Caelers Inge J M H, Rijkers Kim, van Hemert Wouter L W, de Bie Rob A, van Santbrink Henk
Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht.
Contact: I.J.M.H. Caelers (
Ned Tijdschr Geneeskd. 2019 Sep 24;163:D3769.
Lumbar spondylolisthesis is usually asymptomatic. However, symptomatic spondylolisthesis results in back and/or leg pain such as radicular syndrome or neurogenic claudication. Variation in symptoms is caused by different types of spondylolisthesis. Lytic spondylolisthesis, most common at L5S1, is caused by spondylolysis of the pars interarticularis. This results in foraminal nerve compression and radicular symptoms. Degenerative spondylolisthesis, most common at L4L5 in patients >50 years old, is caused by slippage of the vertebral body and lamina, resulting in lumbar spinal stenosis and neurogenic claudication. Iatrogenic spondylolisthesis develops in 1.6-32.0% of patients after decompression surgery, causing recurrent neurogenic symptoms. It is important to understand the main symptoms patients experience: back or leg pain. In both cases, the preferred treatment is conservative. Surgery is only an option if patients have persistent/progressive leg pain. Shared decision-making is necessary to select the most accurate surgery for each individual patient while also taking into account age, comorbidities and symptoms. Further research is necessary to determine the advantages of each surgery in order to improve advice to patients.
腰椎滑脱通常无症状。然而，有症状的腰椎滑脱会导致背部和/或腿部疼痛，如神经根综合征或神经源性间歇性跛行。症状的差异由不同类型的腰椎滑脱引起。峡部裂性腰椎滑脱最常见于L5S1，由关节突间部峡部裂引起。这会导致椎间孔神经受压和神经根症状。退变性腰椎滑脱最常见于50岁以上患者的L4L5，由椎体和椎板滑脱引起，导致腰椎管狭窄和神经源性间歇性跛行。医源性腰椎滑脱在减压手术后1.6%-32.0%的患者中发生，会引起复发性神经症状。了解患者经历的主要症状（背部或腿部疼痛）很重要。在这两种情况下，首选治疗方法是保守治疗。只有当患者有持续/进行性腿部疼痛时，手术才是一种选择。在为每个患者选择最准确的手术时，共同决策是必要的，同时还要考虑年龄、合并症和症状。有必要进行进一步研究以确定每种手术的优势，从而改善对患者的建议。
