Suk S I, Lee C K, Kim W J, Lee J H, Cho K J, Kim H G
Department of Orthopedic Surgery, Seoul National University Hospital, Korea.
Spine (Phila Pa 1976). 1997 Jan 15;22(2):210-9; discussion 219-20. doi: 10.1097/00007632-199701150-00016.
This is a retrospective study analyzing 76 patients treated by decompression, pedicle screw instrumentation, and fusion for spondylolytic spondyiolisthesis with symptomatic spinal stenosis.
To verify the advantages of adding posterior lumbar interbody fusion to the usual posterolateral fusion with pedicle screw instrumentation.
Stabilization after decompression of spondylolytic spondylolisthesis is difficult because of a lack of fusional bone bases, gap between the transverse process bases, and incompetent anterior disc support. Posterior lumbar interbody fusion offers anterior support, reduction, and a broad fusion base.
Forty patients were treated with posterolateral fusion, and 36 were treated with additional posterior lumbar interbody fusion. They were compared for union, reduction of the deformity, and clinical results.
The patients were followed up for more than 2 years. Nonunion was observed in three patients who underwent posterolateral fusion (7.5%), and no cases of nonunion was found in patients who underwent posterior lumbar interbody fusion. Reduction of slippage was 28.3% in those who underwent posterolateral fusion and 41.6% in those who had posterior lumbar interbody fusion (P = 0.05). In the posterolateral fusion group, eight patients (20%) had recurrence of deformity, with loss of reduction more than 50%. Hardware failures occurred in two patients who had posterolateral fusion. There was no major neurologic complications in both groups. Both groups had satisfactory results in more than 90% of patients, with marked improvement of claudication. However, subjective improvement of back pain by Kirkaldy-Willis criteria revealed differences in the excellent results. An excellent result was reported by 45% in the posterolateral fusion group and by 75% in posterior lumbar interbody fusion group.
The addition of posterior lumbar interbody fusion to posterolateral fusion after a complete decompression and pedicle screw fixation is a recommended procedure for the treatment of spondylolytic spondylolishesis with spinal stenosis.
这是一项回顾性研究，分析了76例因峡部裂性脊椎滑脱伴症状性椎管狭窄而接受减压、椎弓根螺钉内固定及融合治疗的患者。
验证在常规椎弓根螺钉内固定后外侧融合基础上加用腰椎后路椎间融合术的优势。
由于缺乏融合骨基础、横突基底之间存在间隙以及前方椎间盘支撑不足，峡部裂性脊椎滑脱减压后的稳定较为困难。腰椎后路椎间融合术可提供前方支撑、复位及广泛的融合基础。
40例患者接受后外侧融合术，36例患者接受额外的腰椎后路椎间融合术。比较两组的融合情况、畸形矫正及临床结果。
患者随访超过2年。接受后外侧融合术的3例患者（7.5%）出现不融合，而接受腰椎后路椎间融合术的患者未发现不融合病例。接受后外侧融合术患者的滑脱复位率为28.3%，接受腰椎后路椎间融合术患者的为41.6%（P = 0.05）。在后外侧融合组，8例患者（20%）出现畸形复发，复位丢失超过50%。接受后外侧融合术的2例患者出现内固定失败。两组均未发生严重神经并发症。两组超过90%的患者结果满意，跛行明显改善。然而，根据Kirkaldy-Willis标准，背痛的主观改善显示出优良结果存在差异。后外侧融合组45%的患者报告结果优良，腰椎后路椎间融合组为75%。
在完全减压和椎弓根螺钉固定后，在腰椎后外侧融合基础上加用腰椎后路椎间融合术是治疗峡部裂性脊椎滑脱伴椎管狭窄的推荐术式。
