Traumatic L5-S1 spondylolisthesis: report of three cases and a review of the literature.

The literature reports that traumatic spondylolisthesis of L5 is an uncommon lesion. The authors report their experience of three cases of this particular fracture-dislocation of the lumbosacral spine. They stress the importance of certain radiographic signs in the diagnosis: namely, the presence of unilateral multiple fracture of the transverse lumbar apophysis. As far as the treatment is concerned, they state the need for an open reduction and an internal segmental fixation by posterior approach. A preoperative MRI study appears mandatory in order to evaluate the integrity of the L5-S1 disc. In the event of a traumatic disruption of the disc, they state the importance of posterior interbody fusion by means of a strut graft carved from the ilium or, in case of iliac wing fracture (which is not uncommon in these patients), by means of interbody cages.

Surgical treatment of severe L5-S1 spondylolisthesis in children and adolescents. Results of intraoperative reduction, posterior interbody fusion, and segmental pedicle fixation.

STUDY DESIGN: A retrospective study was done in 12 teenagers with severe L5-S1 spondylolisthesis surgically treated with a single-stage posterior procedure for reduction, posterior interbody fusion, and segmental instrumentation. OBJECTIVE: To evaluate the effectiveness and reliability of intraoperative reduction and posterior interbody fusion in severe lumbosacral spondylolisthesis in children. SUMMARY OF BACKGROUND DATA: Twelve young patients (age, 13-18 years; mean = 16 +/- 1.5) with severe L5-S1 spondylolisthesis (slip, 59%-85%; mean = 70.4 +/- 8.8%) were available for follow-up evaluation (6-24 months after surgery). All presented with serious preoperative clinical signs (tight hamstrings, waddling gait, lumbosacral pain, radiated leg pain). METHODS: The patients underwent surgery using a single posterior surgical procedure. After removal of the loosened arch and complete discectomy, a temporary device placed bilaterally between L1 and the sacral wings was used to achieve reduction by distraction. This was followed by a posterior interbody strut graft and pedicle segmental fixation. No postoperative casting was used. Clinical examination was done, and radiographic measurements were taken after surgery and at follow-up evaluation. Patients were evaluated for fusion rate, stability of reduction, clinical outcome, and possible complications. RESULTS: All patients underwent solid fusion without loss of reduction. No intraoperative or postoperative complications were observed. Mean correction of the initial slipping was 79.5 +/- 7% of the initial deformity. No clinical signs were present at follow-up evaluation. CONCLUSIONS: Intraoperative distraction appears to be truly effective in reducing severe lumbosacral olyshtesis in children. Posterior interbody fusion (and eventual sacral dome osteotomy) successfully combines the goals of solid fusion with the requirements of root decompression. No neurologic problems were seen as a consequence of distraction. The solidity of the posterior segmental pedicle instrumentation combined with the anterior strut graft eliminate the need for postoperative casting.

Cotrel-dubousset instrumentation in thoracolumbar seat belt-type and flexion-distraction injuries.

For many years, all the internal fixation devices available for the surgical treatment of thoracolumbar fractures [Harrington rods (HR); Luque rods (LR); Hartshill rectangle (HTR); Roy Camille plates (RCP)] were not always able to distribute all the reductive strains (distraction, compression, derotation), or to guarantee solid stabilization without external supports. In some cases (with HR), only distraction forces might be applied, but stability of the assembly was very poor. Otherwise (with LR, HTR, or RCP), stability was well achieved using segmental fixation systems (with SSW, screws), but reduction was possible only by deflecting the spine towards the rods (or plates), by winging the sublaminar wires (or screws). Restoration of normal sagittal alignment was also very difficult to obtain. The use of internal fixation systems for reduction of thoracolumbar fractures when distraction or compression forces are needed are essential for the spinal surgeon and the patient. In some cases of thoracolumbar fractures (seat belt; flexion-distraction), in fact, the use of distraction forces is not suitable, leading only to overdistraction, not to reduction. The introduction of Cotrel-Dubousset instrumentation (CDI) in 1983, and its subsequent use in spinal traumatology, seems to answer all these unresolved questions.

Surgical treatment of traumatic lesions of the middle and lower cervical spine with Roy-Camille plates.

The authors report their experience in surgical treatment of traumatic lesions of the middle and lower cervical spine using the Roy-Camille method, discussing in detail the mechanism of injury according to the previously reported classification as well as the surgical technique. Special mention is given to the treatment of separation fracture of the articular mass and the results achieved with the "en-tuile" plate. The authors conclude that the Roy-Camille method yields satisfactory short and long-term results provided that the indications are closely followed.

[Conservative treatment of acromioclavicular luxation]. / Il trattamento incruento della lussazione acromion-claveare.

The authors consider the conservative treatment of acromioclavicular dislocation and present a revision of 59 cases treated by Desault bandage and thoraco-brachial cast (mean follow up 46 mos). The indications to conservative treatment are pointed out and the good functional results are stressed.