Herron L D, Trippi A C
Central Coast Spine Institute, San Luis Obispo, California.
Spine (Phila Pa 1976). 1989 May;14(5):534-8.
The results of the treatment of L4-5 degenerative spondylolisthesis by decompressive laminectomy and partial facetectomy without fusion are presented. Patients who met the following criteria were studied: 1) A slip of at least 10%; 2) No compensation/litigation issues involved; 3) No prior surgery; and 4) Follow-up of at least 18 months. Twenty-four patients with an average follow-up of 34 months (range, 18 to 71 months) are reported. The average preoperative slip measured 7 mm (17%; range, 4-12 mm). Sixteen patients, including all patients less than 60 years of age, underwent preoperative supine lateral flexion-extension radiographs for evaluation of instability. No patient had greater than 2 mm of increase in slip on flexion-extension testing. During decompression, the structural integrity of the pars interarticularis and facet joints are preserved. There were 20 good, three fair, and one poor results. The average postoperative slip measured 8 mm (20%; range, 4-11 mm), and no patient had an increase in slip of greater than 4 mm. In the absence of objective instability on preoperative flexion-extension lateral radiographs in L4-5 degenerative spondylolisthesis, decompressive laminectomy with preservation of the structural integrity of the pars interarticularis and articular processes does not require routine spinal fusion and produced satisfactory clinical results.
本文介绍了采用减压性椎板切除术和部分关节突切除术且不进行融合治疗L4-5退行性腰椎滑脱的结果。对符合以下标准的患者进行了研究：1）滑脱至少10%；2）不涉及赔偿/诉讼问题；3）未进行过先前手术；4）随访至少18个月。报告了24例患者，平均随访34个月（范围18至71个月）。术前平均滑脱量为7mm（17%；范围4至12mm）。16例患者，包括所有年龄小于60岁的患者，术前行仰卧位侧位屈伸位X线片以评估不稳定性。在屈伸试验中，没有患者的滑脱增加超过2mm。减压过程中，关节突间部和关节突关节的结构完整性得以保留。结果为优20例，良3例，差1例。术后平均滑脱量为8mm（20%；范围4至11mm），没有患者的滑脱增加超过4mm。对于L4-5退行性腰椎滑脱患者，若术前屈伸位侧位X线片未显示客观不稳定性，保留关节突间部和关节突结构完整性的减压性椎板切除术无需常规脊柱融合，且临床效果满意。
