L5–S1 Spondyloptosis: Surgical treatment by two staged GAINE'S procedure: A Case Report

Dr. Ankit Syal; Dr. Yash Bharat Shah; Dr. Chintan Vinod Desai; Dr. Suryaprakash Pitamber Chandani

Volume : III, Issue : VII, July - 2014

L5–S1 Spondyloptosis: Surgical treatment by two staged GAINE'S procedure: A Case Report

Dr. Ankit Syal, Dr. Yash Bharat Shah, Dr. Chintan Vinod Desai, Dr. Suryaprakash Pitamber Chandani

Abstract :

INTRODUCTION: Various operation techniques are performed for treatment of lumbosacral spondyloptosis. Gaines procedure is one of such procedures. In which there is circumferential excision of L5. With L4-L5-S1 root decompression, with L4-S1 reduction fixation & fusion. MATERIALS and METHODS: A25-year-old lady with lumbosacral spondyloptosis with incapacitating low back pain & neurological claudication, was treated by the Gaines procedure in 2 stages : In 1^st stage in supine, the anterior lumbosacral spine was approached through transperitoneal approach and the body of L5 was first removed to the base of the pedicles; L4-L5 & L5-S1 partial Dissectomy done ;In 2^nd stage in prone, after 7 days ,residual pedicles, discs & complete neural arch of L5 removed; L4 & S1partial laminectomy done, L4-L5-S1& sacral nerve roots decompression done , and the body of L4 was reduced onto S1with pedicle screw fixation and intervening 10 mm height TLIF cage & banked autologous cancellous bone grafts from excised body all around(360 degree), further stabilized by transverse connector, all through a midline posterior approach, without complication. Initially rest for 6 wks, followed by gradual rehabilitation with LS ace done. RESULTS: Complaints of the patient have relieved completely after 3 months & now independent in ADL at 6 months. Anterior plus posterior fusion is progressive on sequential xrays. Satisfactory back ROM is achieved & full function is expected at 1 year CONCLUSION: Though Gaines procedure is technically demanding & time consuming procedure, in experienced hands, it definitely fulfils all requirements of curative surgery & yields good outcome for difficult problem of lumbosacral spondyloptosis in young patients