Goni Vijay, Gopinathan Nirmal-Raj, Saini Uttam-Chand, Kantharajanna Shashidhar-B
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Chin J Traumatol. 2013;16(3):178-81.
High-grade spondylolisthesis is very rare. We came across a case of high-grade spondylolisthesis at the L5-S1 level in a 32-year-old manual labourer who was hit by a heavy object on his flexed back. The patient presented to us with persistent deformity in the back. He complained of back pain on prolonged standing and after moderate work. Because of that he was unable to return to his work. On clinical examination there was a large step in the lower lumbar region. Detailed neurological evaluation of the lower limbs did not reveal any sensory or motor deficit, neither did bowel or bladder involvement. Radiographic examination showed L5 over S1 traumatic spondyloptosis. CT scan revealed that neural canal was in normal width. MRI confirmed spondyloptosis of L5 over S1 without any compromise of the spinal canal and with normal-looking cauda. Concerning the delayed presentation and no neurological deficit, the patient was managed conservatively after thorough counsel. At 6 months, the patient returned to his work and at the latest follow-up (15 months) he was free from back pain. Conservative means of treatment can lead to satisfactory outcome, especially when the patient has delayed presentation.
重度腰椎滑脱非常罕见。我们遇到一例32岁男性体力劳动者，L5 - S1水平的重度腰椎滑脱，其在弯腰时背部被重物砸伤。患者前来就诊时背部存在持续性畸形。他主诉长时间站立及适度劳作后会出现背痛，因此无法重返工作岗位。临床检查发现下腰部有明显台阶样改变。对下肢进行详细的神经学评估未发现任何感觉或运动功能障碍，也未发现肠道或膀胱受累情况。影像学检查显示L5椎体相对于S1椎体发生创伤性椎体滑脱。CT扫描显示椎管宽度正常。MRI证实L5椎体相对于S1椎体发生椎体滑脱，椎管无受压，马尾神经形态正常。鉴于患者就诊延迟且无神经功能缺损，经充分告知后对其进行了保守治疗。6个月时，患者重返工作岗位，在最近一次随访（15个月）时，他已无背痛症状。保守治疗方法可取得满意疗效，尤其是在患者就诊延迟的情况下。
