Samuel Andre M, Moore Harold G, Cunningham Matthew E
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA.
Curr Rev Musculoskelet Med. 2017 Dec;10(4):521-529. doi: 10.1007/s12178-017-9442-3.
Current guidelines for the optimal treatment degenerative spondylolisthesis are weak and based on limited high-quality evidence.
There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.
目前关于退行性腰椎滑脱症最佳治疗的指南依据薄弱，且基于有限的高质量证据。
有一些中等强度的证据表明，对于轻度滑脱的特定人群，单纯减压可能是一种可行的治疗方法，手术并发症较低，且疗效与融合术相似。同样，椎间融合术可能最适合一部分重度退行性腰椎滑脱症患者，尽管这仍存在争议。微创技术越来越多地用于减压和融合手术，越来越多的研究表明患者的疗效相似且术后并发症更低。这可能会是一个持续深入研究的领域。最后，随着对最佳矢状面平衡和脊柱骨盆参数的进一步研究，腰椎滑脱复位的作用可能会得到确定。未来确定矢状垂直轴和滑脱角的理想阈值以防止病情进展和再次手术，将在手术治疗规划中发挥重要作用。目前的证据支持对退行性腰椎滑脱症进行手术治疗。虽然后路脊柱融合术仍是首选治疗方法，但在某些人群中，使用椎间融合和非融合减压可能有效。然而，还需要更多高质量的证据，尤其是在微创技术和矢状面平衡矫正等新的实践领域。
