Ver Mikhail Lew P, Dimar John R, Carreon Leah Y
Norton Leatherman Spine Center, Louisville, KY, USA.
Global Spine J. 2019 Oct;9(7):767-782. doi: 10.1177/2192568218801882. Epub 2018 Sep 27.
Systematic review and case series.
Any acute injury to the posterior elements of the lumbar spine resulting in listhesis is considered a traumatic spondylolisthesis. This rare injury caused by high-energy trauma is variably described in the literature as fracture-dislocation, where only case reports and series have been published. Our objectives were to propose evidence-based treatment recommendations and a new classification system for this injury.
A systematic review of literature from PubMed, EMBASE, and Cochrane without time frame limitations was performed, which included 77 level IV and V articles and 9 patients as case series in the analysis.
A total of 125 cases were reviewed with mean age of 30.5 years. Half of the cases resulted from a vehicular accident. Back pain presented in 82%, while 50% had neurologic deficits. Operative treatment was performed in 93.6% (posterior decompression [PD] = 4%; posterior spinal fusion [PSF] = 43.2%; interbody fusion [IB] = 46.4%) with overall fusion rates of 74%. Binomial regression analysis for achieving solid fusion showed a 28.6× higher odds for IB compared to PSF ( = .008, = 0.633). Subanalysis of cases with disc injuries revealed higher fusion outcomes for IB (87%) compared to PSF (46%; = .006), while there were no significant differences for patients without disc injury. Pain and neurological symptoms improved significantly on final follow-up ( < .001). Overall complication rate was 22%.
Operative management with reduction, decompression for neurologic deficits, instrumentation, and fusion is recommended for traumatic spondylolisthesis. Interbody fusion is recommended to achieve better fusion outcomes especially with preoperatively identified disc lesions.
系统评价与病例系列研究。
腰椎后部结构的任何急性损伤导致椎体滑脱均被视为创伤性椎体滑脱。这种由高能创伤引起的罕见损伤在文献中被不同地描述为骨折脱位，目前仅有病例报告和病例系列发表。我们的目的是为此类损伤提出基于证据的治疗建议和一种新的分类系统。
对来自PubMed、EMBASE和Cochrane的文献进行无时间框架限制的系统评价，分析中纳入了77篇IV级和V级文章及9例患者作为病例系列。
共回顾了125例病例，平均年龄30.5岁。半数病例由车祸导致。82%的患者出现背痛，50%有神经功能缺损。93.6%的患者接受了手术治疗（后路减压[PD]=4%；后路脊柱融合[PSF]=43.2%；椎间融合[IB]=46.4%），总体融合率为74%。实现牢固融合的二项式回归分析显示，与PSF相比，IB实现融合的几率高28.6倍（P=.008，OR=0.633）。对椎间盘损伤病例的亚分析显示，与PSF（46%）相比，IB的融合效果更好（87%；P=.006），而对于无椎间盘损伤的患者，两者无显著差异。末次随访时疼痛和神经症状显著改善（P<.001）。总体并发症发生率为22%。
对于创伤性椎体滑脱，建议采用复位、神经减压、内固定和融合的手术治疗方法。建议采用椎间融合以获得更好的融合效果，尤其是对于术前已确定存在椎间盘病变的情况。
