RESULTS OF SURGICAL TREATMENT OF HIGH-GRADE SPONDYLOLISTHESIS

Abstract

Spondylolisthesis of Grade III–IV according to the Meyerding classification, referred to in English literature as “high-grade spondylolisthesis,” involves a significant degree of vertebral displacement and leads to substantial impairment of spinal function, gait disturbances, and early disability in patients. Despite the fact that clinical symptoms, classifications, and diagnostic methods have been known and established for quite some time, the issue of surgical treatment remains a subject of debate to this day. Objective. To evaluate the outcomes of surgical treatment in patients with high-grade spondylolisthesis. Methods. A retrospective analysis was conducted on the surgical outcomes of 24 patients with significant vertebral displacement who underwent intraoperative traction and transpedicular fixation using a “spine–pelvis” system. Pre- and postoperative radiographic measurements included the slip angle, pelvic incidence, lumbar lordosis, sacral slope, pelvic tilt, as well as evaluation of sagittal vertical axis alignment and pelvic tilt angle. Results. All patients demonstrated a reduction in slip angle and restoration of sagittal vertical axis alignment to within normal limits. Other parameters of spinopelvic balance were also moderately improved, thereby bringing sagittal spinal alignment closer to normal values and enhancing the biomechanical conditions for spinal function. Conclusions. The use of intraoperative traction via ligamentotaxis allowed for repositioning of the displaced vertebra and facilitated the placement of transpedicular screws. The combination of intraoperative spinal traction and pulling on transpedicular screws using reduction devices enabled correction of the displaced vertebra to Grade I–II according to Meyerding, thereby restoring the supportive function of the spine.