Epstein N E
Cornell University Medical College, Ithaca, New York, USA.
J Spinal Disord. 1998 Apr;11(2):116-22; discussion 123. doi: 10.1097/00002517-199804000-00004.
The management of degenerative spondylolisthesis with laminectomy alone or laminectomy with fusion remains controversial. From the early 1970s to 1996, 290 patients with degenerative spondylolisthesis were treated with 249 laminectomies and 41 fenestration procedures over an average of 3.2 levels. One level olisthesis was encountered in 250 patients, and two levels of slip in 40. Patients averaged 67 years of age, and were followed an average of 10 years. Using Prolo's outcome scale, 69% of patients exhibited excellent, 13% good, 12% fair, and 6% poor outcomes. Secondary decompressions with fusions for increased olisthy/instability (five patients) and recurrent stenosis/disc disease/instability (three patients) required one posterolateral "in situ" fusion and seven Texas Scottish Rite Hospital instrumented procedures. Decompression alone successfully managed degenerative spondylolisthesis in 290 patients treated over 3 decades, because only 8 (2.7%) required secondary fusion.
单纯椎板切除术或椎板切除融合术治疗退变性腰椎滑脱仍存在争议。从20世纪70年代初到1996年，290例退变性腰椎滑脱患者接受了249次椎板切除术和41次开窗手术，平均手术节段为3.2个。250例患者为单节段滑脱，40例为双节段滑脱。患者平均年龄67岁，平均随访10年。根据普罗洛（Prolo）疗效评分标准，69%的患者疗效为优，13%为良，12%为可，6%为差。因滑脱/不稳定加重（5例）以及复发性狭窄/椎间盘疾病/不稳定（3例）而行二次减压融合术的患者中，1例采用后外侧“原位”融合术，7例采用德克萨斯州苏格兰礼仪医院的内固定手术。在30多年来接受治疗的290例患者中，单纯减压成功治疗了退变性腰椎滑脱，因为只有8例（2.7%）需要二次融合。
