Service d'Orthopédie et Chirurgie Vertébrale, Hôpital de la Conception, Marseille, France.
Eur Spine J. 1992 Sep;1(2):62-83. doi: 10.1007/BF00300931.
The purpose of this paper is to review the current concepts on spondylolysis and spondylolytic spondylolisthesis. The two are very closely connected, and both result from a growth disturbance of the lumbosacral vertebrae, linked to the human biped standing position, and depending on genetic and environmental factors. Pars defect occurs usually in early childhood. The primum movens of lumbosacral deformities in spondylolisthesis is the slippage and its biomechanical consequences for the growing vertebrae. Most cases are asymptomatic but symptomatic cases can be very disabling. Major clinical symptoms are presented here, as are the roentgenographic parameters usually required for the assessment. Most cases do not require surgery. However, surgical procedures have been widely developed in the last 60 years for the cases resistant to non-operative treatments. They are presented here in a logical order, from the most physiological to the most aggressive. Isthmic repair is reliable but requires very strict local conditions. Excision of the loose arch alone should no longer be practised especially in young patients. Fusions in situ are widely used, especially by the posterior approach, but owing to unfavourable biomechanical conditions, a significant amount of pseudarthrosis is reported as well as slip progression in young patients. Additional internal fixation is recommended. Associated reduction allows placement of the spine in the best mechanical conditions for a stable fusion. Several procedures have been reported, involving either single or staged approaches. Either anterior and posterior fusion associated with reduction seems to give the best results, in spite of some few cases of transitory neurological involvement. Resection of the olisthetic vertebra associated with reduction and fusion is a therapeutic alternative in very severe cases in young people. Elective indications are given at the end of the Discussion on the basis of current procedures, according to the type of lesion and the category of patient.
本文旨在回顾当前关于峡部裂和峡部裂性腰椎滑脱的概念。这两者密切相关，均源于腰骶椎的生长障碍，与人类的直立姿势有关，并受遗传和环境因素的影响。椎板裂通常发生在儿童早期。腰椎滑脱中脊柱畸形的最初动力是滑移及其对生长中的椎体的生物力学后果。大多数病例无症状，但有症状的病例可能非常致残。本文介绍了主要的临床症状以及评估通常需要的影像学参数。大多数病例不需要手术。然而，在过去的 60 年中，对于那些对非手术治疗有抵抗的病例，手术治疗已经得到了广泛的发展。本文按照从最生理性到最具侵袭性的顺序进行介绍。峡部修复是可靠的，但需要非常严格的局部条件。单独切除松动的弓状结构不应再进行，尤其是在年轻患者中。原位融合被广泛应用，特别是通过后入路，但由于生物力学条件不佳，报告了大量假关节形成和年轻患者的滑脱进展。建议进行额外的内固定。联合复位可使脊柱处于稳定融合的最佳机械条件下。已经报道了几种手术方法，涉及单入路或分期入路。无论是前路和后路联合复位似乎都能获得最好的结果，尽管有少数病例出现短暂性神经功能障碍。对于年轻患者非常严重的病例，切除滑脱椎体并复位融合是一种治疗选择。根据病变类型和患者类别，在讨论的最后，根据目前的治疗方法，给出了选择性手术适应证。
