Srivastava Abhishek, Bayley Edward, Boszczyk Bronek M
Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Eur Spine J. 2016 Oct;25(10):3027-3031. doi: 10.1007/s00586-014-3519-0. Epub 2014 Sep 9.
It is relatively common for a scoliosis deformity to be associated with a lumbar spondylolisthesis in adolescents (up to 48 % of spondylolistheses). In the literature two types of curve have been described: 'sciatic' or 'olisthetic'. However, there is no consensus in the literature on how best to treat these deformities. Some authors advocate a single surgical intervention, where both deformities are corrected; whereas, others advocate treating them as separate entities. In this situation, it has been shown that the scoliosis will correct with treatment of the spondylolisthesis.
We present a 12-year-old girl who had a concomitant high-grade spondylolisthesis and scoliosis. Her main complaints were those of low back pain and an L5 radiculopathy. We took the decision to treat the spondylolisthesis surgically, but observe the scoliosis, rather than correcting them both surgically at the same sitting.
Although the immediately post-operative radiographs showed persistence of the scoliosis, 1-year follow-up demonstrated full resolution of the deformity. This young lady also had relief of her low back pain and leg pain following the surgery.
There are no standard guidelines and therefore, we discuss the management of this difficult problem, exemplifying a case of a young girl who had high-grade spondylolisthesis along with a clinically non-flexible scoliosis treated at our institution. We demonstrate that it is safe to observe the scoliosis, even in high-grade spondylolistheses.
青少年脊柱侧弯畸形合并腰椎滑脱相对常见(高达48%的腰椎滑脱病例)。文献中描述了两种类型的曲线:“坐骨型”或“滑脱型”。然而,对于如何最佳治疗这些畸形,文献中尚无共识。一些作者主张进行单一手术干预,同时矫正两种畸形;而另一些人则主张将它们视为独立的病症进行治疗。在这种情况下,已表明脊柱侧弯会随着腰椎滑脱的治疗而得到矫正。
我们介绍一名12岁的女孩,她同时患有高度腰椎滑脱和脊柱侧弯。她的主要症状是腰痛和L5神经根病。我们决定对腰椎滑脱进行手术治疗,但对脊柱侧弯进行观察,而不是在同一次手术中同时矫正两者。
尽管术后即刻的X线片显示脊柱侧弯持续存在,但1年的随访显示畸形完全消失。这位年轻女士在手术后腰痛和腿痛也得到了缓解。
目前尚无标准指南,因此,我们讨论了这个难题的处理方法,以我们机构治疗的一名患有高度腰椎滑脱以及临床僵硬性脊柱侧弯的年轻女孩为例。我们证明,即使在高度腰椎滑脱病例中,观察脊柱侧弯也是安全的。