Two-stage operative therapy of L5 vertebra spondyloptosis (surgery technique introduced by R. Gaines)

Bulatov, Aleksandr; Kubeckiy, Yuliy; Evsyukov, Aleksey; Rzaev, Jamil

doi:10.21608/pajn.2022.108045.1040

Two-stage operative therapy of L5 vertebra spondyloptosis (surgery technique introduced by R. Gaines)

Document Type : Case Reports

Authors

¹ Federal Neurosurgical Center, Federal State Budgetary Institution under the RF Ministry of Healthcare, city of Novosibirsk, Russia

² The Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Federal State Budgetary Institution under the RF Ministry of Healthcare, city of Kurgan

10.21608/pajn.2022.108045.1040

Abstract

Abstract

Grade V spondylolisthesis or spondyloptosis is a clinical state quite rare for the population of less than 1% (1, 2). The main aspects of operative improvement are rather few in number. One-stage spondyloptosis treatment involves in situ fixation, partial reduction and stabilization (3,4). Another option, when the surgical aid includes a multi-stage approach for this pathology, for example, by L5 vertebrotomy with L4 - S1 interbody fusion development, was described by R. Gaines (1). But this procedure is accompanied by a high complications risk described by the author himself (2,5).

Herein a case of surgical treatment of 27 years old young man, who filed a complaint stating severe lumbar pain and pain in both legs is observed. In particular, L5 vertebra spondyloptosis was detected. The patient has undergone a two-stage R. Gaines surgery, including L5 vertebrotomy, L4 vertebra repositioning over S1, L4-S1 interbody fusion with mesh cage and L3-L4-S1-S2-alar transpedicular fixation. 12 months later, after bone block shaping at L4-S1 level, a part of screw attachment system was removed. L5 vertebra dislocation (100% dislocation) was measured, and the parameters of sagittal modifiers: (PI, PT, LL, L4-S1, SS, TK, SVA) were assessed. Clinical outcomes were monitored using VAS, ODI and MacNab scales. After 18 months, the patient was able to resume his working activity associated with hard physical labor.

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