Postacchini F, Cinotti G, Perugia D
I Clinica Ortopedica dell'Università La Sapienza, Roma.
Ital J Orthop Traumatol. 1991 Dec;17(4):467-77.
The authors analyze the results of operative treatment in 32 cases of degenerative spondylolisthesis with various degrees of compression of the nervous structures. Five types of surgery were performed: unilateral laminotomy; bilateral laminotomy with or without transverse process fusion; bilateral laminectomy with or without spinal fusion; and laminectomy, spinal fusion, and interspinous wiring. Satisfactory results were achieved in 84% of the cases. Seventy-six percent of the patients had further vertebral displacement, and 81% showed varying degrees of articular process regeneration more than two years after surgery; these findings concern both patients who had been treated with spinal fusion and those who had not. Bilateral laminotomy is indicated in patients with isolated nerve root canal stenosis; as the olisthesis is mild and lateral flexion-extension radiographs show no vertebral hypermobility, spinal fusion is not necessary. When central spinal canal stenosis is present, bilateral laminectomy, extensive lateral decompression, and spinal fusion are recommended. Interspinous wiring may be useful for immediate vertebral stabilization.
作者分析了32例伴有不同程度神经结构受压的退行性腰椎滑脱症患者的手术治疗结果。共实施了五种手术方式：单侧椎板切开术；双侧椎板切开术，伴或不伴横突融合；双侧椎板切除术，伴或不伴脊柱融合；椎板切除术、脊柱融合术及棘突间钢丝固定术。84%的病例取得了满意的效果。76%的患者出现了进一步的椎体移位，81%的患者在术后两年以上显示出不同程度的关节突再生；这些结果在接受脊柱融合术和未接受脊柱融合术的患者中均有出现。对于单纯神经根根管狭窄的患者，建议行双侧椎板切开术；由于滑脱程度较轻，且侧屈-后伸位X线片显示无椎体活动度增加，故无需进行脊柱融合。当存在中央椎管狭窄时，建议行双侧椎板切除术、广泛的侧方减压及脊柱融合术。棘突间钢丝固定术可能有助于立即实现椎体稳定。
