Lundin David A, Wiseman Diana, Ellenbogen Richard G, Shaffrey Christopher I
Department of Neurological Surgery, University of Washington Medical Center, University of Washington, Seattle, Wash. 98195, USA.
Pediatr Neurosurg. 2003 Oct;39(4):195-200. doi: 10.1159/000072471.
Spondylolysis and spondylolisthesis can be associated with significant low back pain, especially in physically active adolescents. Non-operative management is usually successful in improving symptoms, but surgical intervention is occasionally required for those that fail reduction of activity and bracing. In a subpopulation of these patients, direct repair of the pars interarticularis defect can be an effective modality of treatment. The advantage of direct pars repair over intertransverse fusion with or without segmental instrumentation is the preservation of the anatomic integrity and motion of the affected segment. We describe our experience in 5 patients (aged 15-18 years) managed by direct pars interarticularis repair after failing multimodality non-operative treatment. The length of stay averaged 3.2 days (range 3-4 days). All 5 patients were able to return to full activity with either no (60%) or minor (40%) symptoms. No immediate or delayed complications were noted. Patients were followed a minimum of 30 months (range 30-78 months). All 5 patients demonstrated evidence of bony fusion by radiographic criteria. This demonstrates that direct pars repair is a safe and effective modality to treat select groups of patients with spondylolysis and low-grade spondylolisthesis.
椎弓根峡部裂和椎体滑脱可伴有严重的下腰痛，尤其是在身体活跃的青少年中。非手术治疗通常能成功改善症状，但对于那些通过减少活动和支具治疗无效的患者，偶尔需要进行手术干预。在这些患者的一个亚组中，直接修复关节突间部缺损可能是一种有效的治疗方式。与采用或不采用节段性内固定的横突间融合术相比，直接修复关节突间部的优点是保留了患节段的解剖完整性和活动度。我们描述了5例（年龄15 - 18岁）经多模式非手术治疗失败后接受关节突间部直接修复治疗的患者的经验。住院时间平均为3.2天（范围3 - 4天）。所有5例患者均能够恢复全部活动，其中无症状者占60%，有轻微症状者占40%。未发现即刻或延迟并发症。对患者进行了至少30个月（范围30 - 78个月）的随访。根据影像学标准，所有5例患者均显示有骨融合迹象。这表明直接修复关节突间部是治疗特定组别的椎弓根峡部裂和低度椎体滑脱患者的一种安全有效的方式。
