Davis I S, Bailey R W
Clin Orthop Relat Res. 1976 Jun(117):129-34.
Pain mechanisms attributable to spondylolisthesis are discussed with particular regard to the anatomic relationships at the site of nerve root impingement where the exiting lumbar nerve root is noted to pass anterior to the pseudoarthrosis mass in the pars interarticularis portion of the posterior element of the vertebral body. Clinical findings support the fact that nerve root impingement is a definite factor in producing the pain and associated symptoms in root impingement further supports this hypothesis. The incidence of lower motor neuron deficit is determined by a combination of muscle testing and electromyography. Postoperative results are evaluated in terms of patients having arthritic changes associated with the spondylolisthesis and in those patients with absence of arthritic change. These changes distinguish the patients who might respond best to simple decompression of the nerve root impingement from those patients who might better benefit from spinal fusion. Operative techniques should include adequate decompression of the exiting lumbar nerve root by means of total laminectomy approach. Exision of the pseudarthrosis mass attached to the pedicle side of the pars interarticularis of the vertebra is necessary to relieve pressure on the shoulder of the exiting nerve root.
本文讨论了与腰椎滑脱相关的疼痛机制，尤其关注神经根受压部位的解剖关系，在该部位，腰椎神经根穿出时经过椎体后部关节突间部假关节肿块的前方。临床研究结果证实，神经根受压是导致疼痛的一个明确因素，而神经根受压时出现的相关症状进一步支持了这一假说。通过肌肉测试和肌电图相结合的方法来确定下运动神经元功能缺损的发生率。根据腰椎滑脱患者是否伴有关节炎变化来评估术后结果，并与无关节炎变化的患者进行对比。这些变化区分出了可能对单纯神经根减压反应最佳的患者，以及可能从脊柱融合术中获益更多的患者。手术技术应包括采用全椎板切除术对腰椎神经根进行充分减压。切除附着于椎体关节突间部椎弓根侧的假关节肿块，对于减轻穿出神经根肩部的压力是必要的。
