Reduction of High-Grade Isthmic and Dysplastic Spondylolisthesis in

Abstract Treatment of high-grade isthmic and dysplastic spondylo-listhesis in children and adolescents remains a challenge. Surgical treatment of spondylolisthesis has been recom-mended in adolescents with pain refractory to nonopera-tive modalities, slippage progression, or >50% slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. In this report, we describe 5 cases of high-grade isthmic and dysplastic spondylolisthesis in adolescents and review the literature on surgical treatment for this entity. Operative records, charts, x-rays, and Scoliosis Research Society outcome question-naires (SRS-22) were retrospectively evaluated for 5 con-secutive patients diagnosed with and treated for high-grade spondylolisthesis. Each patient received treatment consist-ing of decompression, reduction, and circumferential fusion with transpedicular and segmental fixation from a posterior approach. Two patients had transient L5 nerve root deficit, which resolved within 3 months. Reduction benefits include a decrease in shear stresses (and resulting decreased rates of postoperative pseudarthrosis and slip progression), restoration of sagittal alignment and lumbosacral spine bal-ance, and improvement in clinical deformity.