- When do you operate
- All high grade will progress
- The moment lumbar sacral kyphosis occurs will progress
- How to assess flexibility
- Use supine bolster
- Supine, flex and extend lateral xray
- How to obtain fusion
- Can try bone on bone fusion
- Cage and bone graft
- S1 Dome resection
- To reduce or not reduce: Equivocal
- Reduce 2 parts
- Sagittal Rotational
- Measured by LS kyphosis
- Translational
- Measured by Myerdin
- Do not do completely reduce the translation as it can increase risk of L5 traction injury
- Use IONM to monitor L5
- Must get fusion
- Decompression for radiculopathy or Cauda equina syndrome
- Surgical goal
- Kyphosis correction
- Not necessary translation correction
- Need only 25% to 50% bone contact for fusion
- Nerve root decompression
- Surgical technique
- How to obtain kyphosis correction
- Release and shortening (like any spinal deformity)
- Iliac fixation
- L4 fixation
- Reduction screws and compression
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