Wiltse L L, Guyer R D, Spencer C W, Glenn W V, Porter I S
Spine (Phila Pa 1976). 1984 Jan-Feb;9(1):31-41. doi: 10.1097/00007632-198401000-00008.
This syndrome occurs in two types of patients: (1) the elderly person with degenerative scoliosis and (2) a somewhat younger adult population with isthmic spondylolisthesis and at least 20% slip. On plain radiograph, the Ferguson view (25 degrees caudocephalic) is best for visualizing the condition, however, CT is by far the best diagnostic tool. To show this far laterally, the "window" on the CT scanner must be opened wider than usual. Both coronal and parasagittal views will demonstrate the condition, but the coronal is the most valuable. Symptoms are classical spinal nerve compression. Usually it is the L5/S1 level that is involved, but other levels can be. At surgery, it is most important that nerve decompression be carried far enough laterally. This can mean sacrificing the lower half of the pedicle and the entire transverse process. Part of the body of S1 and of the sacral ala can be removed if the surgeon prefers. Because so much bone is removed, instability is a factor to be seriously considered. How to decompress adequately and still maintain stability often poses a most difficult problem.
（1）患有退行性脊柱侧凸的老年人；（2）患有峡部裂性腰椎滑脱且滑脱至少20%的较为年轻的成年人。在X线平片上，Ferguson位（尾头向25度）最有利于观察病情，然而，CT是目前最好的诊断工具。为了更清楚地显示外侧情况，CT扫描仪上的“窗口”必须比平时打开得更宽。冠状位和矢状旁位视图都能显示病情，但冠状位最有价值。症状为典型的脊神经受压。通常受累的是L5/S1节段，但其他节段也可能受累。在手术中，最重要的是神经减压要向外侧进行得足够远。这可能意味着要牺牲椎弓根的下半部分和整个横突。如果外科医生愿意，也可以切除S1椎体的一部分和骶骨翼。由于切除了大量骨质，稳定性是一个需要认真考虑的因素。如何充分减压同时又能保持稳定性常常是一个极其困难的问题。
