Boyd Evan D, Mundluru Surya N, Feldman David S
Bull Hosp Jt Dis (2013). 2019 Sep;77(3):172-182.
Bracing (thoraco-lumbar-sacral orthosis) has been accepted as mainstay of treatment for symptomatic spondylolysis (SP) and grade I spondylolisthesis (SPL1). However, increasing costs and patient noncompliance can make bracing prohibitive and difficult to manage. The purpose of this study was to determine if SP and SPL1 can be effectively treated using physical therapy and other non-bracing conservative management techniques in order to relieve pain and restore physical function.
We performed a cross-sectional study in which patients who presented from June 1, 2004, to May 1, 2015, with symptomatic SP and SPL1 who were treated with nonbracing conservative management, entailing a universal 6-week physical therapy program and restriction of offending activity, were considered for the study. Physical therapy included core strengthening activities, hamstrings stretching, and spine range of motion exercises. Patients meeting inclusion criteria were contacted via phone interview and asked to complete an Oswestry Disability Questionnaire (ODQ) in order to generate a disability score to assess their current pain and daily function. Patients were then stratified into groups based on their level of disability as denoted by their disability score; minimal disability = disability score of 0% to 19.9%, moderate disability = 20% to 39.9%, severe disability = 40% to 59.9%, crippled = 60% to 79.9%, and bed bound or exaggerating = 80% to 100%.
Fourty-six patients were identified as meeting inclusion criteria (28 with SP and 18 with SPL1). Twenty-three of 46 were successfully contacted and agreed to complete the ODQ (10/23 with SP and 13/23 with SPL1). Twenty-two of 23 (96%) patients had a minimal disability score (0% to 19.9%), One of 23 (4%) patients had a moderate disability score (20% to 39.9%), and 18/23 (78%) patients had a disability score of zero, denoting no pain or limitation of function.
The results of this study suggest that, in patients with symptomatic spondylolysis and grade I spondylolisthesis, pain relief and restoration of function can be achieved using conservative management techniques without use of a brace.
支具（胸腰骶矫形器）已被公认为有症状的椎弓根峡部裂（SP）和I度椎体滑脱（SPL1）的主要治疗方法。然而，成本的增加和患者的不依从性可能使支具治疗变得昂贵且难以管理。本研究的目的是确定是否可以使用物理治疗和其他非支具保守管理技术有效治疗SP和SPL1，以缓解疼痛并恢复身体功能。
我们进行了一项横断面研究，纳入了2004年6月1日至2015年5月1日期间因有症状的SP和SPL1而接受非支具保守治疗的患者，该治疗包括为期6周的通用物理治疗计划和限制诱发活动。物理治疗包括核心强化活动、腘绳肌拉伸和脊柱活动度练习。通过电话访谈联系符合纳入标准的患者，并要求他们完成奥斯威斯利残疾问卷（ODQ），以生成残疾评分来评估他们当前的疼痛和日常功能。然后根据患者的残疾评分所表示的残疾程度将患者分层；轻度残疾=残疾评分为0%至19.9%，中度残疾=20%至39.9%，重度残疾=40%至59.9%，残疾严重=60%至79.9%，卧床或夸大残疾=80%至100%。
46例患者被确定符合纳入标准（28例为SP，18例为SPL1）。46例中有23例成功联系并同意完成ODQ（28例SP患者中的10例和18例SPL1患者中的13例）。23例患者中有22例（96%）的残疾评分为轻度（0%至19.9%），23例中有1例（4%）的残疾评分为中度（20%至39.9%），23例中有18例（78%）的残疾评分为零，表明无疼痛或功能受限。
本研究结果表明，对于有症状的椎弓根峡部裂和I度椎体滑脱患者，不使用支具采用保守管理技术也可实现疼痛缓解和功能恢复。
