Moo Ing How, Tan See Wei, Kasat Niraj, Thng Leong Keng
Department of Orthopaedics Surgery, Changi General Hospital, Singapore.
University Malaya Medical Centre, Malaysia.
Int J Surg Case Rep. 2015;8C:120-3. doi: 10.1016/j.ijscr.2014.10.018. Epub 2014 Dec 11.
Lumbar degenerative spondylolisthesis is a major cause of impaired quality of life and diminished functional capacity in the elderly. Degenerative spondylolisthesis often involves only one or two level and tend to present with one or two level spinal canal stenosis.
The authors describe an unusual case of degenerative spondylolisthesis involving 3 levels of the lumbar spine from L2 to L5. The patient was a 58-year-old woman who suffered chronic back pain and neurogenic claudication. Plain radiography revealed grade I degenerative spondylolisthesis at L2-L3, L3-L4 and L4-L5. Elevated pedicle-facet joint angles and W-type facet joints at the lumbar spine was observed. Magnetic resonance imaging showed L2-S1 spinal cord compression at the lumbar spine. Patient underwent L2-S1 decompression laminectomy and posterior lateral fusion of L2-S1 with posterior instrumentation and bone grafting. Symptoms improved significantly at 4 months follow-up.
Thorough evaluation for multilevel segmental involvement in degenerative spondylolisthesis is important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment. Good surgical outcome can be expected from decompression and stabilisation. The pathogenesis of multi-level lumbar degenerative spondylolisthesis can be complex and heterogeneous.
腰椎退行性滑脱是导致老年人生活质量下降和功能能力减退的主要原因。退行性滑脱通常仅累及一个或两个节段，并往往伴有一个或两个节段的椎管狭窄。
作者描述了一例不寻常的腰椎退行性滑脱病例，累及从L2至L5的3个腰椎节段。患者为一名58岁女性，患有慢性背痛和神经源性间歇性跛行。X线平片显示L2-L3、L3-L4和L4-L5节段存在I度退行性滑脱。观察到腰椎椎弓根-小关节角增大及W型小关节。磁共振成像显示腰椎L2-S1脊髓受压。患者接受了L2-S1减压椎板切除术以及L2-S1后路外侧融合术，并进行了后路内固定和植骨。随访4个月时症状明显改善。
由于严重症状性椎管狭窄或椎间孔侵犯的发生率较高，对退行性滑脱的多节段受累进行全面评估很重要。减压和稳定手术有望取得良好的手术效果。多节段腰椎退行性滑脱的发病机制可能复杂且多样。
