Spinal Column Biomechanics and Surgical Outcomes Laboratory, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Spinal Column Biomechanics and Surgical Outcomes Laboratory, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2018 May;113:e383-e390. doi: 10.1016/j.wneu.2018.02.039. Epub 2018 Feb 15.
To present diagnosis and surgical management of postlaminectomy spondylolisthesis in patients without preoperative instability and a review of relevant literature.
Medical records and radiographic studies of 105 patients who underwent first-time bilateral 1- to 4-level open laminectomies for degenerative lumbar disease at a single academic institution were reviewed. Patients who initially presented with listhesis and had additional discectomy or fusion procedures were excluded.
Of 105 patients with laminectomies across 1-4 levels, 10 patients (9.5%; 5 men and 5 women with average age of 63.0 ± 11.2 years) developed subsequent iatrogenic spondylolisthesis at the same operative levels that required reoperation. New or worsening low back pain and lower extremity pain were reported over an average period of 19.0 ± 17.5 months postoperatively. Imaging studies showed new spondylolisthesis that was not present before the index surgery, most commonly at L4-L5 level. All patients were treated surgically with posterior instrumented fusion. The average period between the first and second surgery was 32.6 ± 19.9 months. Surgical reduction of spondylolisthesis resulted in significant clinical improvement of patients' symptoms.
In patients without overt pre-existing instability, laminectomy for lumbar stenosis can disrupt spinal stability and result in iatrogenic spondylolisthesis. The extent of decompression of the facet joints, number of levels decompressed, and preoperative disc space height can help assess the risk of postoperative spondylolisthesis. Patients who develop recurrent radiculopathy after decompressive lumbar laminectomy should be evaluated for potential iatrogenic spondylolisthesis.
介绍无术前不稳的椎板切除术后脊柱滑脱的诊断和手术治疗，并复习相关文献。
回顾单所学术机构的 105 例患者的病历和影像学研究，这些患者首次在同一部位接受双侧 1-4 级开放式椎板切除术治疗退行性腰椎疾病。排除最初表现为滑脱且有额外椎间盘切除术或融合术的患者。
在 105 例接受 1-4 个节段椎板切除术的患者中，有 10 例（9.5%；5 名男性和 5 名女性，平均年龄 63.0±11.2 岁）在同一手术节段发生了需要再次手术的医源性脊柱滑脱。术后平均 19.0±17.5 个月时报告出现新的或加重的下腰痛和下肢痛。影像学研究显示新的脊柱滑脱，且在指数手术前不存在，最常见于 L4-L5 节段。所有患者均接受后路器械融合的手术治疗。首次手术和第二次手术之间的平均间隔为 32.6±19.9 个月。脊柱滑脱的手术复位使患者的症状得到了显著的临床改善。
在无明显术前不稳的患者中，腰椎管狭窄症的椎板切除术可能破坏脊柱稳定性，导致医源性脊柱滑脱。关节突关节减压的程度、减压的节段数和术前椎间盘间隙高度有助于评估术后脊柱滑脱的风险。接受减压性腰椎椎板切除术的患者如果出现复发性神经根病，应评估是否存在医源性脊柱滑脱。
