Song Deyong, Chen Zhong, Song Dewei, Li Zaixue
Department of Spine Surgery, Foshan Hospital of Traditional Chinese Medicine, China.
Department of Spine Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China.
Clin Neurol Neurosurg. 2015 Nov;138:111-6. doi: 10.1016/j.clineuro.2015.08.012. Epub 2015 Aug 20.
Spondylolytic defects involving multiple vertebral levels are rare. It is reported that only 1.48% of patients with back pain were diagnosed with multi-level spondylolysis. The incidence of multiple-level spondylolisthesis is even rarer, so far there have been few reports of multi-level isthmic spondylolisthesis in the literature. The aim of this study is to evaluate clinical and radiological outcomes of two different fusion techniques for treatment of double-level isthmic spondylolisthesis.
Fifty-four patients who were managed surgically for treatment of double-level symptomatic isthmic spondylolisthesis were included in this study. Between May 2004 and September 2012, 29 consecutive patients underwent posterior lumbar interbody fusion (PLIF) with autogenous bone chips (group I) at Foshan Hospital of Traditional Chinese Medicine, Guangdong, China. Between March 2005 and December 2013, 25 consecutive patients underwent PLIF with cage (group II) at Zhujiang Hospital of Southern Medical University, Guangdong, China. The mean follow-up periods were 27.2 and 26.8 months, respectively.
The mean VAS scores of back and leg pain significantly decreased from 7.2 to 2.2 and 5.8 to 2.1 in the group I and from 7.0 to 1.9 and 6.1 to 1.8 in the group II, respectively. In the group I, mean ODI scores improved significantly from 54% to 14.2% and, in the group II, from 60% to 12.6%. In both groups, VAS and ODI scores significantly changed from pre- to postoperatively (p<0.001), but postoperative outcome between groups was statistically not significant. Solid union was observed in 27 of 29 patients (89.6%) in the group I and in 22 of 25 patients (88%) in the group II, without statistically significant differences (p>0.05). In both groups, changes in disc height, degree of listhesis, and whole lumbar lordosis between the pre- and postoperative periods were significant.
Clinical and functional outcomes demonstrate no significant differences between groups in treating back and leg pain of adult patients with double-level isthmic spondylolisthesis.
累及多个椎体节段的椎弓根峡部裂缺损较为罕见。据报道，仅有1.48%的背痛患者被诊断为多节段椎弓根峡部裂。多节段椎体滑脱的发生率甚至更低，迄今为止，文献中关于多节段峡部裂性椎体滑脱的报道很少。本研究的目的是评估两种不同融合技术治疗双节段峡部裂性椎体滑脱的临床和影像学结果。
本研究纳入了54例接受手术治疗双节段症状性峡部裂性椎体滑脱的患者。2004年5月至2012年9月，中国广东佛山市中医院29例连续患者接受了自体骨粒后路腰椎椎间融合术（PLIF）（I组）。2005年3月至2013年12月，中国广东南方医科大学珠江医院25例连续患者接受了椎间融合器PLIF（II组）。平均随访时间分别为27.2个月和26.8个月。
I组患者的背部和腿部疼痛VAS平均评分分别从7.2显著降至2.2和从5.8降至2.1，II组分别从7.0降至1.9和从6.1降至1.8。I组ODI平均评分从54%显著改善至14.2%，II组从60%改善至12.6%。两组患者术前和术后VAS和ODI评分均有显著变化（p<0.001），但两组间术后结果无统计学差异。I组29例患者中有27例（89.6%）观察到牢固融合，II组25例患者中有22例（88%），无统计学差异（p>0.05）。两组术前和术后椎间盘高度、滑脱程度和整个腰椎前凸的变化均显著。
在治疗成年双节段峡部裂性椎体滑脱患者的背部和腿部疼痛方面，两组的临床和功能结果无显著差异。
