Spondyloptosis represents an extreme form of spondylolisthesis that requires specialized surgical intervention. Recently, medical experts shared a unique case involving sacral pedicle subtraction osteotomy for a pediatric patient. This approach successfully salvaged a complex revision case where previous methods had failed. However, revision surgery in these instances presents significant challenges. Consequently, clinicians need clear literature to guide their surgical choices. Specifically, the authors describe the first pediatric application of this technique for severe olisthetic scoliosis.

Utilizing Sacral Pedicle Subtraction Osteotomy in Revision Surgery

The 14-year-old adolescent female patient originally faced L5-S1 spondyloptosis and an 80-degree scoliosis. Initially, she underwent a posterior spinal fusion from T3 to the pelvis using the Bohlman technique. However, the patient experienced recurrent hardware failure twice within a single year. Consequently, surgeons needed a more robust salvage solution to address her progressive sagittal imbalance and high shear stresses. Therefore, the surgical team performed a sacral pedicle subtraction osteotomy.

Notably, they executed this procedure proximal to the previously fused Bohlman dowel. Additionally, the surgeons supplemented the multirod construct with four rods and a specialized kickstand rod. This combination successfully provided the necessary stability to counteract the underlying deformity. Ultimately, the procedure allowed for significant restoration of sagittal alignment. Furthermore, it highlights how sacral techniques can effectively salvage complex pediatric cases when traditional lumbar options might fail.

Frequently Asked Questions

What is spondyloptosis?

Spondyloptosis is the most severe grade of spondylolisthesis. It occurs when the L5 vertebra slips completely off the S1 segment. This condition typically causes significant pain, postural changes, and neurological weakness.

Why is a kickstand rod used in spine surgery?

A kickstand rod provides additional structural support in complex spinal deformity cases. It helps surgeons achieve and maintain coronal correction while serving as a buttress to prevent future loss of alignment.

When is a sacral PSO preferred over a lumbar PSO?

A sacral PSO is particularly useful as a salvage technique for distal kyphotic deformities. It targets the lumbosacral junction directly to restore sagittal balance and reduce shear stresses, especially when previous fusions are already in place.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Davuluri S et al. Salvage of pediatric spondyloptosis treated with sacral pedicle subtraction osteotomy: illustrative case. J Neurosurg Case Lessons. 2026 May 18. doi: undefined. PMID: 42150205.


2. Safaee M et al. Sacral Pedicle Subtraction Osteotomy for Treatment of High-Grade Spondylolisthesis: A Technical Note and Review of the Literature. Oper Neurosurg (Hagerstown). 2022 Aug 1;23(2):e84-e90.


3. Lenke LG et al. The \"kickstand rod\" technique for correction of coronal malalignment: two-year clinical and radiographic outcomes. Spine Deform. 2022;10(6):1345-1353.