Johnson L P, Nasca R J, Dunham W K
Division of Orthopaedic Surgery, University of Alabama, Birmingham.
Spine (Phila Pa 1976). 1988 Jan;13(1):93-7. doi: 10.1097/00007632-198801000-00022.
In order to determine the factors that produce a successful outcome in the surgical management of spondylolisthesis, 44 consecutive patients who underwent surgical treatment were reviewed. Preoperative evaluation was directed towards determining the presence or absence of nerve root compression. The patients without nerve root compression typically underwent fusion alone, while those with evidence of nerve root compression had decompression and fusion. After an average 36-month follow-up, results were good in 78%, fair in 18%, and poor in 4%. There were five complications, all of which were successfully managed. Two patients required reoperation for pseudoarthrosis. An eventual 100% fusion rate was achieved. Results in the patients with Grade III or Grade IV olisthesis were nearly equivalent to the less severe cases. Nine patients received allograft, with a fusion rate equal to the 32 receiving autogenous bone. This study suggests that in patients who have isthmic spondylolisthesis with mechanical lumbar symptoms only, or in patients with low-back pain with radicular extremity pain caused by nerve root irritation, fusion alone is indicated. In patients with documented radiculopathy resulting from nerve root compression, decompression in addition to fusion is indicated.
为了确定腰椎滑脱症手术治疗取得成功结果的因素，我们回顾了44例连续接受手术治疗的患者。术前评估旨在确定是否存在神经根受压情况。无神经根受压的患者通常仅接受融合手术，而有神经根受压证据的患者则接受减压和融合手术。经过平均36个月的随访，结果良好的占78%，一般的占18%，差的占4%。有5例并发症，均得到成功处理。2例患者因假关节形成需要再次手术。最终实现了100%的融合率。III级或IV级滑脱患者的结果与病情较轻的病例几乎相当。9例患者接受了同种异体骨移植，其融合率与32例接受自体骨移植的患者相同。本研究表明，对于仅有峡部裂性腰椎滑脱且伴有机械性腰部症状的患者，或因神经根刺激导致腰背痛并伴有神经根性肢体疼痛的患者，仅行融合手术即可。对于有记录显示因神经根受压导致神经根病的患者，则除融合外还需进行减压手术。
