Results of surgical treatment for grade IV-V spondylolisthesis using in situ technique with modified screws: An experience

Background: The surgical treatment of high-grade spondylolisthesis remains a complex and multifaceted task requiring an individual approach in each case. The diverse treatment modalities and conflicting techniques used in this treatment indicate a limited understanding of this condition in modern medicine. In this study, we report our results on implementing a modified in situ technique for the surgical treatment of high-grade spondylolisthesis. Hypothesis: In high-grade lumbar spondylosis, especially grades IV and V, posterior fixation using a specially designed transpedicular screw is effective in terms of adequate decompression and reliable stabilization leading to intervertebral fusion. Methods: This study is a prospective review of 24 consecutive patients with grades IV and V lumbar spine malalignment who underwent surgery between 2019 and 2022. The surgical technique was unique in that it allowed the surgeon to perform extensive spinal canal decompression, deformity reduction, and fixation with custom-designed pedicle screws in a single stage. Patients were followed at 3, 6, and 12 months and then annually. Clinical, radiological, visual analogue scale (VAS), and Oswestry disability index (ODI) data were collected. Results: Among 24 patients with high-grade spondylolisthesis at the L5-S1 level, good results were achieved in 62.5% of patients. The median follow-up period was 16 months (12; 24 months). All patients, except one case, had bone fusion at the level of vertebral fixation within 6 months. The radiographic parameters after surgery showed statistically significant differences. No deep infections were recorded. The mean VAS and ODI scores demonstrated improvement in pain and disability. Conclusions: This procedure allows for adequate reduction of severe spondylolisthesis with favorable clinical and radiological results. Despite the need for surgical intervention, the procedure was safe and reproducible.

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