Singh Manjot, Balmaceno-Criss Mariah, Alsoof Daniel, Burch M Benjamin, Sakr Itala, Diebo Bassel G, McDonald Christopher, Basques Bryce, Kuris Eren O, Daniels Alan H
Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States.
Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States.
N Am Spine Soc J. 2023 Aug 9;16:100263. doi: 10.1016/j.xnsj.2023.100263. eCollection 2023 Dec.
High-grade isthmic spondylolisthesis poses a clinical challenge in the pediatric and adolescent population. Current surgical management using posterior-based approaches may lead to incomplete reduction and restoration of listhesis, disc height, and lordosis. Combined anterior and posterior approach addresses these issues but has been infrequently reported, mainly in the treatment of low-grade isthmic spondylolisthesis. Neither offers good disc space visualization and control of spinal alignment during reduction.
A healthy 17-year-old female presented with 9 months of progressively worsening lower back pain radiating down the left lower extremity and 3 inches of height loss. Diagnosis of grade IV L5-S1 spondylolisthesis was made using plain radiographs, CT, and MRI. Management with combined anterior and posterior fusion, involving the manual manipulation of segments using an anterior pedicle screw joystick, was pursued.
Satisfactory alignment, solid arthrodesis, no complications, and improved patient reported outcomes.
Combined anterior and posterior fusion with anterior joystick manipulation allowed for full reduction of grade IV spondylolisthesis and restoration of disc/foraminal height and L5-S1 segmental lordosis without neurological complication. Although less commonly performed in children and adolescents, this surgical approach can assist in restoring optimal alignment in isthmic spondylolisthesis.
重度峡部裂型腰椎滑脱在儿童和青少年人群中是一项临床挑战。目前采用后路手术的治疗方式可能导致滑脱、椎间盘高度和脊柱前凸无法完全复位和恢复。前后联合入路可解决这些问题，但相关报道较少，主要用于治疗轻度峡部裂型腰椎滑脱。在复位过程中，这两种方法都无法很好地观察椎间盘间隙和控制脊柱对线。
一名17岁健康女性，下背部疼痛逐渐加重9个月，疼痛向左下肢放射，身高降低3英寸。通过X线平片、CT和MRI诊断为L5-S1 IV度腰椎滑脱。采用前后联合融合术治疗，术中使用前路椎弓根螺钉操纵杆手动调整节段。
对线满意，植骨融合牢固，无并发症，患者报告的结果有所改善。
前后联合融合术及前路操纵杆操作可使IV度腰椎滑脱完全复位，恢复椎间盘/椎间孔高度及L5-S1节段前凸，且无神经并发症。尽管这种手术方式在儿童和青少年中较少应用，但可有助于恢复峡部裂型腰椎滑脱的最佳对线。
