Department of Orthopaedics, Division of Spine, University of British Columbia, Vancouver, British Columbia;
Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario; and.
J Neurosurg Spine. 2015 Aug;23(2):178-89. doi: 10.3171/2014.11.SPINE1426. Epub 2015 May 15.
OBJECT A range of surgical options exists for the treatment of degenerative lumbar spondylolisthesis (DLS). The chosen technique inherently depends on the stability of the DLS. Despite a substantial body of literature dedicated to the outcome analysis of numerous DLS procedures, no consensus has been reached on defining or classifying the disorder with respect to stability or the role that instability should play in a treatment algorithm. The purpose of this study was to define grades of stability and to develop a guide for deciding on the optimal approach in surgically managing patients with DLS. METHODS The authors conducted a qualitative systematic review of clinical or biomechanical analyses evaluating the stability of and surgical outcomes for DLS for the period from 1990 to 2013. Research focused on nondegenerative forms of spondylolisthesis or spinal stenosis without associated DLS was excluded. The primary extracted results were clinical and radiographic parameters indicative of DLS instability. RESULTS The following preoperative parameters are predictors of stability in DLS: restabilization signs (disc height loss, osteophyte formation, vertebral endplate sclerosis, and ligament ossification), no disc angle change or less than 3 mm of translation on dynamic radiographs, and the absence of low-back pain. The validity and magnitude of each parameter's contribution can only be determined through appropriately powered prospective evaluation in the future. Identifying these parameters has allowed for the creation of a preliminary DLS instability classification (DSIC) scheme based on the preoperative assessment of DLS stability. CONCLUSIONS Spinal stability is an important factor to consider in the evaluation and treatment of patients with DLS. Qualitative assessment of the best available evidence revealed clinical and radiographic parameters for the creation of the DSIC, a decision aid to help surgeons develop a method of preoperative evaluation to better stratify DLS treatment options.
对象
存在多种手术方法可用于治疗退行性腰椎滑脱症（DLS）。所选择的技术本质上取决于 DLS 的稳定性。尽管有大量文献致力于分析多种 DLS 手术的结果，但对于稳定性的定义或分类，以及不稳定性在治疗算法中的作用，尚未达成共识。本研究的目的是定义稳定性等级，并制定指导方针，以决定对 DLS 患者进行手术治疗的最佳方法。
方法
作者对 1990 年至 2013 年间评估 DLS 稳定性和手术结果的临床或生物力学分析进行了定性系统回顾。排除了非退行性形式的脊椎滑脱症或没有相关 DLS 的脊椎狭窄症的研究。主要提取的结果是表明 DLS 不稳定性的临床和影像学参数。
结果
以下术前参数是 DLS 稳定性的预测指标：复位迹象（椎间盘高度丧失、骨赘形成、椎体终板硬化和韧带骨化）、动态 X 光片上无椎间盘角度变化或小于 3 毫米的移位，以及没有下腰痛。每个参数的有效性和重要性只能通过未来的适当功率前瞻性评估来确定。确定这些参数允许根据 DLS 稳定性的术前评估创建初步的 DLS 不稳定性分类（DSIC）方案。
结论
脊柱稳定性是评估和治疗 DLS 患者的一个重要因素。对最佳现有证据的定性评估显示了创建 DSIC 的临床和影像学参数，这是一种决策辅助工具，可帮助外科医生制定术前评估方法，以更好地分层 DLS 治疗方案。
