Departments of1Neurosurgery and.
2Department of Neurosurgery, Leiden University Medical Center, Leiden; and.
Neurosurg Focus. 2018 Jan;44(1):E7. doi: 10.3171/2017.10.FOCUS17571.
OBJECTIVE The health care costs for instrumented spine surgery have increased dramatically in the last few decades. The authors present a novel noninstrumented surgical approach for patients with isthmic spondylolisthesis, with clinical and radiographic results. METHODS Charts of patients who underwent this technique were reviewed. The procedure consisted of nerve root decompression by reconstruction of the intervertebral foramen. This was achieved by removal of the pedicle followed by noninstrumented posterolateral fusion in which autologous bone graft from the right iliac crest was used. Outcomes regarding radicular complaints, bony fusion, progression of the slip, and complications were evaluated using patient history and radiographs obtained at follow-up intervals of 3-18 months after surgery. RESULTS A total of 58 patients with a mean age of 47 years were treated with this method. Partial removal of the pedicle was performed in 93.1% of the cases, whereas in 6.9% of the cases the entire pedicle was removed. The mean duration of surgery was 216.5 ± 54.5 minutes (range 91-340 minutes). The mean (± SD) duration of hospitalization was 10.1 ± 2.9 days (range 5-18 days). After 3 months of follow-up, 86% of the patients reported no leg pain, and this dropped to 81% at last follow-up. Radiographic follow-up showed bony fusion in 87.7% of the patients. At 1 year, 5 patients showed progression of the slip, which in 1 patient prompted a second operation within 1 year. No major complications occurred. CONCLUSIONS Treatment of isthmic spondylolisthesis by reconstruction of the intervertebral neuroforamen and posterolateral fusion in situ is a safe procedure and has comparable results with the existing techniques. Cost-effectiveness research comparing this technique to conventional instrumented fusion techniques is necessary to evaluate the merits for both patients and society.
在过去几十年中，器械性脊柱手术的医疗费用大幅增加。作者介绍了一种新的非器械手术方法，用于治疗峡部裂性脊椎滑脱症，并报告了其临床和影像学结果。
回顾接受该技术治疗的患者病历。该手术包括通过重建椎间孔来进行神经根减压。具体方法是切除椎弓根，然后进行非器械性的后路融合，使用右侧髂嵴的自体骨移植物。通过术后 3-18 个月的随访时获得的患者病史和影像学检查来评估神经根症状、骨融合、滑脱进展和并发症等方面的结果。
共 58 例平均年龄 47 岁的患者接受了该方法治疗。93.1%的病例部分切除了椎弓根，6.9%的病例完全切除了椎弓根。手术平均时间为 216.5±54.5 分钟（范围 91-340 分钟）。平均（±SD）住院时间为 10.1±2.9 天（范围 5-18 天）。随访 3 个月时，86%的患者报告无腿部疼痛，而最后一次随访时这一比例降至 81%。影像学随访显示 87.7%的患者有骨融合。1 年内，5 例患者出现滑脱进展，其中 1 例在 1 年内进行了第二次手术。未发生重大并发症。
通过重建椎间孔和原位后路融合治疗峡部裂性脊椎滑脱症是一种安全的手术方法，其结果与现有技术相当。需要进行成本效益研究，将该技术与传统器械融合技术进行比较，以评估其对患者和社会的益处。
