L5 vertebrectomy for the surgical treatment of spondyloptosis: thirty cases in 25 years.

Retrospective review. To review the long-term results, complications, and predictability of outcomes of the L5 vertebrectomy and reduction of L4 onto S1 for the surgical treatment of fixed spondyloptosis. Before the development of the procedure, surgical instrumentation with Harrington rods and posterolateral fusion, or fusion in situ with cast immobilization, with or without a period of bedrest, in the cast, were the alternatives for patients who elected operative treatment. Charts, operative notes, hospital and office records, preoperative and postoperative radiographic studies, and clinical photographs were reviewed for the 30 patients who had had the L5 vertebrectomy, over the past 25 years. The average follow-up of the patients was 15 years. The follow-up was performed by the treating physician/surgeon. The clinical results of the first 16 patients were independently reviewed by a surgeon who was not involved in the patients treatment, at all. His independent review indicated that the patients were functioning well. All of them would recommend the surgery to other patients who needed it. None of them was taking narcotic medication on a regular basis. The follow-up of the additional 14 patients operated since that review was performed by the author. The results of the patients operated since 1994 was the same as the group operated before 1994, except there have been 2 patients who had to have surgical revision and reinstrumentation for screw fracture, although neither lost reduction, as a consequence of their nonunion and screw fracture. Both healed their reconstruction, following removal and replacement of the fractured pedicle screws and grafting of the nonunion. None of the patients has required any treatment at all (surgical or nonsurgical) for "junctional problems" with follow-up, now, on the earliest patients, up to 25 years. Improvement in the "spinal performance" of the patients, in particular the resolution of the "crouch gait," which many of them showed before surgery, is particularly gratifying to them, since, for that group, the improvement in gait efficiency is particularly dramatic. Extensive review of all the complications in the series is accomplished in the manuscript. While 23 of the patients have had some temporary clinical deficit in the L5 root for from 6 weeks to 3 years following their reconstruction, all but 2 have recovered fully, and only 2 of the patients wear ankle foot orthoses (AFO) on a regular basis. No patient has had any problem with bowel or bladder or sexual neurologic deficit, but 1 patient does have retrograde ejaculation.