• Satoshi Nozawa, Atsushi Nakano, Kenta Fujiwara, Yoshiharu Nakaya, Shingo Fukumoto, Takashi Fujishiro, Keiichiro Kino, Ichiro Baba, Haruhiko Akiyama, and Masashi Neo.
• Department of Orthopaedic Surgery, Gifu University, Gifu, Japan. Electronic address: noza618@yahoo.co.jp.
• World Neurosurg. 2019 Jun 1; 126: 383-388.

BackgroundControversy exists regarding surgical treatment of high-grade spondylolisthesis (HGS) in terms of decompression with surgical reduction or in situ fusion. In situ fusion has the advantage of being less technically demanding. However, the residual bone graft area is extremely limited, and posterolateral bone grafting is complex as the transverse process of the slipped vertebrae is located anterior to the sacral ala, which correlates with high rates of pseudoarthrosis.MethodsFour cases of L5/S1 HGS complaining of low back pain were treated using our new bone graft technique with an exposed osseous end plate. Transdiskal screw holes were made from the S1 pedicle, and bone chips were packed into the L5/S disk space through the screw holes. The slipped L5 vertebra was fixed with a combination of L5/S1 transdiskal and L5 pedicle screws.ResultsAll cases exhibited good bony fusion, and the low back pain disappeared in all patients up to the 12-month follow-up. This technique involved packing the bone into the closed space, relieving any concerns regarding bone graft migration.ConclusionsTranspedicular bone graft via transdiskal screw holes is an easy and practical technique for raising the fusion rate in surgical treatment of HGS.Copyright © 2019 Elsevier Inc. All rights reserved.

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