Tian Wei, Han Xiao-Guang, Liu Bo, Liu Ya-Jun, He Da, Yuan Qiang, Xu Yun-Feng
Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Chin Med J (Engl). 2015 Apr 5;128(7):865-70. doi: 10.4103/0366-6999.154278.
The treatment of high-grade developmental spondylolisthesis (HGDS) is still challenging and controversial. In this study, we investigated the efficacy of the posterior reduction and monosegmental fusion assisted by intraoperative three-dimensional (3D) navigation system in managing the HGDS.
Thirteen consecutive HGDS patients were treated with posterior decompression, reduction and monosegmental fusion of L5/S1, assisted by intraoperative 3D navigation system. The clinical and radiographic outcomes were evaluated, with a minimum follow-up of 2 years. The differences between the pre- and post-operative measures were statistically analyzed using a two-tailed, paired t-test.
At most recent follow-up, 12 patients were pain-free. Only 1 patient had moderate pain. There were no permanent neurological complications or pseudarthrosis. The magnetic resonance imaging showed that there was no obvious disc degeneration in the adjacent segment. All radiographic parameters were improved. Mean slippage improved from 63.2% before surgery to 12.2% after surgery and 11.0% at latest follow-up. Lumbar lordosis changed from preoperative 34.9 ± 13.3° to postoperative 50.4 ± 9.9°, and 49.3 ± 7.8° at last follow-up. L5 incidence improved from 71.0 ± 11.3° to 54.0 ± 11.9° and did not change significantly at the last follow-up 53.1 ± 15.4°. While pelvic incidence remained unchanged, sacral slip significantly decreased from preoperative 32.7 ± 12.5° to postoperative 42.6 ± 9.8°and remained constant to the last follow-up 44.4 ± 6.9°. Pelvic tilt significantly decreased from 38.4 ± 12.5° to 30.9 ± 8.1° and remained unchanged at the last follow-up 28.1 ± 11.2°.
Posterior reduction and monosegmental fusion of L5/S1 assisted by intraoperative 3D navigation are an effective technique for managing high-grade dysplastic spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal balance can be achieved.
重度发育性腰椎滑脱（HGDS）的治疗仍然具有挑战性且存在争议。在本研究中，我们调查了术中三维（3D）导航系统辅助下的后路复位及单节段融合治疗HGDS的疗效。
连续13例HGDS患者接受了L5/S1节段的后路减压、复位及单节段融合治疗，术中采用3D导航系统辅助。评估临床和影像学结果，随访至少2年。术前和术后测量值的差异采用双尾配对t检验进行统计学分析。
在最近一次随访时，12例患者无疼痛。仅1例患者有中度疼痛。无永久性神经并发症或假关节形成。磁共振成像显示相邻节段无明显椎间盘退变。所有影像学参数均得到改善。平均滑脱率从术前的63.2%改善至术后的12.2%，在最近一次随访时为11.0%。腰椎前凸从术前的34.9±13.3°变为术后的50.4±9.9°，在最后一次随访时为49.3±7.8°。L5倾斜角从71.0±11.3°改善至54.0±11.9°，在最后一次随访时（53.1±15.4°）无显著变化。虽然骨盆倾斜角保持不变，但骶骨滑移明显从术前的32.7±12.5°降至术后的42.6±9.8°，并在最后一次随访时保持稳定（44.4±6.9°）。骨盆倾斜度从38.4±12.5°显著降至30.9±8.1°，在最后一次随访时保持不变（28.1±11.2°）。
术中3D导航辅助下的L5/S1后路复位及单节段融合是治疗重度发育异常性腰椎滑脱的有效技术。可实现局部畸形的完全复位及整体矢状面平衡的良好矫正。
