal instrumentation, use of interbody fusion, and choice of bone graft. This technique paper reviews commonly used surgical techniques with a focus on the pearls and pitfalls of each. Recommended postoperative care and management of common complications are included. Key Concepts: • There are a variety of techniques described for surgical treatment of adolescent lumbar spondylolisthesis with no one identified as superior to the rest. • If doing a reduction of L5-S1, wide decompression of the dural sac and bilateral L5 nerve roots is advised along with use of neuromonitoring. • Lumbar interbody fusion (posterior, transforaminal, or anterior) may aid in fusion at the L5-S1 segment. • Understanding the preoperative and target postoperative sagittal plane alignment of the spine and pelvis is important to achieve appropriate sagittal balance postoperatively.