Fijación transpedicular percutánea versus técnica abierta en pacientes con fracturas toracolumbares tipo A / Percutaneous versus open technique transpedicular fixation in patients with thoracolumbares type A fractures

Resumen: Introducción: Las técnicas de fijación transpedicular percutánea son una herramienta emergente en el tratamiento del trauma espinal, sin embargo, su uso no es totalmente aceptado. Objetivo: Comparar resultados en pacientes con fractura vertebral traumática que fueron tratados con cirugía de fijación transpedicular percutánea versus fijación transpedicular abierta. Material y métodos: De Enero a Diciembre de 2016, 15 pacientes con fractura vertebral traumática fueron divididos aleatoriamente en dos grupos: el grupo A fue de seis pacientes tratados con fijación transpedicular percutánea y el grupo B fue de seis pacientes tratados con fijación transpedicular con técnica abierta; tres pacientes fueron eliminados. Se evaluó el sangrado transoperatorio, el dolor postoperatorio con la escala visual análoga a las 24 horas y a las dos semanas del postoperatorio; también se evaluó el índice de discapacidad de dolor lumbar Oswestry a seis semanas, además de tres, seis, 12 y 24 meses del postoperatorio. Resultado: El seguimiento fue de 24 meses. Se reportaron diferencias estadísticamente significativas en el sangrado transoperatorio (p 2.43E-05), EVA al primer día (p < 0.0003), EVA a las dos semanas (p = 0.01); también en el cuestionario de discapacidad de dolor lumbar Oswestry a las seis semanas (p = 0.0007), tres meses (p = 0.005), seis meses (p = 0.005), 12 meses (p = 0.01) y 24 meses (p = 0.004). No se observaron diferencias significativas con respecto al tiempo operatorio (p = 0.12). Discusión: En nuestro trabajo encontramos que el sangrado transoperatorio, dolor postoperatorio y discapacidad funcional son significativamente menores en el grupo de fijación transpedicular percutánea.

Abstract: Introduction: Percutaneous transpedicular fixation techniques are an emerging tool in the treatment of spinal trauma, however, their use is not fully accepted. Objective: Compare results in patients with traumatic vertebral fracture, treated with percutaneous transpedicular fixation surgery versus open transpedicular fixation. Material and methods: From January to December 2016, 15 patients with traumatic vertebral fracture were randomly divided into 2 groups, group A were six treated with percutaneous transpedicular fixation, group B were treated with open technique transpedicular fixation, three patients were eliminated. Transoperative bleeding, postoperative pain with the 24-hour and two-week postoperative visual scale, the six-week Oswestry lumbar pain disability index, and three, six, 12 and 24 months of postoperative control were evaluated. Results: The follow-up was 24 months. Statistically significant differences in transoperative bleeding (p 2.43E-05), EVA on the first day (p < 0.0003), EVA at two weeks (p = 0.01) were reported in the Oswestry lumbar pain disability questionnaire at six weeks (p = 0.0007), three months (p = 0.005), six months (p = 0.005), 12 months (p = 0.01) and 24 months (p = 0.004), no significant differences were observed with respect to operating time (p = 0.12). Discussion: In our work we find that transoperative bleeding, postoperative pain and functional disability are significantly minor in the percutaneous transpedicular fixation group.

One-stage surgical treatment for thoracic and lumbar Spinal tuberculosis by transpedicular fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach / 华中科技大学学报（医学）（英德文版）

This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association (ASIA) impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association (JOA) scores and oswestry disability index (ODI) of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4-12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.

Juxtafacet Spinal Synovial Cysts

STUDY DESIGN: This was a retrospective study. PURPOSE: To study the surgical outcome of synovial cysts of the lumbar spine through posterior laminectomy in combination with transpedicular screw fixation. OVERVIEW OF LITERATURE: Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. METHODS: Retrospective data from 6 patients, treated during the period of March 2007 to February 2011, were analyzed. All preoperative and postoperative manifestations, extension/flexion radiographs, magnetic resonance imaging, and computed tomography records were reviewed. All underwent surgery for synovial cysts with excision and decompression combined with posterior fixation. The result of surgery was evaluated with Macnab's classification. An excellent or good outcome was considered as satisfactory. Japanese Orthopedic Association Scale was used for evaluation of back pain. RESULTS: All patients included in this study had excellent outcomes as regarding to improvement of all preoperative manifestations and returning to normal daily activities. Only 2 cases developed postoperative transient cerebro-spinal fluid leak and were treated conservatively and improved during the follow up period. CONCLUSIONS: Although this study included a small number of cases and we could not have statistically significant results, the good outcome of decompression of synovial cysts combined with posterior fixation and fusion encouraged us to recommend this approach for patients with juxtafacet synovial cysts.

Clinical observation of combined anterior and posterior surgeries approach for the treatment of lumbosacral tuberculosis in 31 cases / 重庆医学

Objective To investigate the safety and clinical effect of combined anterior and posterior surgeries approach for the treatment of lumbosacral tuberculosis .Methods There were 31 cases of low lumbar and sacrum spinal tuberculosis in this se‐ries .All cases that anti‐tuberculosis treatment lasted 3 weeks before the operation received posterior transpedicular screw system in‐ternal fixation ,anterior radical focus debridement and auto‐grafting with iliac bone .Bed rest was for 6-12 weeks after surgery and no brace was needed .Anti‐tuberculosis treatment lasted 12 -18 months .Results The period follow‐up was 12 -43 months and there was one case of the formation of the sinus and bilateral abscess after surgical resection of re‐healing ,and there was no cases of bone block displacement .All tuberculosis lesions were healing .13 cases with neurological symptoms had recovery .There was no spondylolisthesis postoperative follow‐up;The heigh ,kyphosis correction and restore stability of vertebral body were satisfied .The patients had solid bony fusion without internal fixation loosening and rupture after 5-9 months .Conclusion It is a safe and effec‐tive method to treat lumbosacral tuberculosis by posterior transpedicular screw system internal fixation and anterior radical focus debridement with interbody autografting .which can thoroughly clear focus of spinal tuberculosis ,decompress sufficiently spinal cord ,correct effectively the kyphosis deformity and achieve the stability of a strong three‐column .

Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series / Colocação de parafusos pediculares na coluna torácica alta utilizando fluoroscopia: avaliação do posicionamento dos parafusos por tomografia computadorizada em uma série de casos durante quatro anos

OBJECTIVE: To evaluate the feasibility, safety and accuracy of pedicle screw placement in the upper thoracic spine using the free-hand technique with the aid of fluoroscopy; to analyze the methods used to verify correct screw positioning intra and postoperatively. METHOD: All patients with instability of the cervicothoracic or upper thoracic spine and at least one screw placed in the segment T1-T6 as part of a posterior construct entered the study. Only C-arm intraoperative fluoroscopy was used to guide screw placement. RESULTS: We obtained excellent positioning in 98.07 percent of the screws. CT scans precisely demonstrated pedicle wall and anterolateral body violations. There was no hardware failure, no neurological or vascular injury and no loss of alignment during the follow-up period. CONCLUSION: Pedicle screws can be safely placed in the upper thoracic spine when strict technical principles are followed. Only a CT scan can precisely demonstrate vertebral body and medial pedicle cortical violations.

OBJETIVO: Avaliar a factibilidade, segurança e eficácia da colocação de parafusos pediculares na coluna torácia alta utilizando apenas a fluoroscopia; analisar os métodos intra e pós-operatórios de verficação do posicionamento de parafusos. MÉTODO: Todos os pacientes com instabilidade da coluna cervico-torácica ou torácica alta e pelo menos um parafuso colocado no segmento T1-T6 foram incluídos no estudo. Apenas fluoroscopia intra-operatória foi utilizada para guiar a colocação dos parafusos. RESULTADOS: Obtivemos excelente posicionamento em 98,07 por cento dos parafusos. TC axial mostrou precisamente violações pediculares e da parede anterolateral do corpo vertebral. Não houve falência do instrumental, lesões neurológicas ou vasculares, ou perda do alinhamento sagital no período de seguimento. CONCLUSÃO: Os parafusos pediculares podem ser colocados com segurança na coluna torácica alta desde que técnicas operatórias precisas sejam executadas. Somente a TC pode demonstrar precisamente violações do corpo vertebral e da parede pedicular.

Comparison of Three Different Techniques in Cervical Transpedicular Screw Insertion

OBJECTIVE: This is a cadaver study to assess the accuracy of three cervical screw insertion techniques: the blind technique (Group I), the laminotomy technique (Group II), and the funnel technique (Group III). METHODS: Ten human cadavers embalmed with formaldehyde were prepared. After exposing the spinous processes, the laminas and the lateral masses, titanium alloy transpedicular screws were inserted from C3 to C7. A total of 100 pedicles were ramdomly assigned to one of three techniques (the blind technique: 31 screws, the laminotomy technique: 51 screws, the funnel technique: 18 screws). Axial computed tomography with 1-mm slices, and sagittal and coronal reformation were performed to identify the accuracy of the screw insertion and the anatomic relationships. RESULTS: In Group I, 9 screws (29%) were either contained within or penetrated less than 1mm, which were rated as successful. In Group II, 24 screws (47%) were successful. In Group III, 16 screws (89%) were successful. In the multiple comparison, there was a statistically significant difference between Groups I and III and between Groups II and III (chi-square test and Bonfenoni test). CONCLUSION: The funnel technique can help a surgeon's understanding about the cervical pedicle more precisely than the other two techniques. The funnel technique is less dependent on lateral soft tissue retraction state.

Outcome of thoracolumbar fracture with spinal cord injury treated with short-segment pedicle instrumentation / 中国矫形外科杂志

[Objective]To evaluate the outcome of thoracolumbar fracture with spinal cord injury treated with short-segment pedicle instrumentation.[Method]47 cases of thoracolumbar fracture with spinal cord injury from 1999 to 2004 in our department were collected,all of them were treated with short-segment pedicle instrumentation.The radiologic,neurologic,and functional outcome were assessed.[Result]All of the 47 cases were followed up,the mean follow-up were 51.9 months(18~ 86 months),the average of vertebral anterior and posterior height were corrected from 43.6%,71.4% to 92.2%,96.4%;and 88.3%,93.1% at the last follow-up separately.The Cobb's angle were corrected from 23.5?to 4.3?,and 8.8? at the last follow-up.62.8% of the vertebral canal was occupied pre-operation,and 11.4% post-operation,6.2% at last follow-up.There was significant deference in targets between pre-operation and post-operation(P0.05).Neurologic status improved at least 1 Frankel grade in the patients who had preoperative incomplete paraplegia.61.7% of patients returned to work.[Conclusion]Short-segment pedicle instrumentation can provide good reduction,strong fixation,complete decompression and fusion.The treatment outcome is good.Moreover,it is a less traumatic,simple and safe technique.

A Biomechanical Comparison among Three Surgical Methods in Bilateral Subaxial Cervical Facet Dislocation

OBJECTIVE: The biomechanical stabilities between the anterior plate fixation after anterior discectomy and fusion (ACDFP) and the posterior transpedicular fixation after ACDF(ACDFTP) have not been compared using human cadaver in bilateral cervical facet dislocation. The purpose of this study is to compare the stability of ACDFP, a posterior wiring procedure after ACDFP(ACDFPW), and ACDFTP for treatment of bilateral cervical facet dislocation. METHODS: Ten human spines(C3-T1) were tested in the following sequence: the intact state, after ACDFP(Group 1), ACDFPW(Group 2), and ACDFTP(Group 3). Intervertebral motions were measured by a video-based motion capture system. The range of motion(ROM) and neutral zone(NZ) were compared for each loading mode to a maximum of 2.0Nm. RESULTS: ROMs for Group 1 were below that of the intact spine in all loading modes, with statistical significance in flexion and extension, but NZs were decreased in flexion and extension and slightly increased in bending and axial rotation without significances. Group 2 produced additional stability in axial rotation of ROM and in flexion of NZ than Group 1 with significance. Group 3 provided better stability than Group 1 in bending and axial rotation, and better stability than Group 2 in bending of both ROM and NZ. There was no significant difference in extension modes for the three Groups. CONCLUSION: ACDFTP(Group 3) demonstrates the most effective stabilization followed by ACDFPW(Group 2), and ACDFP(Group 1). ACDFP provides sufficient strength in most loading modes, ACDFP can provide an effective stabilization for bilateral cervical facet dislocation with a brace.

Short-segment transpedicular instrumentation and fusion for thoracic and lumbar spine unstable fractures: A retrospective study on the AO Universal Spine System / 中国微创外科杂志

Objective To evaluate the role of the short-segment transpedicular instrumentation and fusion in the treatment of thoracic and lumbar spine unstable fractures. Methods We reviewed 121 patients of thoracic and lumbar vertebral fractures treated by short-segment transpedicular instrumentation (attachment of one level above the fracture to one level below the fracture) by using an AO Universal Spine System (USS), plus posterolateral fusion by using autogenous iliac crest bone graft. Results Out of the 121 cases, 104 had been followed clinically, radiographically, and functionally for 12 to 72 months (mean 31.3 months). Follow-up observations showed that, 101 patients (97.1%) had neurological function improvement more than one Frankel grade (3 no change), the average loss of vertebral body height basically reversed to normal (mean 58.3% preoperatively versus mean 3.2% postoperatively, with mean loss of 2.1% in follow-up), and the kyphotic angles were basically corrected (mean 29?preoperatively versus mean 3.4?postoperatively, with mean loss of 3.4?in follow-up). Conclusions The short-segment transpedicular instrumentation and fusion can provide excellent reduction and fixation, indirect decompression, and stabilization for unstable thoracic and lumbar fractures. The USS may be effectively employed in the short-segment fixation of thoracic and lumbar fractures.[

Tratamento da instabilidade degenerativa da coluna lombar com fixação transpedicular / Transpedicular lumbar fixation for degenerative lumbar instability. An analysis of 53 cases

Os autores apresentam um estudo retrospectivo dos resultados de 53 pacientes, com instabilidade degenerativa da coluna lombar e toracolombar, que foram tratados consecutivamente com fixaçãotranspedicular por via posterior usando material Socon e Spine System da Aesculap. A casuística é constituída por 27 homens e 26 mulheres, com média etária de 53,4 anos (27 a 81 anos). A média do acompanhamento foi de 15 meses. O procedimento foi feito nos casos de espondilolistesedegenerativa (25 casos), instabilidade pós-operatória (12 casos), escoliose degenerativa (7 casos), fraturas degenerativas (5 casos), canal estreito lombar (2 casos) e instabilidade segmentar (2 casos).A cirurgia consistiu em descompressão neural, fixação interna com instrumentação transpedicular e enxerto ósseo. Em 18 casos foi associado o cage metálico. Obtiveram-se 90% de resultados bons e satisfatórios pela escala de Stauffer e Coventry, com 96% de taxa de fusão e 4% de pseudo-artrose. As complicações incluíram quatro casos de radiculalgia pós-operatória em virtude do contato da raiz com o instrumental, dois de fístulas liquóricas com resolução espontânea, duas infecções (uma profunda e outra superficial) e dois casos de estenose acima do nível t ratado. Destes pacientes, sete (14%) necessi taram dereoperação. Não houve óbito nem quebra do instrumental. Os resul tados comprovaram que, apesar do cur to per íodo de acompanhamento, a fixação transpedicular é um bom método para instrumentação e tratamento das instabilidades degenerativas, oferecendo vantagens biomecânicas comparadas com outras formas de tratamento, permitindo montagens curtas, preservando segmentos adjacentes e a lordose fisiológica. A seleção apropriada dos pacientes para a cirurgia é provavelmente o fator mais importante associado com bons resultados.

The authors present the results of the treatment of 53 consecutive patients with lumbar and thoraco-lumbar spine degenerative instability by a posterior transpedicular fixation using Socon and Spine Aesculap instrumentation systems. The mean follow-up was 15 months. Surgery was performed for degenerative spondilolisthesis (25 cases), post-surgical instability (12 cases), degenerative scoliosis (7 cases), degenerative fractures (5 cases), lumbar spine stenosis (2 cases) and segmental instability (2 cases). There were 27 men and 26 women, aging from 27 to 81 years (mean 53,4), all of them complained of back pain.The surgical procedure consisted in neural decompression, transpedicular fixation and instrumentation and bone graft. In eighteen cases we associated the use of a metallic cage. The results were good or fair in 90% of the cases (according to the Stauffer and Coventry?s scale), with 96% of fusion rate and 4% of pseudarthrosis. Complications included: four cases of radiculopaty due the contact of the nerve roots with the instrumentation system; two cases of CSF leak, both clearing spontaneously; two cases of infection (one superficial, the other deep) and two cases of stenosis above the level of instrumentation. Seven (14%) of these complication cases required reoperation. There were no deaths in this series and no problems with the instrumentation device itself. We concluded that, despite the short follow-up period, the transpedicular fixation is a good methodfor treatment of degenerative instability, with biomechanical advantages if compared with other modalities of treatment. It allows short instrumentation, sparing adjacent segments and the physiological lordosis is preserved. Careful selection of the patients for surgery is probably themost important factor associated with good outcome.

Isthmic Spondylolisthesis with Sciatica: Follow-up Results after Posterior Lumbar Interbody Fusion and Transpedicular Screw Fixation

The main symptoms of adult isthmic spondylolisthesis are frequently low back pain and radicular leg pain. Laminectomy and posterolateral fusion is somtimes unsuccessful because nerve roots are compressed by fibrocartilagenous tissue at pars defect, degenerated disc and slipped bony edge. The patients need complete neural decompression, reduction of slipping and stable fixation. We have operated 22 patients with PLIF using carbon cage and transpedicular screw fixation after posterior decompression by Gill's operation and complete removal of intervertebral disc. We studied the patients postoperatively to evaluate the symptomatic improvement, reduction rate of slipping and stability of lumbar spine. Twenty-two patients were operated from April, 1996 to June, 1997. Mean age was 46, ranging from 35 to 68. Mean follow-up duration was thirteen months. The levels of operarion were 9 at L4-5 and 9 at L5-S1, 4 at both levels. Mean preoprative slip was 17.2%, which was reduced to 11.3% postoperatively. Nineteen patients(86%) were satisfied with the result of operation. The fusion rate of PLIF was 86%. There was no breakage of instrumentation or postoperative instability. We consider that PLIF and transpedicular screw fixation for adult isthmic spondylolisthesis with radicular leg pain is a good methods to obtain complete neural decompression, reduction of slip and stable lumbar fixation.

Ventral and Dorsal Stabilization of the Thoracolumbar Spine by Crossed-screw Fixation

For surgical stabilization of thoracolumbar instability either posterior transpedicular fixation or anterior interbody fixation is commonly performed. On some occasions, however, combined ventral and dorsal stabilization is needed, in which case surgery is usually performed in separate stages. To achieve this goal in a single operation, the authors used the crossed-screw fixation technique, with the pedicle screw-rod system, in eight patients. Their thoracolumbar instabilities were caused by trauma(n=6), tumor(n=1), and congenital deformity(n=1). In all patients, signs of myelo- and/or radiculopathy were present, and as this required extensive ventral and dorsal decompression, combined ventral and dorsal stabilizations was considered necessary. Surgery involved the lateral extracavitary approach: for dorsal stabilization, the conventional transpedicular fixation method, with pedicle screws of 5.5-mm diameter, was used. For ventral stabilization, interbody struts were grafted, using rib autograft or in the case of tumor fibula allograft, supplemented with transverse fixation of the vertebral body with pedicle screws of 7.5-mm diameter. The two stabilization systems, ventral and dorsal, were interconnected with cross-linking plates. Follow-up 12 to 26 (average 18) months after surgery revealed no hardware failures, and all patients showed improvement in their neurological functions during this period. Due to congenital deformity, graft dislodgement occurred in one patient. On the basis of these results the authors believe that the crossed-screw fixation technique is a viable option for three-dimensional stabilization of the thoracolumbar spine.

Short Segment Transpedicular Cotrel-Dubousset Instrumentation including Involved Vertebra for Fractures of Thoracic and Lumbar Spine / 대한정형외과학회잡지

To minimize the numbers of vertebral segments in the fusion area and to prevent the metal failure and recurrence of deformity in the surgical treatment of the fracture and dislocations of the thoracic and lumbar vertebra, short segment transpedicular C-D instrumentation including upper and lower adjacent vertebra and also the involved vertebra had been performed in 56 patients, from 1989 to 1991 and the minimum follow-up period was one years. Fractured vertebra was screwed for the reposition of the compressed upper end plate and its maintainance. The purpose of this study is to report the satisfactory results the procedure in stability and deformity correction. The mechanisms of injuries were fracture-dislocation in 17, compression in 10, burst in 8 and seat belt in 8. Levels of the lesion were between T10 and L4. Extent of fusion was one to 4 motion segments(Av. 2. 1 segments). Ambulation was started Av. 3.8. days after operation. External support of TLSO was applied for 3 months. Complications of metal failure, loss of fixation and the recurrence of the kyphotic deformity were not occurred during follow up period. Anterior vertebral height in average compared to normal vertebra were 69% preoperatively, 89% post operatively and 85% at the end of follow up. Angle of kyphotic deformity in average were 25 preoperatively, 8 post-operatively and 11 at the end of follow up. From the above results, the authors concluded that the short segment transpedicular C-D instrumentation including involved vertebra is a highly successful method of treatment with good correction of deformity and rigid stability, while the operation could be confined in minimum extent.

Surgical Treatment of Spondylolisthesis Using Transpedicular Fixation System / 대한정형외과학회잡지

We have analyzed clinical results of forty-five patients who had spondylolisthesis which were operated using transpedicular screw fixation devices (CD or Steffee VSP system) between June, 1987 and March, 1992 at the department of Orthopedic Surgery of Kwang-ju Christian Hospital. Simultaneously we compared the postoperative results between two groups. The results were as follows: 1. The ratio of man and woman was 1: 2.2 and mean age was 44.3 years (44.8 years in degenerative type and 42.5 years in isthmic type). 2. The most common level was L4 on L5 and two-third of all cases were isthmic type. 3. The clinical results were satisfactory in 91% (41 cases) according to anthors modified evaluation system. There was no significant difference between degenerative and isthmic type. 4. The mean % of slip was improved from 23.3% preoperatively to 7.4% postoperatively and the mean slip angle was improved from 3.5 degrees preoperatively to-5.4 degrees postoperatively. 5. The devices which were used for operation were C-D instrument in 21 cases and Steffee VSP system in 23 cases. There was no difference in radiographic examinaton and clinical result between two groups. 6. The anterior fusion was done for 9 active young patients. The results were significantly satisfactory. 7. We consider the transpedicular fixation system is the most recommandable method of treatment for spondylolisthesis in providing excellent reduction of slippage and maintenance of reduction with rigid fixation device.

Transpedicular Zielke Instrumentation for the Spondylolisthesis: Result of 73 Cases / 대한정형외과학회잡지

Although several kinds of instrumentation systems are available for the transpedicular screw fixation in the treatment of spondylolisthesis, the clinical results and the difference between them remdins unclear. In order to study the feasibility of Zielke instrumentation system for that purpose, the author analysed the clinical results of 73 patients with mild or moderate degree of spondylolisthesis who were instrumented with the systems and followed up 25 months in average(Min. 12Ms). The results between the groups with different rod thickness in the system, 3.2mm(20 patients), 4mm(33 patients) and 5mm(20 patients), were compared to study the most appropriate thickness. Reduction of the deformity were done by aid of temporarilly applied Harrington system in 3.2mm group. Inlayed reduction potential coming from the jointing mechanism was utilized in the cases with less than 30% of slippage in 4 and 5mm group. Percentage of slippage was changed from 20% preoperatively, to 4% postoperatively and 6% at the end of follow up. The methods of fusion after reduction and fixation were anterior in 25 and posterolateral in 48. Bony fusion was achieved in all but one with pathological spondylolisthesis. Rod failures were observed in two of 3.2mm and one of 4mm group, and loosening of the joint were developed in three of 5mm group. Clinically, 93% of the patient showed excellent and good results at the end of follow up. From the results, we concluded that the instrumentation is a efficient method of treatment with several advantages in the reduction capacity and the stability of fixation. However, this system has several points in its mechanics that needs to be improved.