Sixteen patients who had Grade-IV or V spondylolisthesis underwent a
staged reconstruction for the salvage of a failed result of previous
procedures. The indications for operation were incapacitating pain,
radicular pain, pseudoclaudication, or the inability to stand upright. All
patients had shown progression of the deformity after the previous surgery.
At an average length of follow-up of fifty-two months, all patients had
resumed normal activities and were free of the pain and symptoms of spinal
stenosis. The complications included delayed union in six patients and a
traumatic pseudarthrosis in one patient. In all of these patients a solid
fusion was obtained after additional surgery. In five patients, neuropathy
of the fifth lumbar-nerve root developed after surgery; it resolved in
three patients. From this work, it is concluded that staged reconstructive
surgery is feasible in patients who have Grade-IV or V spondylolisthesis
with incapacitating pain and deformity that interfere with normal function.
The benefits outweighed the risks in this very select group of
patients.