Grade II L5-S1 isthmic spondylolisthesis.

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Grade II L5-S1 isthmic spondylolisthesis. Grade II L5-S1 isthmic spondylolisthesis. (A) The preoperative height of the ligamentous portion of the middle column (posterior longitudinal ligament) was measured utilizing Spine Align, a digital software program capable of measuring a curved perimeter. The 2 extraneous portions of the closed perimeter were subtracted leaving a preoperative middle column length of 60.2 mm, measured from midpedicle of L4 to the midpedicle of S1. (B) Following posterior decompression, pedicle screw L4 to S1 instrumentation and adjustable expandable L5-S1 spacer, the middle-column height was restored to 59.6 mm, or within our acceptable target of 0.6 mm. So, postoperatively using a closed perimeter measurement, the perimeter was 17.66 cm. Therefore, if the extraneous 2 legs of the perimeter measuring 5.82 and 5.88 cm respectively are subtracted out, the curved line of the middle column is 17.66 cm − 5.82 cm − 5.88 cm = 5.96 cm. In summary, by using a spacer at L5-S1 and reducing the L5-S1 spondylolisthesis the surgery has not overstretched the middle column: preoperative measurement = 6.02 cm and postoperatively the middle column was 5.96 cm. It is hoped that even more exacting postoperative height restoration is possible with precise intraoperative digital measuring techniques. PAUL C. McAFEE et al. Int J Spine Surg 2018;12:160-171 ©International Society for the Advancement of Spine Surgery