Liu Xinyu, Wang Lianlei, Yuan Suomao, Tian Yonghao, Zheng Yanping, Li Jianmin
Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
J Neurosurg Spine. 2015 Mar;22(3):283-7. doi: 10.3171/2014.10.SPINE14415. Epub 2014 Dec 19.
Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels.
During July 2007-March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair.
Both low-back pain scores improved significantly after surgery (p < 0.05). Postoperative radiographs or CT scans showed satisfactory interbody fusion or pars interarticularis healing. No breakage, dislodging, or loosening of the pedicle screw hardware was observed for any patient.
Multiple-level lumbar spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3-5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.
腰椎峡部裂和峡部裂性腰椎滑脱最常仅发生于一个脊柱节段。作者报告了13例多节段腰椎峡部裂伴腰椎滑脱的病例。
2007年7月至2012年3月期间，山东大学齐鲁医院诊断出13例（男10例，女3例）多节段峡部裂伴腰椎滑脱患者。患者平均年龄为43.5±14.6岁。腰痛持续时间为11.7±5.1个月。2例患者峡部裂发生于L-2，4例发生于L-3，所有患者均有L-4峡部裂，5例发生于L-5。3例患者峡部裂发生于3个脊柱节段，10例发生于2个节段。所有患者均有1或2个节段的腰椎滑脱。采用日本骨科学会评分和视觉模拟量表评分评估术前和术后神经功能及腰痛情况。所有患者均接受椎弓根螺钉固定及椎间融合或直接峡部修复术。
术后腰痛评分均显著改善（p<0.05）。术后X线片或CT扫描显示椎间融合或峡部愈合情况良好。未观察到任何患者的椎弓根螺钉器械出现断裂、移位或松动。
多节段腰椎峡部裂和腰椎滑脱在男性中更为常见。多数多节段腰椎峡部裂发生于2个脊柱节段，与运动、外伤或重体力劳动有关。多节段腰椎峡部裂大多发生于L3-5；相关的腰椎滑脱通常发生于L-4和L-5，以L-4居多。治疗原则与单节段腰椎滑脱相同。
