Bridwell Keith H
Washington University School of Medicine, Department of Orthopaedic Surgery, One Barnes-Jewish Hospital Plaza, Suite 11300 WP, Campus Box 8233, St. Louis, MO 63110, USA.
Spine (Phila Pa 1976). 2005 Mar 15;30(6 Suppl):S88-96. doi: 10.1097/01.brs.0000155562.60754.62.
Retrospective case analysis and presentation.
The purpose of this article is to discuss the spectrum of failed spondylolisthesis cases for which either anterior column support or iliac screw fixation or both are useful in salvaging failed spondylolisthesis surgeries.
Past studies and experience have suggested that there is a relatively high rate of sacral screw failure both in long constructs to the sacrum in the adult population and also with treatment of both high-grade and adult spondylolisthesis at L5-S1. It has been noted that anterior column support at L5-S1 and additional fixation points in the sacropelvic unit provide some protection to the sacral screws.
This article details the author's personal and institutional experience with sacropelvic fixation and anterior column support at L5-S1 to salvage failed spondylolisthesis cases.
To some extent, each case needs to be individualized. It is not always necessary to provide both anterior column support at L5-S1 and protection of the sacral screws with iliac screws. However, in the most complex problems using both seems to provide the greatest chance for an acceptable radiographic and clinical outcome. Most biomechanical studies have supported the use of anterior column support and iliac fixation to protect sacral screws, suggesting, of the two, that the iliac screws are more valuable.
For many of these cases of both high-grade dysplastic spondylolisthesis and low-grade adult isthmic spondylolisthesis, a reasonable combination of anterior column support and/or iliac screw fixation may be logical to reduce the incidence of failure and need for revision. The biggest concern with using iliac screw fixation is that these screws are prominent in a percentage of patients and the ultimate impact on the sacroiliac joint is not fully investigated. However, at our institution with 5- to 10-year follow-up, the impact on the sacroiliac joint has been minimal.
回顾性病例分析与报告。
本文旨在探讨滑脱复位失败病例的情况，对于此类病例，前柱支撑或髂骨螺钉固定或两者联合使用，有助于挽救滑脱复位失败的手术。
既往研究与经验表明，在成人中，用于骶骨的长节段固定结构以及治疗L5-S1节段的高度发育不良性和成人峡部裂性滑脱时，骶骨螺钉失败率相对较高。值得注意的是，L5-S1节段的前柱支撑以及骶骨盆部单元的额外固定点可为骶骨螺钉提供一定保护。
本文详细介绍了作者个人及所在机构在采用骶骨盆部固定和L5-S1节段前柱支撑挽救滑脱复位失败病例方面的经验。
在某种程度上，每个病例都需要个体化处理。并非总是需要同时进行L5-S1节段的前柱支撑和使用髂骨螺钉保护骶骨螺钉。然而，在最复杂的问题中，两者联合使用似乎为获得可接受的影像学和临床结果提供了最大机会。大多数生物力学研究支持使用前柱支撑和髂骨固定来保护骶骨螺钉，表明两者之中，髂骨螺钉更有价值。
对于许多高度发育不良性滑脱和低度成人峡部裂性滑脱病例，合理联合使用前柱支撑和/或髂骨螺钉固定，对于降低失败率和翻修需求可能是合理的。使用髂骨螺钉固定的最大担忧在于，这些螺钉在部分患者中较为突出，且对骶髂关节的最终影响尚未得到充分研究。然而，在我们机构进行的5至10年随访中发现，对骶髂关节的影响极小。
