Surgical Management of Developmental High-Grade Spondylolisthesis
Traditionally, developmental spondylolisthesis has been divided into two groups depending on the degree of slippage: low (<50% slip) and high (>50% slip) grade. These are two different clinical entities with different natural history. While low-grade spondylolisthesis is basically a painful syndrome/entity, high-grade spondylolisthesis (HGS) is a true lumbosacral deformity with significant risk of progression resulting in trunk deformity. More recent classifications take into consideration the spinopelvic alignment to further guide treatment. The objectives of surgery in HGS are to decompress the involved neural structures, correct the lumbosacral kyphosis and trunk unbalance, and stabilize the lumbosacral junction segment by fusing the least number of vertebrae. Fusion can be performed in situ or after reducing the slipped vertebra. The decision to correct high-grade slippage defects by reduction is still controversial.
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