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Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 51-52

Two-point fixation to stabilize hypermobile lumbar vertebral body during posterior spinal fixation

Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication28-Apr-2015

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-2585.153984

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How to cite this article:
Agrawal A. Two-point fixation to stabilize hypermobile lumbar vertebral body during posterior spinal fixation. J Orthop Allied Sci 2015;3:51-2

How to cite this URL:
Agrawal A. Two-point fixation to stabilize hypermobile lumbar vertebral body during posterior spinal fixation. J Orthop Allied Sci [serial online] 2015 [cited 2022 Jan 18];3:51-2. Available from:


Spondylolisthesis is the anterior subluxation of one vertebral body over another and is characterized by a failure of the three-column support requiring reconstruction to develop altered supporting structures. [1],[2],[3] In patients with symptomatic spondylolisthesis, posterior lumbar pedicle screw instrumentation has been successfully and widely used for reconstruction of the affected segments. [4],[5],[6] A 54-year female presented with progressively increasing low back pain of two-year duration radiating to both the lower limbs. There was no history of motor weakness. Bowel and bladder functions were normal. On examination, she was overweight. Straight leg raising test was 45 o . There were no motor or sensory deficits. Bilateral ankle jerks were absent. Planters were flexor. The X-ray lumbar spine showed grade II L5 over S1 listhesis [Figure 1]. The magnetic resonance imaging MRI lumbar spine showed the similar findings without any evidence of disc prolapse. The patient did not respond to initial conservative management and she was planned for posterior lumbar pedicle screw instrumentation. Standard technique of open posterior lumbar pedicle screw instrumentation was adopted in the present case. [7],[8],[9] Intra-operative fluoroscopy was used to confirm the level as well as for localization of the pedicles and the acceptable entry point, and the alignment was defined. An awl was used to create the entry point for screw. However, it was realized that there was excessive mobility of the L5 vertebral body while the awl was tried to gently hammer into the L5 body through the pedicle. To overcome this limitation and to stabilize the hypermobile L5 vertebral body during surgery, another awl was inserted into the opposite pedicle to stabilize the vertebral body during the hammering movement [Figure 2]. With the help of intra-operative fluoroscopy the position of the awls was confirmed and the pedicle screws were placed one by one into the L5 vertebral body while restricting the movements of the L5 body during surgery [Figure 3] and [Figure 4]. Cancellous bone harvested from the laminae and spinous process was packed over the decorticated bone surface. Standard procedure was followed in the present case i.e., neural decompression, internal fixation, and autogenous bone grafting for the fusion in a case of spondylolistheses to provide three-column stabilization. [1],[2],[3],[4],[5],[6] In addition to the well-described procedure, we used two awl techniques to stabilize the L5 vertebral body for hypermobile bone segment with good outcome.
Figure 1: X-ray lumbo-sacral spine showing grade II L5 over S1 listhesis

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Figure 2: Intra-operative photograph showing two awls were placed in both right and left pedicle

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Figure 3: Intra-operative fluoroscopy confirmed the position of the awls

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Figure 4: Final position of the screws

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  References Top

La Rosa G, Conti A, Cacciola F, Cardali S, La Torre D, Gambadauro NM, et al. Pedicle screw fixation for isthmic spondylolisthesis: Does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg 2003;99:143-50.  Back to cited text no. 1
Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 1984;66:699-707.  Back to cited text no. 2
Frymoyer JW, Selby DK. Segmental instability. Rationale for treatment. Spine (Phila Pa 1976) 1985;10:280-6.  Back to cited text no. 3
Boos N, Marchesi D, Zuber K, Aebi M. Treatment of severe spondylolisthesis by reduction and pedicular fixation. A 4-6-year follow-up study. Spine (Phila Pa 1976) 1993;18:1655-61.  Back to cited text no. 4
Boos N, Webb JK. Pedicle screw fixation in spinal disorders: A European view. European Spine J 1997;6:2-18.  Back to cited text no. 5
Yuan HA, Garfin SR, Dickman CA, Mardjetko SM. A Historical Cohort Study of Pedicle Screw Fixation in Thoracic, Lumbar, and Sacral Spinal Fusions. Spine (Phila Pa 1976) 1994;19:2279S-96S.  Back to cited text no. 6
Dickman CA, Fessler RG, MacMillan M, Haid RW. Transpedicular screw-rod fixation of the lumbar spine: Operative technique and outcome in 104 cases. J Neurosurg 1992;77:860-70.  Back to cited text no. 7
Masferrer R, Gomez CH, Karahalios DG, Sonntag VK. Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: A 5-year review. J Neurosurg 1998;89:371-7.  Back to cited text no. 8
Steffee AD, Biscup RS, Sitkowski DJ. Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin Orthop Relat Res 1986:45-53.  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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