Seitsalo S, Schlenzka D, Poussa M, Osterman K
Orton Orthopedic Hospital, Invalid Foundation, Helsinki, Finland.
Eur Spine J. 1997;6(6):393-7. doi: 10.1007/BF01834066.
The purpose of this long-term follow-up was (1) to investigate disc changes in the olisthetic segment in patients treated conservatively, (2) to compare disc changes above the slipped vertebra in conservatively treated patients with those in operatively treated patients, and (3) to establish possible relations of disc changes to the degree of the slip and to subjective back pain symptoms of the patients. The subjects were 227 patients with isthmic L5 olisthesis diagnosed under 20 years of age (mean 13.8 years) with a mean follow-up of 15.4 (range 5-30) years. Of these, 145 patients had been treated with segmental fusion and 82 had been treated conservatively. At follow-up, standing anteroposterior and lateral radiographs as well as flexion/extension views of the lumbar spine were taken. Disc degeneration was graded semiquantitatively: 0 = normal disc height, 1 = decrease of disc height < 50%, 2 = decrease > or = 50%, and 3 = obliteration of the disc. In the conservatively treated patients degeneration of the olisthetic disc was distributed by grade as follows: O: n = 38, 1: n = 24, 2: n = 14, 3: n = 6. No motion at all was observed in the olisthetic segment in 40 patients (48%) with a mean slip of 30%, segmental motion of 4 degrees-18 degrees was found in 42 patients with a mean slip of 14%. There was a statistically significant association of the degree of slip to the severity of disc degeneration and non-mobility of the segment. Grade 1 degeneration of the L4/5 disc occurred in 25.6% of the conservatively treated patients and in 32% of 48 patients treated with L5-S1 fusion. This correlated with the severity of the slip, but not with pain symptoms or pathologic segmental mobility at the time of follow-up. Out of 84 patients with L4-S1 fusion, in 17% grade 1 degeneration of the L3/4 disc was observed, and 3 out of 13 patients (23%) with L3-S1 fusion had grade 1 degeneration of the disc above the fusion. The disc changes had no correlation with subjective pain symptoms. It is concluded that the natural course of isthmic spondylolisthesis is associated with disc degeneration and spontaneous stabilization of the olisthetic segment. Fusion operations do not significantly increase the rate of disc degeneration in the adjacent disc above the fusion after a mean postoperative follow-up of 13.8 years. No correlation between the number of degenerated discs or the degree of degeneration and subjective low back pain symptoms was found.
（1）调查保守治疗患者滑脱节段椎间盘的变化；（2）比较保守治疗患者滑脱椎体上方椎间盘的变化与手术治疗患者的情况；（3）确定椎间盘变化与滑脱程度以及患者主观背痛症状之间可能存在的关系。研究对象为227例20岁以下诊断为峡部裂性L5椎体滑脱的患者（平均年龄13.8岁），平均随访时间为15.4年（范围5 - 30年）。其中，145例患者接受了节段融合治疗，82例接受了保守治疗。随访时，拍摄了腰椎的站立位前后位和侧位X线片以及屈伸位片。椎间盘退变采用半定量分级：0级 = 椎间盘高度正常；1级 = 椎间盘高度降低<50%；2级 = 椎间盘高度降低≥50%；3级 = 椎间盘消失。在保守治疗的患者中，滑脱椎间盘的退变分级分布如下：0级：n = 38；1级：n = 24；2级：n = 14；3级：n = 6。40例（48%）平均滑脱30%的患者，其滑脱节段未观察到任何活动；42例平均滑脱14%的患者，节段活动度为4° - 18°。滑脱程度与椎间盘退变的严重程度及节段不活动之间存在统计学显著关联。L4/5椎间盘1级退变在保守治疗患者中占25.6%，在48例接受L5 - S1融合治疗的患者中占32%。这与滑脱的严重程度相关，但与随访时的疼痛症状或病理性节段活动度无关。在84例接受L4 - S1融合治疗的患者中，观察到17%的患者L3/4椎间盘有1级退变；在13例接受L3 - S1融合治疗的患者中，有3例（23%）融合上方椎间盘有1级退变。椎间盘变化与主观疼痛症状无相关性。研究得出结论，峡部裂性椎体滑脱的自然病程与椎间盘退变及滑脱节段的自发稳定有关。平均术后随访13.8年后，融合手术并未显著增加融合上方相邻椎间盘的退变率。未发现退变椎间盘数量或退变程度与主观下腰痛症状之间存在相关性。
