Ruf Michael, Koch Hannjörg, Melcher Robert P, Harms Jürgen
Department of Orthopaedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Germany.
Spine (Phila Pa 1976). 2006 Feb 1;31(3):269-74. doi: 10.1097/01.brs.0000197204.91891.eb.
A retrospective review of the clinical and radiographic outcomes of reduction by temporary instrumentation of L4 and monosegmental fusion of L5/S1 in patients with high-grade developmental spondylolisthesis.
To assess the efficacy of this technique in the reduction of local deformity and correction of overall sagittal profile.
In situ fusions as well as partial reduction with fusion L4-S1 via various approaches have been described previously. To date and to our knowledge, there have been no reports describing complete reduction and monosegmental fusion for high-grade developmental spondylolisthesis.
A total of 27 consecutive patients with severe developmental spondylolisthesis of L5/S1 were treated with operative reduction via temporary instrumentation of L4 and monosegmental fusion of L5/S1. The clinical and radiographic outcomes were retrospectively reviewed for each case at a minimum of 2 years (mean follow-up of 45 months; range 24-80). Mean age at surgery was 16.7 years (range 9-29).
At most recent follow-up, 23 patients were pain free. There were 4 patients who had moderate pain. All radiographic parameters improved. Mean slippage improved from 74.0% before surgery to 11.0% after surgery and 10.0% at latest follow-up. Slip angle improved from 36.6 degrees before surgery to 8.1 degrees after surgery and 7.6 degrees at latest follow-up. Sacral inclination improved from 34.6 degrees before surgery to 43.4 degrees after surgery and 47.2 degrees at latest follow-up. The overall sagittal profile improved dramatically. There was 1 superficial infection, 6 patients had L5 root symptoms (5 of these resolved, 1 patient had a persistent sensory deficit). Four patients had decompensation at L4/5 (2 reoperations).
Reduction of L5/S1 with temporary instrumentation of L4 and monosegmental fusion of L5/S1 is an effective technique for the treatment of high-grade developmental spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal profile can be achieved. Fusion of the primarily healthy segment L4/5 can be avoided.
对采用L4临时内固定及L5/S1单节段融合治疗重度发育性腰椎滑脱患者的临床及影像学结果进行回顾性分析。
评估该技术在矫正局部畸形及整体矢状面轮廓方面的疗效。
此前已有关于原位融合以及通过各种方法对L4 - S1进行部分复位融合的描述。据我们所知，迄今为止尚无关于重度发育性腰椎滑脱完全复位及单节段融合的报道。
连续27例L5/S1重度发育性腰椎滑脱患者接受了L4临时内固定及L5/S1单节段融合的手术复位治疗。对每例患者的临床及影像学结果进行了至少2年的回顾性分析（平均随访45个月；范围24 - 80个月）。手术时的平均年龄为16.7岁（范围9 - 29岁）。
在最近一次随访时，23例患者无痛。4例患者有中度疼痛。所有影像学参数均有改善。平均滑脱率从术前的74.0%改善至术后的11.0%，在最近一次随访时为10.0%。滑脱角从术前的36.6度改善至术后的8.1度，在最近一次随访时为7.6度。骶骨倾斜角从术前的34.6度改善至术后的43.4度，在最近一次随访时为47.2度。整体矢状面轮廓显著改善。发生1例浅表感染，6例患者出现L5神经根症状（其中5例症状缓解，1例患者存在持续性感觉障碍）。4例患者在L4/5节段出现失代偿（2例再次手术）。
采用L4临时内固定及L5/S1单节段融合对L5/S1进行复位是治疗重度发育性腰椎滑脱的有效技术。可实现局部畸形的完全复位及整体矢状面轮廓的良好矫正。可避免对原本健康的L4/5节段进行融合。
