General Editor: Luiz Vialle

Authors: Jean Ouellet

Spondylolisthesis Type 1

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Glossary

1 Comment on approach top

Fluoroscopy is used to confirm the correct level of L5 and S1.


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A midline skin incision is performed to access the L5-S1 joint.

The subperiosteal dissection is taken down onto the lamina of L5 exposing the L5-S1 joint

Care must be taken not to violate neither the L5-S1 joint nor the L4-L5 joint.

Dissection is carried laterally onto the transverse process of L5.

2 Instrumentation top

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Pedicle screw insertion

Pedicle screws are inserted bilaterally into L5 taking care not to breach the L4-L5 facet.


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Hook placement

A small notch is created on the inferior aspect of the L5 lamina in preparation for a sublaminar hook.

3 Decortication top

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Using a high speed burr the defect in the pars articularis must be decorticated and the pseudoarthrosis excised down to bleeding bone.


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Decortication is also taken to the transverse process of L5 along the lamina of L5.

4 Bone grafting top

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A separate incision is made over the posterior superior iliac crest.


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Muscle attached to the outer iliac crest is reflected in a blunt fashion exposing the outer iliac crest.


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Using an osteotome or a gouge, corticocancellous strips are harvested in 4-5 cm length and 1 cm wide.


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Smaller cancellous bone graft is also harvested from the iliac crest.


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Bone graft must be impacted into the pars defect as well as the cortico cancellous strips are laid across the lamina and transverse process.

5 Rod insertion top

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Bilaterally, laminar hooks are inserted.

Short rods are connected to the laminar hooks and pedicle screws and compression is applied to close the pars defect.

v1.0 2016-12-01