Resident Emory University Decatur, Georgia, United States
Introduction: High-grade spondylolisthesis at L5-S1 is difficult to treat due to the forces at play. Several surgical options have been described including posterior, anterior, and circumferential, with optional reduction, and techniques have evolved along with implant technology; however, no clear approach is superior. The Rialto fenestrated cage was introduced for sacroiliac joint fusion but may be an robust alternative for transsacral fixation with a fibular strut or bolt.
Methods: Retrospective case series of patients treated by posterior alone with the Medtronic Rialto case for transsacral fixation spanning the L5-S1 disc space. Data was collected on preoperative and postoperative lumbosacral parameters, follow up, fusion rate, and complications.
Results: Nine patients underwent the procedure (7 female, 2 males, average age 52 +/- 14 yrs) between 2014 and 2022. Spondylolisthesis was a grade 2 in three cases, grade 3 in four cases, and grade 4 in two cases. All patients had at least one outpatient follow up visit, with overall followup ranging from 1mo to 4.8 yrs. No patient had evidence of non-union or complication in any follow up imaging. All patients experienced either complete or partial resolution of pain, with no worsening of symptoms. One patient had a superficial dehiscence requiring washout.
Conclusion : The Rialto fenestrated cage provides robust transsacral fixation with easy delivery
How to Improve Patient Care: Efficient technique for solid lumbosacral fusion
