"Roberto Rodriguez" General Hospital

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"Roberto Rodriguez" General Hospital Moron, Ciego
de Avila, Cuba
Neurological Surgery Department
Translaminar facet screw fixation in ithsmic
lumbar spondylolisthesis.
Angel J. Lacerda MD PhD, Daisy Abreu MD, Julio A.
Díaz MD, Sandro Perez MD, Julio C Martin MD,
Daiyan Martin MD.
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Introduction
Herbineaux described first spondylolisthesis
(1667) in a pregnant woman who had a tumor in
minor pelvis which was causing obstruction to the
delivery. Kilian, Robert, and Lambl described
spondylolysis accompanied by spondylolisthesis in
the literature in the mid 1800s but development
of spondylolisthesis was appreciated only after
Naugebauer's anatomic studies in the late
1800s. Wiltse, Macnab, and Newman developed a
classification to help outline causes of
vertebral translation in an anterior
direction.Their categories include the following
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Type I Congenital spondylolisthesis. Type II
Isthmic spondylolisthesis. Type III
Degenerative spondylolisthesis. Type IV
Traumatic spondylolisthesis. Type V Pathologic
spondylolisthesis.
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• Isthmic lumbar spondylolisthesis is a defect in
  the pars interarticularis and occurred when
  forward translation of lumbosacral vertebra
  relative to another is of 25.
• Translaminar facet screw fixation is an easy form
  of lumbar internal fixation but it is less
  invasive than other techniques.
• Indications for this procedure are
• Disabling mechanical lower back pain because of
  degenerative disk disease or facet joint
  syndrome.
• Symptomatic grade I spondylolisthesis.
• The aim of this study was to report the surgical
  results in our hospital in patients with lumbar
  ithsmic spondylolisthesis operated on by
  translaminar facet screw fixation.

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Methods
We have conducted a descriptive study about 12
patients operated on neurosurgery department of
Roberto Rodríguez general hospital, Moron,
Ciego de Avila, Cuba, between january 2001 and
december 2006, with ithsmic lumbar
spondylolisthesis using the translaminar facet
screw fixation. Although this technique was
described by King in 1948 and Boucher in 1954,
the current method of performing the procedure
was described by Montesano and colleagues. Spondyl
olisthesis was evaluated by Meyerding grading
system. Results were evaluated by Ebelin scale.
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Meyerding grading system classification
Grade 1 1- 25 slippage Grade 2 26-50
slippage Grade 3 51-75 slippage Grade 4
76-100 slippage Grade 5 Greater than 100
slippage.
Grade I lumbar ithsmic spondylolistesis
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Surgical procedure
A meca position and lumbar midline approach is
generally used. Neural microsurgical
decompression is performed as indicated. The
articular surfaces of the involved facet should
not be decorticated to avoid screw purchase
weaken. Only the articular cartilaginous end
plate is removed.
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Only the articular cartilaginous end plate is
removed. After that a drill bit is inserted
percutaneously and directed toward the base of
the spinous process and toward the base of the
contralateral transverse process, through a plane
across the base of spinous process and lamina and
into the facet joint before ending in the
transverse process. A small laminotomy allows
palpation of the undersurfase of the lamina to
avoid drilling into the spinal canal. After that
a 4.5 mm standard cortical screw is inserted. The
screw length is 50-54mm. The entry point of the
second screw is slightly cephalad to avoid
crossing the first screw. After screw placement
if fusion techcnique will be used the grafts are
placed over the graft sites.
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Screw inserted
Screw inserted
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Results
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Characteristic Characteristic
Number of patients 12
Sex(Male/Fem) 10/2
Mean age(years) 54,65
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66,67
33,33
83,33
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Luque system
Translaminar facet screw fixation
Transpedicular screw fixation
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Conclusions

• There were no complications with this technique.
• It is relatively simple and brief technique
  compared with other stabilization techniques.
• Surgical tima is low.
• It is biomechanically similar to Luque
  rectangles.
• The facet joint fixating achieves a degree of
  stabilization that increased the chance for
  successful fusion in some cases without grafting.
• The instrumentation is inexpensive compared with
  other techniques.