Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Orthop Surg. 2024 Oct;16(10):2569-2573. doi: 10.1111/os.14175. Epub 2024 Aug 7.
Lumbar spondylolysis is a common cause of low back pain in adolescents. A lot of adolescent idiopathic scoliosis with concomitant spondylolysis has been reported before, but only two cases with acquired spondylolysis following long fusion for scoliosis were reported. We described another similar rare case and discussed its causes and treatment options in this paper.
A 17-year-old female underwent growing rod implantation, growing rod extension, and final long spinal fusion for idiopathic scoliosis. Then, she suffered from low back pain with a VAS of 1-2 points and gradually aggravated to a VAS of 7-8 points at 3.5 years after the final fusion. The X-ray images showed that there was L4-S1 instability. And the CT scan images showed new bilateral spondylolysis of L5.
These findings suggested that distal mechanical stress might cause spondylolysis of the distal vertebra following long fusion for scoliosis. Surgeons should keep instrumentation as short as possible and avoid choosing a low lumbar as LIV when they decide on the fusion levels.
腰椎峡部裂是青少年腰痛的常见原因。以前有很多青少年特发性脊柱侧凸合并峡部裂的报道，但仅有两例脊柱侧凸后路长节段融合后获得性峡部裂的报道。我们描述了另一个类似的罕见病例，并在本文中讨论了其病因和治疗选择。
一名 17 岁女性因特发性脊柱侧凸行生长棒植入、生长棒延长和最终长节段脊柱融合术。最终融合后 3.5 年，她开始出现腰痛，VAS 评分为 1-2 分，逐渐加重至 7-8 分。X 线片显示 L4-S1 不稳定。CT 扫描图像显示 L5 双侧新的峡部裂。
这些发现提示脊柱侧凸后路长节段融合后远端机械应力可能导致远端椎骨峡部裂。当决定融合节段时，外科医生应尽量缩短内固定，并避免选择低位腰椎作为 LIV。
