The Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland.
Eur Spine J. 1993 Aug;2(2):104-12. doi: 10.1007/BF00302712.
Summary. The results of 23 patients with symptomatic spondylolysis or mild isthmic spondylolisthesis treated by Scott's direct repair of the defect (secclusion) were analyzed with particular reference to spinal mobility and the condition of the intervertebral discs, and compared with the outcome of 25 patients treated by posterolateral segmental fusion without instrumentation. The two groups were comparable as to age at operation (17.4 +/- 5.7 vs. 15.6 +/- 2.6 years), follow-up time (54 +/- 8 vs. 54 +/- 25 months), gender, and preoperative subjective symptoms. The mean preoperative vertebral slip was greater in the fusion group (7.2 +/- 8.4 vs. 13.1 +/- 4, P = 0.003). The follow-up assessment was carried out by an independent observer. It included an interview, Oswestry questionnaire, pain scale drawing, physical examination, plain radiographs, magnetic resonance imaging (MRI), and functional testing (lumbar spine mobility, static lifting power). For statistical analysis, the Student's t-test, the chi2 test, and the paired t-test were used. At followup, 87% of the Scott's group and 96% of the fusion group had occasional pain, not interfering with daily activities, or no pain at all. There was no statistical difference in the subjective, clinical, or functional outcome between the two operation groups. Plain radiographs in both groups showed significant loss of disc height in the operated segment during follow-up, indicating postoperative progression of disc degeneration. In flexion/extension radiographs the total range of movement in the three lowermost lumbar segments was slightly greater after secclusion. This difference was not significant. In MRI there was no statistical difference in disc hydration index between the two groups. The condition of the disc above the fusion was not worse than that of the corresponding disc above the secclusion. There was no correlation between pathologic disc findings in MRI and clinical outcome. It is concluded that in a small group of young patients the early results both after direct repair of the defect and after segmental fusion are satisfactory in the majority of cases. At this point of follow-up it is impossible to say which of the two procedures should be preferred for operative treatment of this condition in young patients. Direct repair does not protect the disc of the lytic/olisthetic segment from further degeneration. Pathologic disc changes in MRI should be interpreted with caution because their clinical relevance is still unclear.
总结。对 23 例有症状的峡部裂或轻度峡部不连脊椎滑脱患者采用 Scott 直接修复（封闭）治疗的结果进行了分析，重点关注脊柱活动度和椎间盘状况，并与 25 例未采用器械进行后路节段融合治疗的患者进行了比较。两组在手术时的年龄（17.4±5.7 岁比 15.6±2.6 岁）、随访时间（54±8 个月比 54±25 个月）、性别和术前主观症状方面具有可比性。融合组术前平均椎体滑移程度更大（7.2±8.4 比 13.1±4，P=0.003）。随访评估由独立观察者进行，包括访谈、Oswestry 问卷、疼痛评分图、体格检查、平片、磁共振成像（MRI）和功能测试（腰椎活动度、静态举力）。统计分析采用学生 t 检验、卡方检验和配对 t 检验。随访时，Scott 组 87%和融合组 96%的患者偶有疼痛，但不影响日常生活或无疼痛。两组手术的主观、临床和功能结果无统计学差异。两组平片在随访过程中均显示手术节段椎间盘高度明显丢失，表明术后椎间盘退变进展。屈伸位 X 线片显示，封闭术后三个最下段腰椎的总活动范围稍大，但无统计学意义。MRI 显示两组之间椎间盘水合指数无统计学差异。融合上方的椎间盘状况并不比封闭上方的相应椎间盘差。MRI 中椎间盘病理表现与临床结果之间无相关性。结论是，在一小部分年轻患者中，直接修复缺陷和节段融合后的早期结果在大多数情况下都是令人满意的。在这个随访点，无法确定这两种手术方法哪一种更适合年轻患者的这种情况的手术治疗。直接修复并不能防止溶骨性/滑脱性节段的椎间盘进一步退化。MRI 中椎间盘的病理变化应谨慎解读，因为其临床相关性尚不清楚。
