Geiger F, Wirries A
Wirbelsäulenzentrum, Orthopädische Fachkliniken, Hessing Kliniken Augsburg, Hessingstraße 17, 86199, Augsburg, Deutschland.
Orthopade. 2019 Jun;48(6):494-502. doi: 10.1007/s00132-019-03742-5.
Spondylolisthesis (Greek for sliding vertebra) in children is usually the result of a defect (=lysis) or an elongation of the interarticular portion. The cause can be a congenital dysplasia of the dorsal stabilizing structures or pressure of the facet on the interarticular portion. This is a consequence of lumbar lordosis which is necessary for an upright posture.
The treatment depends on the symptoms and the risk of progression. This is related to the sliding distance, the degree of secondary dysplasia of the vertebral bodies and the sagittal profile, which is considered in the Mac-Thiong classification. For low-grade olistheses, conservative therapy is an option; for a symptomatic lysis without disc degeneration, pars repair should be considered. In higher-grade olistheses, repositioning and spondylodesis are usually recommended. Repositioning improves the fusion rate and sagittal profile, but increases the risk of nerve root damage, so complete repositioning should not be forced.
儿童脊柱滑脱（希腊语意为椎体滑移）通常是关节间部分缺陷（即峡部裂）或延长的结果。其原因可能是背部稳定结构的先天性发育异常或关节突对关节间部分的压迫。这是维持直立姿势所必需的腰椎前凸的结果。
治疗取决于症状和病情进展风险。这与滑移距离、椎体继发性发育异常程度和矢状面形态有关，Mac-Thiong分类中会考虑这些因素。对于低度滑脱，保守治疗是一种选择；对于无症状的峡部裂且无椎间盘退变，应考虑峡部修复。对于高度滑脱，通常建议进行复位和脊柱融合术。复位可提高融合率和改善矢状面形态，但会增加神经根损伤的风险，因此不应强行进行完全复位。
