Frymoyer JW
College of Medicine, University of Vermont, Burlington.
J Am Acad Orthop Surg. 1994 Jan;2(1):9-15. doi: 10.5435/00124635-199401000-00002.
Degenerative spondylolisthesis is most often seen at the L4-5 level. The most common complaint is back pain, but the advent of leg symptoms, such as claudication and restless legs syndrome, is often the reason for seeking specialized medical attention. Conservative treatment usually suffices; extended bed rest is of little value. The 15% of patients who are surgical candidates are those with clinical signs and symptoms of cauda equina abnormality, progressive muscular weakness, or progressive incapacitating radicular pain or claudication. The author advocates pedicle-to-pedicle decompression with preservation of the articular facets as the essential operation. The indications for fusion have been debated, but recent prospective studies show improved outcomes after fusion. The risk of significant morbidity associated with laminectomy and fusion increases as a function of age and magnitude of operation; therefore, careful patient selection for surgical intervention is vital.
退行性腰椎滑脱最常发生于L4 - 5节段。最常见的症状是背痛，但出现腿部症状，如间歇性跛行和不安腿综合征，往往是寻求专科医疗关注的原因。保守治疗通常就足够了；长时间卧床休息作用不大。15%的患者适合手术，这些患者具有马尾神经异常、进行性肌肉无力、进行性致残性神经根性疼痛或间歇性跛行的临床体征和症状。作者主张以保留关节突的椎弓根对椎弓根减压作为基本手术方式。融合术的适应证一直存在争议，但最近的前瞻性研究表明融合术后效果有所改善。与椎板切除术和融合术相关的严重并发症风险随年龄和手术规模增加而增加；因此，仔细选择手术干预的患者至关重要。
