Cheung Jason Pui Yin, Cheung Prudence Wing Hang, Cheung Kenneth Man Chee, Luk Keith Dip Kei
Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.
Asian Spine J. 2016 Feb;10(1):75-84. doi: 10.4184/asj.2016.10.1.75. Epub 2016 Feb 16.
Retrospective series.
Assess results of decompression-only surgery for low-grade degenerative spondylolisthesis with consideration of instability.
There is no consensus on whether fusion or decompression-only surgery leads to better outcomes for patients with low-grade degenerative spondylolisthesis. Current trends support fusion but many studies are flawed due to over-generalization without consideration of radiological instability and their variable presentations and natural history.
Patients with surgically treated degenerative spondylolisthesis from 1990-2013 were included. Clinical and radiological instability measures were included. Any residual or recurrence of symptoms, revision surgery performed and functional outcome scores including the numerical global rate of change scale, visual analogue scale, and modified Barthel index were measured. Follow-up periods for patients were divided into short-term (<5 years), mid-term (5-10 years) and long-term (>10 years).
A total of 64 patients were recruited. Mechanical low back pain was noted in 48 patients and most (85.4%) had relief of back pain postoperatively. Radiological instability was noted in 4 subjects by flexion-extension radiographs and 12 subjects with prone traction radiographs by increased disc height and reduction of olisthesis and slip angle. From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period. All functional scores improved from preoperative to postoperative 1-year follow-up.
Decompression-only for low-grade degenerative spondylolisthesis has good long-term results despite instability. Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option.
回顾性系列研究。
评估单纯减压手术治疗低度退行性椎体滑脱并考虑不稳定性的结果。
对于低度退行性椎体滑脱患者，融合手术或单纯减压手术哪种能带来更好的治疗效果尚无共识。当前趋势支持融合手术，但许多研究存在缺陷，因为过度概括而未考虑放射学不稳定及其不同表现和自然病程。
纳入1990年至2013年接受手术治疗的退行性椎体滑脱患者。纳入临床和放射学不稳定指标。测量任何症状残留或复发情况、进行的翻修手术以及功能结局评分，包括数字整体变化率量表、视觉模拟量表和改良巴氏指数。患者的随访期分为短期（<5年）、中期（5 - 10年）和长期（>10年）。
共招募64例患者。48例患者存在机械性下腰痛，大多数（85.4%）术后腰痛缓解。通过屈伸位X线片发现4例患者存在放射学不稳定，通过俯卧位牵引X线片发现12例患者存在放射学不稳定，表现为椎间盘高度增加、椎体滑脱和滑移角减小。从短期、中期和长期随访结果来看，再次手术仅发生在最初的5年随访期内。所有功能评分从术前到术后1年随访均有所改善。
对于低度退行性椎体滑脱，尽管存在不稳定性，单纯减压手术仍有良好的长期效果。对于存在放射学不稳定的该患者群体，应开展进一步的高级别研究以推荐更优的手术方案。
