Review Article On Recent Trends in Surgical Techniques for High-grade Spondylolisthesis

Vol. 6 | Issue 1 | July-December 2021 | page: 02-05  | Rajendra Sakhrekar

DOI 10.13107/jor.2021.v06i01.025

Authors: Rajendra Sakhrekar [1]

[1] Department of Orthopaedics, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Rajendra Sakhrekar,
Orthopaedic Spine Surgeon, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.


Introduction: High-grade spondylolisthesis is defined as cases with more than 50% displacement and spondylolisthesis with Meyerding grade III and higher. The surgical management of high-grade spondylolisthesis is highly controversial. Many surgical methods have been reported like posterior in situ fusion, instrumented posterior fusion with or without reduction, combined anterior and posterior procedures, spondylectomy with reduction of L4 to the sacrum (for spondyloptosis), posterior interbody fusion with trans-sacral fixation. Minimally invasive transforaminal lumbar interbody fusion for high-grade spondylolisthesis has also been recently mentioned in literature. This study aimed to review the recent literature which has described the surgical outcomes associated with various surgical techniques used for high-grade spondylolisthesis
Materials and Methods: Recent articles were searched on search engines such as PubMed, Google Scholar with the use of Keywords like ‘High-grade Spondylolisthesis’, ‘Surgical Techniques’ ‘complications’.
Discussion: The surgical management of high-grade spondylolisthesis is an area of significant controversies. The literature is replete with regards to need for reduction, need for decompression, levels of fusion, the nature of instrumentation, surgical approaches including open, minimally invasive, and “mini-open” procedures, as well as various techniques for reduction of the slip and fusion strategy. The three basic options of high-grade spondylolisthesis include in-situ fusion, partial reduction and fusion, and complete reduction.
Conclusion: Various techniques have been described for high-grade spondylolisthesis. Spine Deformity Study Group (SDSG) classification gives guidelines about balanced and unbalanced pelvis and advising reduction and fusion in case of unbalanced pelvis for correction of biomechanical and global sagittal alignment. Each of the surgical techniques has their own advantages and disadvantages. Although individual authors’ experience, skill levels, anatomic reduction with fusion techniques has yielded highly encouraging results.
Keywords: High-grade spondylolisthesis, Surgical techniques, In situ fusion, Reduction and fusion, Complications


1) Meyerding H. Spondylolisthesis. Surg Gynecol Obstet 1932;54:371-77.
2) Wagner Scott, Shufflebarger Harry et al, Surgical Techniques: Management of High-Grade Spondylolisthesis Including Reduction Techniques DOI – 10.1007/978-1-4899-7575-1_18
3) Rajasekaran S, Das G, Aiyer SN, et al. Analysis of spinopelvic parameters with L5 as the new sacrum after fusion in high-grade spondylolisthesis: A possible explanation for satisfactory results with in-situ fusion. Asian Spine J 2018;12:103-11
4) Speed K. Spondylolisthesis: treatment by anterior bone graft. Arch Surg., 1938; 37: 175 – 89
5) Poussa M, Remes V, Lamberg T, Tervahartiala P, Schlenzka D, Yrjönen T, et al. Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: Long-term clinical, radiologic, and functional outcome. Spine (Phila Pa 1976) 2006;31:583-90;discussion 591-2.
6) Lamberg T, Remes V, Helenius I, Schlenzka D, Seitsalo S, Poussa M. Uninstrumented in situ fusion for high-grade childhood and adolescent isthmic spondylolisthesis: Long-term outcome. J Bone Joint Surg Am 2007;89:512-8.
7) Schoenecker PL, Cole HO, Herring JA, Capelli AM, Bradford DS. Cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction. J Bone Joint Surg Am. 1990;72(3):369–77.
8) Bohlman HH, Cook SS. One-stage decompression and posterolateral and interbody fusion for lumbosacral spondyloptosis through a posterior approach. Report of two cases. J Bone Joint Surg Am1982;64:415-8.
9) Smith JA, Deviren V, Berven S, Kleinstueck F, Bradford DS: Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade L5–S1 spondylolisthesis. Spine (Phila Pa 1976) 26:2227–2234, 2001
10) Maestre IC, Utrilla AL, Hermida TB, Fernandez EP, Guillen VG. Transdiscal screw versus pedicle screw fixation for high-grade L5-S1 isthmic spondylolisthesis in patients younger than 60 years: A case control study. Eur Spine J 25:1806-12.
11) Jamshidi A,A. D. Levi, Reverse Bohlman technique for treatment of high-grade spondylolisthesis in an adult population, Journal of Clinical Neuroscience,
12) Mac-Thiong JM, Labelle H, Parent S, Hresko MT, et al Members of the Spinal Deformity Study Group. Reliability and development of a new classification of lumbosacral spondylolisthesis. Scoliosis 2008;3:19.
13) Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: A correlation study. Spine (Phila Pa 1976) 2004;29:2049-54.
14) Harrington PR, Tullos HS. Spondylolisthesis in children. Observations and surgical treatment. Clin Orthop Relat Res. 1971;79:75–84.
15) Karampalis C, Grevitt M, Shafafy M, Webb J. High-grade spondylolisthesis: gradual reduction using Magerl’s external fixator followed by circumferential fusion technique and long-term results. Eur Spine J. 2012;21 Suppl 2(Suppl 2):S200-S206. doi:10.1007/s00586-012-2190-6
16) Gaines RW. L5 vertebrectomy for the surgical treatment of spondyloptosis: Thirty cases in 25 years. Spine (Phila Pa 1976) 2005;30(6 Suppl):S66-70.
17) Harms et al : Spondylolisthesis. In: Bridwell KH, DeWald RL, editors: The Textbook of Spinal Surgery. 2nd ed. Philadelphia: Lippincott-Raven; 1997.
18) Shufflebarger HL, Geck MJ. High-grade isthmic dysplastic spondylolisthesis: Monosegmental surgical treatment. Spine (Phila Pa 1976) 2005;30:S42-8.
19) Hresko MT, Labelle H, Roussouly P, Berthonnaud E. Classification of high-grade spondylolistheses based on pelvic version and spine balance: Possible rationale for reduction. Spine (Phila Pa 1976) 2007;32:2208-13.
20) Goyal N, Wimberley DW, Hyatt A et al .Radiographic and clinical outcomes after instrumented reduction and transforaminal lumbar interbody fusion of mid and high-grade isthmic spondylolisthesis. J Spinal Disord Tech. 2009 Jul;22(5):321-7. doi: 10.1097/BSD.0b013e318182cdab. PMID: 19525786.
21) Quraishi NA, Rampersaud YR. Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis. Eur Spine J 2013;22:1707-13.
22) Rajakumar DV, Hari A, Krishna M, Sharma A, Reddy M. Complete anatomic reduction and monosegmental fusion for lumbar spondylolisthesis of Grade II and higher: use of the minimally invasive “rocking” technique. Neurosurg Focus. 2017 Aug;43(2):E12. doi: 10.3171/2017.5.FOCUS17199. PMID: 28760034.
23) Patel VH, Peshwattiwar VB. Grade III Spondylolisthesis L5-S1 Treated by Minimally Invasive Spine Transforaminal Lumbar Interbody Fusion (MIS-TLIF) in a Patient of Rheumatoid Arthritis. Indian Spine J 2020;3:91-6.


How to Cite this Article: Sakhrekar R | Review Article On Recent Trends in Surgical Techniques for High grade Spondylolisthesis | Journal of Orthopaedic and Rehabilitation | July-December 2021; 6(1): 02-05.

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