Spine Deform. 2025 Dec 27. doi: 10.1007/s43390-025-01260-3. Online ahead of print.
ABSTRACT
STUDY DESIGN: Retrospective case series.
OBJECTIVE: To evaluate clinical and radiological outcomes following in situ transdiscal L5-S1 fixation (delta fixation) in elderly osteoporotic patients with high-grade spondylolisthesis, with emphasis on functional recovery and changes in sagittal spinopelvic alignment.
METHODS: 15 patients aged > 60 years (mean age 74.9 ± 14.8 years) with Meyerding Grade III-IV L5-S1 spondylolisthesis and osteoporosis (DEXA T score ≤ – 2.5) underwent posterior-only in situ transdiscal fixation and neural decompression. Pre- and postoperative spinopelvic parameters were assessed using standing radiographs and Surgimap® software. Functional outcomes were evaluated using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain, with a minimum follow-up of 24 months.
RESULTS: All patients demonstrated significant functional improvement. ODI improved from 66.8 ± 7.1 to 37.3 ± 5.1 (p < 0.001), VAS for low back pain from 8.3 ± 1.5 to 2.7 ± 0.5 (p < 0.001), and VAS for leg pain from 4.5 ± 1.7 to 1.2 ± 0.6 (p < 0.001). Among sagittal parameters, significant improvements were observed in thoracic kyphosis (p = 0.006), sagittal vertical axis (p = 0.010), and PI-LL mismatch (p = 0.032). Changes in pelvic incidence, pelvic tilt, lumbar lordosis, and sacral slope were not statistically significant.
CONCLUSIONS: In situ delta fixation with neural decompression offers substantial clinical benefit in elderly osteoporotic patients with high-grade L5-S1 spondylolisthesis. Functional recovery occurred despite limited changes in local spinopelvic sagittal alignment, highlighting that global compensation and neural decompression may suffice for clinical improvement in this high-risk population.
LEVEL OF EVIDENCE: Level IV-Case series.
PMID:41455089 | DOI:10.1007/s43390-025-01260-3
