Mac-Thiong Jean-Marc, Labelle Hubert
Division of Orthopaedics, Hôpital Sainte-Justine, Montreal, QC, Canada.
Eur Spine J. 2006 Oct;15(10):1425-35. doi: 10.1007/s00586-006-0101-4. Epub 2006 Jun 7.
The classification presented in this paper is the first specifically designed to guide surgical treatment of L5-S1 spondylolisthesis in children and adolescents. It also presents objective criteria to differentiate between low- and high-dysplastic spondylolisthesis and incorporates recent knowledge in the study of sagittal spinopelvic balance. The proposed classification is based on the following: (1) the degree of slip, (2) the degree of dysplasia, and (3) the sagittal spinopelvic balance. To classify a patient, the degree of slip is quantified first to determine if it is low-grade, high-grade, or a spondyloptosis. Then, the degree of dysplasia is evaluated based on seven criteria, in order to separate patients with low- and high-dysplastic spondylolisthesis. Finally, the sagittal spinopelvic balance is assessed from the measurement of the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). For low-grade spondylolisthesis, it is classified as low PI/low SS (nutcracker type) or high PI/high SS (shear type). For high-grade spondylolisthesis, it is classified as high SS/low PT (balanced pelvis) or low SS/high PT (retroverted pelvis). Such a comprehensive classification could allow to better evaluate and compare available surgical techniques, and to optimize the treatment of L5-S1 spondylolisthesis. Because the classification was designed so that groups are organized in an ascending order of severity, it becomes easier and more intuitive to develop an associated surgical algorithm because the complexity of the surgery should increase as the severity of the spondylolisthesis increases. A tentative treatment algorithm is proposed but it is not definitive because further studies are required to define the most appropriate treatment for each group.
本文提出的分类是首个专门为指导儿童和青少年L5 - S1椎体滑脱的手术治疗而设计的。它还提出了区分低度和高度发育不良性椎体滑脱的客观标准，并纳入了矢状位脊柱骨盆平衡研究的最新知识。所提出的分类基于以下几点：（1）滑脱程度；（2）发育不良程度；（3）矢状位脊柱骨盆平衡。为了对患者进行分类，首先量化滑脱程度以确定其为低度、高度还是椎体前移。然后，根据七个标准评估发育不良程度，以区分低度和高度发育不良性椎体滑脱患者。最后，通过测量骨盆入射角（PI）、骶骨坡度（SS）和骨盆倾斜度（PT）来评估矢状位脊柱骨盆平衡。对于低度椎体滑脱，分为低PI/低SS（胡桃夹型）或高PI/高SS（剪切型）。对于高度椎体滑脱，分为高SS/低PT（平衡骨盆）或低SS/高PT（后倾骨盆）。这样一个全面的分类能够更好地评估和比较现有的手术技术，并优化L5 - S1椎体滑脱的治疗。由于该分类的设计使得各组按严重程度升序排列，因此开发相关的手术算法变得更加容易和直观，因为随着椎体滑脱严重程度的增加，手术的复杂性也应增加。本文提出了一个初步的治疗算法，但它并不确定，因为需要进一步研究来确定每组最合适的治疗方法。
