Wu Chin-Hsien, Kao Yu-Hsien, Yang Shih-Chieh, Fu Tsai-Sheng, Lai Po-Liang, Chen Wen-Jer
Department of Orthopaedics, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taipei.
Acta Orthop. 2008 Feb;79(1):67-73. doi: 10.1080/17453670710014789.
There have been few reports assessing the outcome of laminectomy and posterolateral fusion with pedicle screw fixation for degenerative spondylolisthesis in the elderly. In a retrospective study, we assessed the clinical and radiographic outcome of this treatment in degenerative spondylolisthesis patients aged >or= 65 years.
82 patients (61 females) aged >or= 65 years underwent laminectomy and posterolateral fusion with pedicle screw fixation for degenerative spondylolisthesis. The median age at surgery was 69 (65-79) years. The mean bone mineral density before surgery was -1.9 (-1.0 to -2.5). After an average of 3 (2-11) years follow-up, patients were classified as "satisfied" or "dissatisfied" according to self-reported outcomes and also as "solid fusion" or "no solid fusion" according to the radiographic findings.
At final follow-up, the average Oswestry disability index (ODI) score was lower than the preoperative score (30 vs. 56) (p = 0.03). Four-fifths of the patients stated that they were satisfied with the outcome. Almost three-quarters of the patients achieved definite fusion. Although patients with advanced age or reduced bone mineral density were not more likely to have dissatisfactory results (p = 0.8 and p = 0.6, respectively) they were more likely to have radiographic results showing "absence of solid fusion" (p = 0.005 and p < 0.001, respectively).
We believe that supplementary pedicle screw fixation after laminectomy and posterolateral fusion will be an effective choice for the ever-increasing number of patients aged >or= 65 years who will be prone to develop degenerative spondylolisthesis.
关于老年人退变性腰椎滑脱行椎板切除及后路椎弓根螺钉固定融合术的疗效评估报道较少。在一项回顾性研究中，我们评估了该治疗方法用于年龄≥65岁的退变性腰椎滑脱患者的临床及影像学疗效。
82例年龄≥65岁（61例女性）的退变性腰椎滑脱患者接受了椎板切除及后路椎弓根螺钉固定融合术。手术时的中位年龄为69岁（65 - 79岁）。术前平均骨密度为-1.9（-1.0至-2.5）。平均随访3年（2 - 11年）后，根据患者自我报告的结果将其分为“满意”或“不满意”，并根据影像学检查结果分为“坚固融合”或“未坚固融合”。
末次随访时，平均Oswestry功能障碍指数（ODI）评分低于术前评分（30对56）（p = 0.03）。五分之四的患者表示对结果满意。近四分之三的患者实现了确切融合。尽管高龄或骨密度降低的患者出现不满意结果的可能性并不更高（分别为p = 0.8和p = 0.6），但他们出现影像学结果显示“未坚固融合”的可能性更高（分别为p = 0.005和p < 0.001）。
我们认为，对于越来越多易患退变性腰椎滑脱的≥65岁患者，椎板切除及后外侧融合术后辅以椎弓根螺钉固定将是一种有效的选择。
