Jones Thomas R, Rao Raj D
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226-0099, USA.
J Am Acad Orthop Surg. 2009 Oct;17(10):609-17. doi: 10.5435/00124635-200910000-00003.
Isthmic spondylolisthesis is present in a small subset of the adult population. Although the incidence of low back pain in these persons is similar to that of the general population, both pars interarticularis defect and forward slip can serve as unique pain generators. Neurologic symptoms may result from nerve root impingement related to the pars defect or degenerative changes associated with the deformity. Most symptomatic cases are successfully managed nonsurgically, but patients with intractable pain or neurologic symptoms may benefit from surgical decompression and stabilization. Surgical intervention has shown >80% success in appropriately selected patients, with a low incidence of complications. Surgical techniques include decompression, posterolateral fusion, anterior lumbosacral interbody fusion, and circumferential fusion methods. Circumferential fusion results in improved fusion rates and, in some studies, superior clinical outcomes. The choice of procedure is generally guided by the patient's radiographic and clinical findings as well as risk-benefit considerations.
峡部裂型腰椎滑脱症在成年人群中所占比例较小。尽管这些人下腰痛的发生率与普通人群相似，但关节突间部缺损和椎体前滑均可成为独特的疼痛根源。神经症状可能源于与关节突缺损相关的神经根受压或与畸形相关的退变改变。大多数有症状的病例通过非手术治疗可成功处理，但疼痛顽固或有神经症状的患者可能从手术减压和稳定手术中获益。手术干预在适当选择的患者中成功率超过80%，并发症发生率较低。手术技术包括减压、后外侧融合、腰骶前路椎间融合和环形融合方法。环形融合可提高融合率，在一些研究中，临床效果更佳。手术方式的选择通常由患者的影像学和临床检查结果以及风险效益考量来指导。
