Mehlman Charles T, Crawford Alvin H
Division of Pediatric Orthopaedic Surgery, The Crawford Spine Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
University of Cincinnati College of Medicine, UC Health/University Hospital, Cincinnati, OH, USA.
J Child Orthop. 2023 Jul 5;17(4):367-375. doi: 10.1177/18632521231182427. eCollection 2023 Aug.
The study aim was to present four new well-documented cases of spontaneous improvement of olisthetic scoliosis and to analyze well-documented cases from the literature.
Surgical log search and systematic review were conducted. Inclusion criteria were (1) age less than 18 years, (2) symptomatic high-grade (≥50%) spondylolisthesis, (3) scoliosis ≥20, (4) primary surgical treatment via lumbosacral fusion, (5) complete x-rays, and (6) minimum 1-year radiographic follow-up or until curve resolution.
A total of 13 patients with average age of 13.9 years were included in the study, 4 from the authors' surgical logs and 9 from the literature. Slip percentage of L5-S1 ranged from 51% to 95%. Olisthetic curve magnitude averaged 34.6° (range: 20°-45°) with majority (8/13) demonstrating long thoracic curves with lateral trunk shift. All but one of these were apex right with rightward trunk shift. The remainder of the curves were isolated lumbar curves, with an apex left morphology without trunk shift. Eleven of the 13 patients showed curve improvement following isolated lumbosacral fusion. Three patients experienced a decrease in curve magnitude of 12°-28° and eight patients enjoyed complete resolution (≤10°) of their scoliosis.
The current study summarizes 13 well-documented cases of olisthetic scoliosis (4 new cases and 9 from the literature) that associated with symptomatic high-grade spondylolisthesis. All were treated via a primary posterior lumbosacral fusion strategy. Eleven of the 13 curves showed spontaneous improvement (8 complete resolution of scoliosis) following their lumbosacral surgery.
Therapeutic level IV.
本研究旨在介绍4例记录完整的脊柱滑脱性脊柱侧弯自然改善病例，并分析文献中记录完整的病例。
进行手术记录检索和系统评价。纳入标准为：（1）年龄小于18岁；（2）有症状的重度（≥50%）椎体滑脱；（3）脊柱侧弯≥20°；（4）通过腰骶融合进行初次手术治疗；（5）有完整的X线片；（6）至少1年的影像学随访或直至侧弯消失。
本研究共纳入13例患者，平均年龄13.9岁，其中4例来自作者的手术记录，9例来自文献。L5-S1节段的滑脱百分比为51%至95%。脊柱滑脱性侧弯平均角度为34.6°（范围：20°-45°），大多数（8/13）表现为长胸弯并伴有躯干侧移。除1例患者外，其余患者均为右凸并伴有躯干右移。其余侧弯为孤立的腰弯，形态为左凸且无躯干侧移。13例患者中有11例在单纯腰骶融合术后侧弯得到改善。3例患者侧弯角度减小了12°-28°，8例患者的脊柱侧弯完全消失（≤10°）。
本研究总结了13例记录完整的与有症状的重度椎体滑脱相关的脊柱滑脱性脊柱侧弯病例（4例新病例和9例来自文献）。所有病例均采用初次后路腰骶融合策略进行治疗。13例侧弯中有11例在腰骶手术后出现自然改善（8例脊柱侧弯完全消失）。
治疗性IV级。
