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Placement of epidural spinal stimulator
0%
15/3489
Lumbar decompression alone
16/3489
Lumbar decompression with L5 to S1 posterior lumbar fusion
30%
1054/3489
Lumbar decompression, L4 to S1 posterior lumbar fusion, and anterior column support
67%
2352/3489
Minimally invasive direct lateral interbody fusion with percutaneous pedicle screw placement
1%
36/3489
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The clinical presentation and imaging studies are diagnostic of a high grade spondylolisthesis that has failed nonoperative management. Surgery is indicated, and the procedure of choice is a posterior lumbar decompression with an instrumented fusion from L4 to S1 with anterior column support. The Meyerding classification, shown in Illustration A, is used to determine the Grade. Grade I and Grade II are considered Low Grade. Grade III, IV, and V are considered High Grade. Surgical treatment differs between Low Grade and High Grade. DeWald et al performed a retrospective study of 21 patients with high grade spondylolisthesis. They recommend in situ posterior instrumentation from L4 to S1 with anterior column support. Anterior column support can be performed, anteriorly or posteriorly, either by using intervertebral body structural strut support or with a trans-sacral fibular dowel to improve stability and success of arthrodesis. Reduction of the slipped vertebrae remains controversial for all grades of spondylolisthesis. Lenke and Bridwell argue that partial reduction aiming to improve the slip angle (lumbosacral kyphosis) is more beneficial and provides less risk to the L5 nerve roots than complete reduction. They also recommend anterior and posterior spinal fusion at L5-S1.
4.1
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