Pedicular lumbosacral spine fusion for adult/adolescent lumbar developmental high-grade spondylolisthesis

BACKGROUND: Few series report on the management of high-grade spondylolisthesis (HGS) in adolescents and young adults. This review highlights a series of six consecutive cases with developmental (dysplastic) HGS successfully managed with L3 or L4 to S1 transpedicular screw placement, rather than in situ/noninstrumented lumbosacral fusion. METHODS: The six patients with HGS, according to the Meyerding Grading, presented with low back pain and bilateral sciatica (2016–2020). Patients averaged 19.8 years of age and underwent posterior transpedicular L3 or L4-S1 screw fusions. They were all monitored for at least 6 postoperative months. RESULTS: None of the six patients developed any major perioperative/postoperative complications; only one patient had severe postoperative back pain that slowly improved over 3 months. All the patients were clinically improved postoperatively, uniformly demonstrated fusion on postoperative CT studies, and considered the operation worthwhile. CONCLUSION: Posterior transpedicular screw fixation of the lumbosacral spine is an efficient and safe technique for the treatment of L3 or L4 to L5-S1 HGS. It is a suitable instrumented technique for managing adult/adolescent HGS and offers an alternative to the more typically performed in situ/noninstrumented L4-S1 procedures.