Treatment of high-grade spondylolisthesis with Schanz recoil screws: our experience
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ORIGINAL ARTICLE
Treatment of high-grade spondylolisthesis with Schanz recoil screws: our experience Francesco Lombardi • Viola Marta Custodi Raffaelino Pugliese • Andrea Risso • Paolo Gaetani • Giorgio Butti
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Received: 17 August 2013 / Revised: 8 September 2013 / Accepted: 8 September 2013 / Published online: 22 October 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Spondylolisthesis surgical treatment is often difficult with higher degree of slip and related techniques still debated. We have taken into consideration double thread recoil Schanz screws. This system should allow the best reduction of the slip, treating only the affected vertebrae. Methods We retrospectively analyzed 46 patients affected by grade II or higher spondylolisthesis, treated with circumferential arthrodesis using Schanz screws. Duration of surgery, complications, reduction, and rate of fusion have been recorded. Results We found that duration of surgery and complications were similar or slightly lower if compared to our standard Posterior Lumbar Interbody Fusion procedures. However, radiological results and clinical outcome appear better in cases treated with Schanz screws. Conclusions Fixation system with Schanz screws seems to be effective in reducing the slip, treating only the affected level, in high grade of spondylolisthesis. Keywords Spondylolisthesis Reduction Fusion Posterior Schanz
F. Lombardi (&) V. M. Custodi R. Pugliese A. Risso P. Gaetani Department of Neurosurgery, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy e-mail: [email protected] G. Butti Spine Surgery, Centro Ortopedico di Quadrante, Omegna, Italy
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Introduction Starting from the first issue of Herbinaux, in 1782 [1], Spondylolisthesis was studied and debated by various surgeons and pathologist (Rokitansky, Killian, Capener, Wiltse, etc.) [2, 3] not only about the etiopathogenesis and classification, but also about conservative or surgical treatment and its correct timing. Many studies have been published and a lot of treatments have been proposed for the various types and grades of spondylolisthesis, thus creating controversy about which kind of treatment is more suitable for any single case. Reducing the slip before fusion is an attractive concept, and for specific form could be advisable; in other cases the surgical reduction versus ‘‘in situ’’ fusion, versus decompression alone, remains controversial. Current classifications of spondylolisthesis are those by Wiltse et al. [3], and by Marchetti and Bartolozzi [4]. The historical classification proposed by Wiltse–Newmann–McNab [3], based on the pathogenesis and anatomy, describes six forms of Spondylolisthesis: type I or dysplastic, type II or isthmic, type III or degenerative; type IV or traumatic; type V or pathologic; type VI or postsurgical. A second classification based on etiology is proposed by Marchetti and Bartolozzi [4]. They divided spondylolisthesis into two types: congenital or developmental forms, further divided in low-dysplast
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