Carragee E J
Stanford University Medical Center, California, USA.
J Bone Joint Surg Am. 1997 Aug;79(8):1175-80. doi: 10.2106/00004623-199708000-00009.
Forty-two neurologically intact adults in whom non-operative treatment of grade-I or grade-II isthmic spondylolisthesis of the most caudad lumbar segment had failed were entered into a prospective study of the results of operative treatment. Twenty patients who smoked were managed with a posterolateral arthrodesis with instrumentation (transpedicular fixation), and twenty-two patients who did not smoke were managed with a posterolateral arthrodesis without instrumentation. Of the patients who were managed with instrumentation, eight were randomized to treatment with a decompressive laminectomy and twelve, to treatment without it; in the group that was managed without instrumentation, the distribution was ten and twelve patients, respectively. The patients were followed clinically for a mean of 4.5 years (range, 3.5 to six years). Of the eighteen patients who had been managed with decompression, four had a pseudarthrosis and six had an unsatisfactory result compared with none and one of the twenty-four who had been managed without decompression (p = 0.02 and p = 0.01, respectively). In the group of twenty patients (smokers) who had been managed with instrumentation, none of the twelve managed without decompression had a pseudarthrosis compared with one of the eight managed with decompression (p = 0.2). In the group of twenty-two patients (non-smokers) who had been managed without instrumentation, none of the twelve managed without decompression had a pseudarthrosis compared with three of the ten managed with decompression (p = 0.04). In the group managed with instrumentation, two of the eight who had had decompression had an unsatisfactory result compared with none of the twelve who had not had decompression. In the group managed without instrumentation, four of the ten who had had decompression had an unsatisfactory result compared with one of the twelve who had not had decompression. The addition of decompression to arthrodesis, performed with or without instrumentation, for the treatment of low-grade isthmic spondylolisthesis in patients who do not have a serious neurological deficit does not appear to improve the result and may significantly increase the rates of pseudarthrosis and unsatisfactory results.
42例神经功能完好的成年人参与了一项关于I级或II级峡部裂性腰椎滑脱症最尾端腰椎节段非手术治疗失败后手术治疗结果的前瞻性研究。20例吸烟患者采用后路关节融合术并植入器械（经椎弓根固定），22例不吸烟患者采用后路关节融合术但不植入器械。在采用植入器械治疗的患者中，8例随机接受减压性椎板切除术治疗，12例不接受该治疗；在未采用植入器械治疗的组中，分别为10例和12例患者。对患者进行了平均4.5年（范围3.5至6年）的临床随访。在接受减压治疗的18例患者中，4例出现假关节形成，6例结果不理想；相比之下，在未接受减压治疗的24例患者中，分别为0例和1例（p分别为0.02和0.01）。在采用植入器械治疗的20例（吸烟）患者组中，12例未接受减压治疗的患者均未出现假关节形成，而接受减压治疗的8例中有1例出现（p = 0.2）。在未采用植入器械治疗的22例（不吸烟）患者组中，12例未接受减压治疗的患者均未出现假关节形成，而接受减压治疗的10例中有3例出现（p = 0.04）。在采用植入器械治疗的组中，接受减压治疗的8例中有2例结果不理想，而未接受减压治疗的12例中无一例结果不理想。在未采用植入器械治疗的组中，接受减压治疗的10例中有4例结果不理想，而未接受减压治疗的12例中有1例结果不理想。对于没有严重神经功能缺损的患者，在关节融合术（无论是否植入器械）中加用减压治疗I级峡部裂性腰椎滑脱症，似乎并不能改善治疗结果，反而可能显著增加假关节形成率和不理想结果的发生率。
