CASE REPORT
O termo “espondilolistese de alto grau” (EAG) é aplicado quando o deslocamento excede 50% do comprimento do corpo vertebral. A espondiloptose é uma condição clínica rara, afetando menos de 1% da população. O tratamento em um único estágio da espondiloptose inclui fixação in situ, redução parcial e estabilização. Outra opção é o tratamento cirúrgico em múltiplos estágios para essa patologia. Este artigo apresenta um caso de tratamento cirúrgico de um jovem de 34 anos que se queixava de dor intensa na região lombar e em ambas as pernas. Foi diagnosticada espondiloptose da vértebra L5. O paciente foi submetido a uma cirurgia em dois estágios: a intervenção em estágios permite descompressão eficaz e estabilização primária no primeiro estágio, reduzindo a tensão na raiz de L5 e o trauma cirúrgico geral, seguida de redução radical e artrodese inter-somática no segundo estágio, com risco mínimo de deterioração neurológica. No caso clínico apresentado, a abordagem combinada em etapas alcançou regressão sustentada da dor, criou condições ideais para a fusão óssea e restaurou parâmetros espinopélvicos essenciais sem exacerbação do déficit neurológico. Após a formação do bloco ósseo no nível L5-S1, os parâmetros modificadores sagitais (PI, PT, LL, L4-S1, SS, TK, SVA) foram avaliados.
The term “high-grade spondylolisthesis” (HGS) is applied when the displacement exceeds 50% of the vertebral body length. Spondyloptosis is a rare clinical condition, affecting less than 1% of the population. One-stage treatment of spondyloptosis includes in situ fixation, partial reduction, and stabilization. Another option is when surgical management involves a multistage approach to this pathology. This paper presents a case of surgical treatment of a 34-year-old young man who complained of severe pain in the lower back and both legs. Spondyloptosis of the L5 vertebra was diagnosed. The patient underwent a two-stage operation: staging the intervention allows effective decompression and primary stabilization at the first stage, reducing L5 root tension and overall surgical trauma, followed by radical reduction and interbody fusion at the second stage with minimal risk of neurological deterioration. In the presented clinical case, the staged combined approach achieved sustained regression of pain, created optimal conditions for solid fusion, and restored key spinopelvic parameters without exacerbation of neurological deficit. After bone block formation at the L5-S1 level, the sagittal modifier parameters (PI, PT, LL, L4-S1, SS, TK, SVA) were assessed.
1. Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66(5):699-707. http://doi.org/10.2106/00004623-19846605000008. PMid:6373773.
2. Meyerding H. Low backache and sciatic pain associated with spondylolisthesis and protruded intervertebral disc: incidence, significance, and treatment. J Bone Joint Surg Am. 1941;23:461-70.
3. Kunze KN, Lilly DT, Khan JM, et al. High-grade spondylolisthesis in adults: current concepts in evaluation and management. Int J Spine Surg. 2020;14(3):327-40. http://doi.org/10.14444/7044. PMid:32699755.
4. Alzakri A, Labelle H, Hresko MT, et al. Restoration of normal pelvic balance from surgical reduction in high-grade spondylolisthesis. Eur Spine J. 2019;28(9):2087-94. http://doi.org/10.1007/s00586-019-05973-8. PMid:30989359.
5. Mac-Thiong JM, Wang Z, de Guise JA, Labelle H. Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine. 2008;33(21):2316-25. http:// doi.org/10.1097/BRS.0b013e318186b236. PMid:18827698.
6. Wang W, Aubin CE, Cahill P, et al. Biomechanics of high-grade spondylolisthesis with and without reduction. Med Biol Eng Comput. 2016;54(4):619-28. http://doi.org/10.1007/s11517-015-1353-0. PMid:26233229.
7. Petraco DM, Spivak JM, Cappadona JG, Kummer FJ, Neuwirth MG. An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction. Spine. 1996;21(10):1133-8, discussion 1139. http:// doi.org/10.1097/00007632-199605150-00002. PMid:8727186.
8. Lamartina C, Zavatsky JM, Petruzzi M, Specchia N. Novel concepts in the evaluation and treatment of high-dysplastic spondylolisthesis. Eur Spine J. 2009;18(Suppl 1, Suppl 1):133-42. http://doi.org/10.1007/ s00586-009-0984-y. PMid:19399535.
9. Ahsan MK, Yadav KK, Khan SI, et al. Surgical management of adult high-grade spondylolisthesis by partial reduction, decompression and instrumented circumferential fusion. Clin Surg J. 2021;2(2):1-9.
10. Lak AM, Abunimer AM, Devi S, et al. Reduction versus in situ fusion for adult high-grade spondylolisthesis: a systematic review and meta-analysis. World Neurosurg. 2020;138:512-520.e2. http:// doi.org/10.1016/j.wneu.2020.03.030. PMid:32179186.
11. Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V. Evidencebased surgical management of spondylolisthesis: reduction or arthrodesis in situ. J Bone Joint Surg Am. 2014;96(1):53-8. http://doi.org/10.2106/ JBJS.L.01012. PMid:24382725.
12. Crawford CH 3rd, Larson AN, Gates M, et al. Current evidence regarding the treatment of pediatric lumbar spondylolisthesis: a report from the scoliosis research society evidence based medicine committee. Spine Deform. 2017;5(5):284-302. http:// doi.org/10.1016/j.jspd.2017.03.011. PMid:28882346.
13. Labelle H, Roussouly P, Chopin D, Berthonnaud E, Hresko T, O’Brien M. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J. 2008;17(9):1170-6. http://doi.org/10.1007/ s00586-008-0713-y. PMid:18600350.
14. Gaines RW. L5 vertebrectomy for the surgical treatment of spondyloptosis: thirty cases in 25 years. Spine. 2005;30(6, Suppl):S66-70. http://doi.org/10.1097/01.brs.0000155577.19606.df. PMid:15767889.
15. Gaines RW, Nichols WK. Treatment of spondyloptosis by two stage l5 vertebrectomy and reduction of l4 onto s1. Spine. 1985;10(7):680-6. http://doi.org/10.1097/00007632-198509000-00015. PMid:4071276.
16. Min K, Liebscher T, Rothenfluh D. Sacral dome resection and single-stage posterior reduction in the treatment of high-grade high dysplastic spondylolisthesis in adolescents and young adults. Eur Spine J. 2012;21(Suppl 6, Suppl 6):S785-91. http://doi.org/10.1007/s00586011-1949-5. PMid:21800032.
17. Mehdian SH, Arun R. A new three-stage spinal shortening procedure for reduction of severe adolescent isthmic spondylolisthesis: a case series with medium- to long-term follow-up. Spine. 2011;36(11):E705-11. http://doi.org/10.1097/BRS.0b013e3182158c1f. PMid:21358576.
18. Lin YT, Su KC, Chen KH, Pan CC, Shih CM, Lee CH. Biomechanical analysis of reduction technique for lumbar spondylolisthesis: anterior lever versus posterior lever reduction method. BMC Musculoskelet Disord. 2021;22(1):879. http://doi.org/10.1186/s12891-021-04758-9. PMid:34649557.
19. Amritanand R, Arockiaraj J, David KS, Krishnan V. Does the surgical reduction of high grade spondylolisthesis restore spino-pelvic alignment? An analysis of 35 patients. Asian Spine J. 2021;15(5):596603. http://doi.org/10.31616/asj.2020.0252. PMid:33189106.
1Spinal Department for the Federal Center of Neurosurgery, Novosibirsk, Russia.
Received Nov 27, 2025
Accepted Dec 20, 2025
