Combined anterior and posterior fusion

In principle one could chose to do either the posterior or the anterior fusion first.

The first procedure will determine the degree of reduction. The second procedure will only increase the stability.

Detailed postoperative neural assessment must be conducted, specifically looking at the integrity of the L5 nerve root as well as sacral nerves controlling bowel and bladder.

Patients with high grade spondylolisthesis that have been reduced are at high risk of postoperative foot drops secondary to neuro traction injury. To minimize such injuries patients are immediately placed in bed with knees and hips flexed. As long as no neuro injury can be identified the leg can be gradually extended after day two. If neuro injury can be identified, the period of flexion should be extended.

Patients are made to sit up in the bed on the first day after surgery. Bracing is optional. Patients with intact neurological status are made to stand and walk on the second day after surgery. Patients can be discharged when medically stable or sent to a rehabilitation center if further care is necessary. This depends on the comfort levels and presence of other associated injuries.

Patients are generally followed with periodical x-rays at 6 weeks, 3 months, 6 months, and 1 year looking for spinal fusion.

Patients with a diagnosis of dysplastic spondylolisthesis run a higher risk of cauda equina and require closer monitoring of their neurological status during and after surgery.