Department of Orthopaedic Surgery, Osaka Rosai Hospital; and.
J Neurosurg Spine. 2014 Aug;21(2):171-8. doi: 10.3171/2014.4.SPINE13925. Epub 2014 May 16.
The management of isthmic spondylolisthesis remains controversial, especially with respect to reduction. There have been no reports regarding appropriate slip reduction. The purpose of this study was to investigate the following issues: (1) surgical outcomes of posterior lumbar interbody fusion (PLIF) with total facetectomy for low-dysplastic isthmic spondylolisthesis, including postoperative complications; (2) effects of slip reduction on surgical outcomes; and (3) appropriate slip reduction.
A total of 106 patients who underwent PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis and who were followed for at least 2 years were reviewed. The average follow-up period was 8 years. Surgical outcomes, including the scores assessed using the Japanese Orthopaedic Association scoring system, the recovery rate, and postoperative complications were investigated. As for radiographic evaluations, pre- and postoperative slip and disc height, instrumentation failure, and fusion status were also examined.
The pre- and postoperative average Japanese Orthopaedic Association scores were 14 (range 3-25) and 25 (range 11-29) points, respectively. The average recovery rate was 73% (range 0%-100%). The average pre- and postoperative slip was 24% and 10%, respectively. A significant correlation between postoperative slip and clinical outcomes was found; clinical outcomes were better in proportion to slip reduction. Although no statistical difference was detected in clinical outcomes between postoperative slip of less than 10% and from 10% to 20%, patients with postoperative slip of more than 20% showed significantly worse clinical outcomes. Postoperative complications included neurological deficits in 7 patients (transient motor loss in 6 and permanent motor loss in 1), instrumentation failures in 7, adjacent-segment degeneration in 5, and nonunion in 4. Instrumentation failures occurred significantly more often in patients with more slip reduction, although slip reduction did not affect the other postoperative complications. All patients with instrumentation failure showed postoperative slip reduction within 10%.
The use of PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis appears to produce satisfactory clinical outcomes, with an average of 73% recovery rate and few postoperative complications. Although clinical outcomes were better in proportion to slip reduction, excessive reduction caused instrumentation failure, and patients with less reduction demonstrated worse clinical outcomes. Appropriate reduction resulted in a postoperative slip ranging from 10% to 20%.
峡部裂型脊柱滑脱的治疗仍存在争议，尤其是在复位方面。目前尚无关于适当滑脱复位的报道。本研究旨在探讨以下问题：（1）全关节突切除后路腰椎间融合术（PLIF）治疗低度发育不良型峡部裂型脊柱滑脱的手术效果，包括术后并发症；（2）滑脱复位对手术效果的影响；（3）适当的滑脱复位。
回顾性分析 106 例接受全关节突切除 PLIF 治疗且随访至少 2 年的低度发育不良型峡部裂型脊柱滑脱患者的临床资料。平均随访时间为 8 年。评估手术效果，包括日本矫形协会评分系统评分、恢复率和术后并发症。影像学评估包括术前和术后滑脱和椎间盘高度、内固定失败和融合状态。
术前和术后平均日本矫形协会评分分别为 14 分（3-25 分）和 25 分（11-29 分）。平均恢复率为 73%（0%-100%）。术前和术后平均滑脱分别为 24%和 10%。术后滑脱与临床结果存在显著相关性；滑脱减少越多，临床结果越好。虽然术后滑脱小于 10%和 10%-20%之间的临床结果无统计学差异，但术后滑脱大于 20%的患者临床结果明显较差。术后并发症包括 7 例神经功能缺损（6 例为短暂性运动丧失，1 例为永久性运动丧失）、7 例内固定失败、5 例邻近节段退变和 4 例不愈合。尽管滑脱减少不会影响其他术后并发症，但滑脱减少较多的患者更容易发生内固定失败。所有内固定失败的患者术后滑脱均减少了 10%以内。
全关节突切除 PLIF 治疗低度发育不良型峡部裂型脊柱滑脱的临床效果满意，平均恢复率为 73%，术后并发症少。虽然临床结果与滑脱减少呈正相关，但过度复位会导致内固定失败，而减少较少的患者则会出现较差的临床结果。适当的复位可使术后滑脱率维持在 10%-20%之间。
