Schär, Ralph T.; Sutter, Martin; Mannion, Anne F; Eggspühler, Andreas; Jeszenszky, Dezsö; Fekete, Tamas F; Kleinstück, Frank; Haschtmann, Daniel (2017). Outcome of L5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high-grade L5-S1 isthmic spondylolisthesis and the role of intraoperative neurophysiological monitoring. European spine journal, 26(3), pp. 679-690. Springer 10.1007/s00586-017-4964-3
|
Text
Schär2017_Article_OutcomeOfL5RadiculopathyAfterR.pdf - Published Version Available under License Publisher holds Copyright. Download (1MB) | Preview |
PURPOSE
To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5-S1 isthmic spondylolisthesis and the role of intraoperative neurophysiological monitoring (IONM).
METHODS
Consecutive patients treated for high-grade spondylolisthesis with IONM from 2005 to 2013 were screened for eligibility. Prospectively collected clinical and surgical data as well as radiographic outcomes were analyzed retrospectively. Patients completed the multidimensional Core Outcome Measures Index (COMI) before and at 3, 12, and 24 months after surgery.
RESULTS
Seventeen patients were included, with a mean age of 26.3 (±9.5) years. Mean preoperative L5-S1 slip was 72% (±21%) and was reduced to 19% (±13%) postoperatively. Mean loss of reduction at last follow-up [mean 19 months (±14, range 3-48 months)] was 3% (±4.3%). Rate of new L5 radiculopathy with motor deficit (L5MD) after surgery was 29% (five patients). Four patients fully recovered after 3 months, one patient was lost to neurologic follow-up. IONM sensitivity and specificity for postoperative L5MD was 20 and 100%, respectively. COMI, back pain and leg pain scores showed significant (p < 0.001) improvements at 3 months postoperatively, which were retained up to 24 months postoperatively.
CONCLUSIONS
Transient L5 radiculopathy after reduction and instrumented fusion of high-grade spondylolisthesis is frequent. With IONM the risk of irreversible L5 radiculopathy is minimal. If IONM signal changes recover, full clinical recovery is expected within 3 months. Overall, patient-reported outcome of reduction and instrumented fusion of high-grade spondylolisthesis showed clinically important improvement.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery |
UniBE Contributor: |
Schär, Ralph Thomas |
Subjects: |
600 Technology > 610 Medicine & health 500 Science > 570 Life sciences; biology |
ISSN: |
0940-6719 |
Publisher: |
Springer |
Language: |
English |
Submitter: |
Ralph Schär |
Date Deposited: |
12 Jul 2018 10:10 |
Last Modified: |
05 Dec 2022 15:16 |
Publisher DOI: |
10.1007/s00586-017-4964-3 |
PubMed ID: |
28138779 |
Uncontrolled Keywords: |
Complication Intraoperative neurophysiological monitoring Lumbar fusion Patient-rated outcome Spondylolisthesis |
BORIS DOI: |
10.7892/boris.118540 |
URI: |
https://boris.unibe.ch/id/eprint/118540 |
Actions (login required)
 |
Edit item |