Complications in spondylolisthesis surgery: Common, uncommon, and rare

Abstract

Spondylolisthesis is a common pathological condition caused due to numerous etiologies in young and old alike. The forward slippage of one vertebra over the other alters the biomechanics to an extent that can result in various postoperative complications. The most common complications reported are pseudoarthrosis, neurological deficits, and transitional syndrome. The rate of pseudoarthrosis varies based on etiology as well as various intraoperative factors. The authors reviewed the literature for the varying incidence rates and suggest principles of reduction and fusion based on evidence and experience. Similarly, neurological complications are a common occurrence postoperatively particularly in the treatment of high-grade slips. Percentage of reduction of slips, slip angle, and traction injury to nerve roots tend to have a complex interaction leading to neurological injuries. The authors try to decipher this co-relation based on literature. Though most neurological issues have been found reversible, recent innovations like intraoperative neuromonitoring tend to decrease its incidence even further. The development of transition syndrome is an enigma in itself. Whether increased stresses at adjacent levels are due to fusion or a part of an ongoing degenerative process is yet to be understood. On the basis of case examples, the authors suggest recommendations to avoid them. Finally, minimally invasive spine surgeries (MISS) are now being used to treat spondylolisthesis. The authors reviewed comparative studies between open and MISS and found similar complication rates between them with regards to low-grade slips with a word of caution to treat high-grade listhesis with minimally invasive surgery techniques. Last but not the least, a few unusual and rare complications have been enlisted with case examples and learning points. This manuscript aims at reviewing the common, uncommon, and rare complications of treating cases of spondylolisthesis along with enlisting the principles to avoid and treat them in day to day practice.

Keywords

• complications
• neurological complications
• pseudoarthrosis
• spondylolisthesis
• transitional syndrome