Abdu et al. reported in 1994 preliminary results of pedicular transvertebral screw fixation for stabilizing the lumbosacral junction in moderate- to high grade spondylolisthesis.

Fusion was successful in three patients, two with an established pseudarthrosis.

The technique provides immediate three-column stabilization of the lumbosacral junction by means of a posterior approach, and the triangular construct potentially provides stability to the anterior column.

The technique is safe, effective, and employs instrumentation common to spine surgery. Its use in high-grade slips makes the technique more simple to perform than other methods of lumbosacral stabilization 1).

Many case-series studies of lumbosacral fusion for spondylolisthesis have been reported,

but only a few have focused on L5-S1 transdiscal screw fixations 2) 3) 4). , and only 2 of these had more than 20 patients 5) 6).

Other studies had used transdiscal screwing associated with some other technique of fusion 7) 8) 9) 10).


Twenty-five consecutive patients with mean age of 36.7 years underwent transdiscal fixation, and 31 other with mean age of 42.0 years to pedicle fixation were clinically and radiographically compared. Clinical assessments were performed using Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), Short-Form 12 (SF-12), and pain visual analog scale (VAS). Radiographic spinopelvic parameters were also evaluated. The mean follow-up was 2.7 years (range 2.0-5.3).

Preoperative data were comparable between groups. Surgery time, blood loss, and hospital stay were similar between groups. At last follow-up, clinical and radiographic outcomes were significantly improved in both groups. Postoperatively, both lumbar and leg pain VAS were similar between groups, but ODI (20.2 vs. 31.6, p = 0.010), COMI (1.6 vs. 2.8, p = 0.012), and SF-12 physical (84.3 vs. 61.5, p = 0.004) and mental (81.5 vs. 69.4, p = 0.021) scores were significantly better in the transdiscal group. The neurologic complication rate was similar in both groups. There were 4 pseudoarthroses in the pedicle group, and none in the transdiscal group. : L5-S1 transdiscal screw fixation provided better functional and radiographic outcomes at medium-term than conventional pedicle fixation for high-grade spondylolisthesis, although transdiscal sacral screws are difficult to place in correct position 11).


Chell et al. report on a consecutive series of three adult patients with high-grade slippage who were treated with transvertebral pedicle fixation and standard spinal instrumentation, as both primary and revision procedures. There were no complications from the procedure, and a good outcome was achieved in all patients. The results at 4- to 8-year follow-up review are presented. This is a relatively simple and safe method of achieving spinal stabilization, which bypasses some of the problems caused by the associated anatomical distortion in high-grade spondylolisthesis and has good results at midterm follow up 12).

Abdu WA, Wilber RG, Emery SE. Pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis. A new technique for stabilization. Spine (Phila Pa 1976). 1994 Mar 15;19(6):710-5. PubMed PMID: 8009337.
Boachie-Adjei O, Do T, Rawlins BA (2002) Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: clinical and radiographic results in six patients. Spine 27:161–168
Francois J, Lauweryns P, Fabry G (2005) Treatment of high- grade spondylolisthesis by posterior lumbosacral transfixation with transdiscal screws: surgical technique and preliminary results in four cases. Acta Orthop Belg 71:334–341
Logroscino CA, Tamburrelli FC, Scaramuzzo L, Schiro GR, Sessa S, Proietti L (2012) Transdiscal L5-S1 screws for the treatment of adult spondylolisthesis. Eur Spine J 21(Suppl 1):128–133
Rodriguez-Olaverri JC, Zimick NC, Merola A, Vicente J, Rodriguez J, Tabuenca A et al (2008) Comparing the clinical and radiological outcomes of pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis versus unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior cages. Spine 33:1977–1981
Zagra A, Giudici F, Minoia L, Corriero AS, Zagra L (2009) Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis. Eur Spine J 18(Suppl 1):151–155
Grob D, Humke T, Dvorak J (1996) Direct pediculo-body fixation in cases of spondylolisthesis with advanced intervertebral disc degeneration. Eur Spine J 5:281–285
Bartolozzi P, Sandri A, Cassini M, Ricci M (2003) One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5-S1 spondylolisthesis. Spine 28:1135–1141
Smith JA, Deviren V, Berven S, Kleinstueck F, Bradford DS (2001) Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade L5–S1 spondylolisthesis. Spine 26:2227–2234
Lakshmanan P, Ahuja S, Lewis M, Howes J, Davies PR (2009) Transsacral screw fixation for high-grade spondylolisthesis. Spine J 9:1024–1029
Collados-Maestre I, Lizaur-Utrilla A, Bas-Hermida T, Pastor-Fernandez E, Gil-Guillen V. Transdiscal screw versus pedicle screw fixation for high-grade L5-S1 isthmic spondylolisthesis in patients younger than 60 years: a case-control study. Eur Spine J. 2016 Jun;25(6):1806-12. doi: 10.1007/s00586-016-4550-0. Epub 2016 Apr 5. PubMed PMID: 27048540.
Chell J, Quinnell RC. Transvertebral pedicle fixation in severe grade spondylolisthesis. Report of three cases. J Neurosurg. 2001 Jul;95(1 Suppl):105-7. PubMed PMID: 11453407.
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