Disc degeneration in patients with lumbar spondylolysis

The grade of intervertebral disc degeneration in 73 symptomatic patients with lumbar spondylolysis was evaluated with magnetic resonance imaging to assess the prevalence of disc degeneration. The results were compared with those of age- and sex-matched asymptomatic control populations and with patients with clinical back pain symptoms but without spondylolysis. The relationship between disc degeneration and age of patients, the duration and severity of clinical symptoms, and the grade of vertebral slip was evaluated. A five-point grading scale based on T2 signal intensity recommended by Gibson et al. was used to evaluate the degree of disc degeneration. The grade of disc degeneration below the spondylolytic defect in the patients was highly significantly related to the age of patients (p < 0.01) and was more severe than in the controls (p < 0.01), but there was no difference of disc degeneration above the defect between the patients and the controls (p > 0.05). Furthermore, the grade of disc degeneration below the spondylolytic defect in the patients was highly significantly correlated with the duration of clinical symptoms (p < 0.01), although it was not associated with the severity of clinical symptoms or the grade of vertebral slip (p > 0.05). The results suggest that the degree of disc degeneration at the spondylolytic level is a more important determinant for choice of the fusion procedure than the age of the patients or the grade of vertebral slip, and that preoperative magnetic resonance examination is of great importance to evaluation of disc degeneration.     

Direct repair of lumbar spondylolysis

Direct repair of the defect in spondylolysis has been performed on 12 patients with a mean age of 29 years. With an average follow-up period of 3 years, 8 patients had a good result, 2 patients improved only slightly and 2 patients remained unchanged.     

Direct repair of lumbar spondylolysis

Direct repair of the defect in spondylolysis has been performed on 12 patients with a mean age of 29 years. With an average follow-up period of 3 years, 8 patients had a good result, 2 patients improved only slightly and 2 patients remained unchanged.     

Repair of spondylolysis using compression with a modular link and screws

We describe the results of a prospective case series of patients with spondylolysis, evaluating a technique of direct stabilisation of the pars interarticularis with a construct that consists of a pair of pedicle screws connected by a U-shaped modular link passing beneath the spinous process. Tightening the link to the screws compresses bone graft in the defect in the pars, providing rigid intrasegmental fixation. We have carried out this procedure on 20 patients aged between nine and 21 years with a defect of the pars at L5, confirmed on CT. The mean age of the patients was 13.9 years (9 to 21). They had a grade I or less spondylolisthesis and no evidence of intervertebral degeneration on MRI. The mean follow-up was four years (2.3 to 7.3). The patients were assessed by the Oswestry Disability Index (ODI) and a visual analogue scale (VAS). At the latest follow-up, 18 patients had an excellent clinical outcome, with a significant (p < 0.001) improvement in their ODI and VAS scores. The mean ODI score at final follow-up was 8%. Assessment of the defect by CT showed a rate of union of 80%. There were no complications involving the internal fixation. The strength of the construct removes the need for post-operative immobilisation.     

Direct repair of lumbar spondylolysis

Direct repair of the defect in spondylolysis has been performed on 12 patients with a mean age of 29 years. With an average follow-up period of 3 years, 8 patients had a good result, 2 patients improved only slightly and 2 patients remained unchanged.     

腰椎峡部裂的治疗策略

腰椎峡部裂是引起儿童及青少年腰痛症状的常见原因。腰椎峡部裂的治疗包括保守治疗与手术治疗。保守治疗包括休息、限制活动、佩戴支具及理疗等。手术治疗分为两类,峡部修复+节段内固定术与腰椎融合术。本文就腰椎峡部裂常用的治疗方法作一综述。     

钩钉复位固定峡部植骨治疗青年峡部裂

[目的]探讨应用钩钉复位固定、峡部植骨治疗青年峡部裂的疗效。[方法]2003年1月～2004年5月行钩钉复位固定、峡部植骨融合治疗青年峡部裂14例28侧。就手术时间、术中出血量与同期脊柱融合术14例相比较，并进行统计学分析。通过术前、术后VAS评分和影像学资料，分析该术式的优点、手术适应证、临床疗效等。[结果]该术式手术时间短、术中出血少，与脊柱融合术有统计学差异；术前、术后VAS评分有统计学差异；术后随访8～25个月．平均17．4个月，所有患者骨性融合、下腰痛缓解。[结论]彻底的清创、恰当的植骨方式和钩钉系统坚强内固定是治疗青年峡部裂有效的方法，但也有其明确的手术适应证。     

腰椎双节段峡部裂伴滑脱的外科治疗

正腰椎双节段峡部裂伴滑脱指两个腰椎节段出现一侧或两侧椎弓上、下关节突之间的峡部骨质缺损,同时伴有椎体之间的相对滑移。腰椎双节段峡部裂伴滑脱在临床上较少见,Sakai等[1]报道在2000例行腹部和盆腔CT的患者中,多节段峡部裂仅占0.3%。Liu等[2]发现多节段腰椎峡部裂更易发生于男性,且多数腰椎峡部裂发生在L3～L5脊髓水平,常与体育、创伤或沉重的劳动有关;而Zhang等[3]报道两节段腰椎峡部裂并滑脱多发生在L3～L5水平,但更易发生于女性。目前关于腰椎双节段峡部裂伴滑脱报道较少,对不同节段峡部裂伴滑脱的治疗也尚无统一认识,本院自2014年1月～2017年12月共收治腰椎双节段峡部     

腰椎椎弓崩裂临床研究进展

腰椎椎弓崩裂是构成症状性腰背痛的主要原因之一.对经正规保守治疗无效的患者需手术治疗.传统的跨节段固定植骨融合可取到良好的治疗效果,但对青少年患者行直接修复峡部缺损是合乎逻辑的术式,可保留腰椎活动度,减小相邻节段退变的发生,但须严格控制手术适应证.该文就近年来腰椎椎弓崩裂的临床研究及进展作一综述.     

Unilateral spondylolysis combined with contralateral lumbar pediculolysis in a military parachutist

A few cases of unilateral pediculolysis combined with contralateral spondylolysis have been reported, and most of them were related to athletic activities. A case of unilateral spondylolysis combined with contralateral lumbar pediculolysis in a military parachutist is reported. A 34-year-old man experienced low back pain and right sciatica for 3 months. Radiographs revealed a left spondylolysis combined with a right pediculolysis of the L5 vertebra. The patient had parachuted >300 times in the last 5 years. Interbody fusion of L5-S1 was performed, and the patient was free of pain after surgery.     

峡部植骨治疗单纯腰椎椎弓峡部裂

目的 :介绍单纯腰椎椎弓峡部裂行峡部植骨治疗方法。方法 :通过对 12例共 2 4处病变的手术结果进行分析。结果 :随访 6个月～ 2年 2个月 ,平均 13个月。X线片提示所有病例均获得骨性融合 ,优 9例 ;良 3例。结论 :峡部植骨融合术符合生物力学原则 ,对腰椎的正常生理活动范围干扰小、操作简单、创伤也较小 ,是治疗单纯腰椎椎弓峡部裂的理想方法。但要求术中植骨确实可靠 ,术后正确指导康复。     

椎弓根钉-椎板钩系统固定治疗单纯腰椎峡部裂

目的：观察应用椎弓根钉-椎板钩系统固定治疗单纯腰椎峡部裂的临床疗效。方法：自2002年6月以来．使用椎弓根钉-椎板钩系统治疗单纯腰椎峡部裂15例，均为男性，年龄19～36岁，平均27岁。L46例，L59例，均为双侧病变。所有患者均主诉明确的腰痛，持续6个月以上。术前腰痛疼痛评分（VAS）7．8分，采用后正中入路，暴露烈侧病灶，将峡部裂中的纤维瘢痕组织彻底清除，咬除骨残端硬化部分至出血为止，髂后上棘取骨行峡部裂局部植骨。安放病椎竹弓根螺钉及椎板钩，放置连杆后将同定系统锁紧。结果：术后疼痛症状明显缓解，VAS评分2．4分。随访12～26个月，峡部裂植骨均骨性愈合，末见骨不连及内同定断裂。结论：对于年轻的、单纯峡部裂患者可以采用椎弓根钉-椎板钩系统进行峡部修复，避免脊柱融合术：椎弓根钉-椎板钩系统是一种安全、有效的内同定装置。     

Repair of lumbar spondylolysis using Morscher material: 14 children followed for 1-5 years

We evaluated the results of spondylolysis repair in children and adolescents with the Morscher system. 14 patients (8 girls) with symptomatic spondylolysis unresponsive to closed treatment were operated on. Mean age at operation was 12 (7-15) years. The average followup was 33 (16-66) months. Results were assessed clinically according to the Henderson classification and radiographically. Clinical results were excellent in 9 patients, good in 4 and poor in 1. Radiographs showed that fusion was obtained in 12 patients, it was doubtful in 1 and 1 patient had non-union. Loosening of the screw on one or both sides was noted in 8 patients and necessitated removal of the osteosynthesis material which, however, did not alter the final outcome. The satisfactory results obtained in our series are similar to those reported in the literature.     

Lytic spondylolysis. Repair by wiring

A technique for repairing the defect in spondylolysis by wiring is presented together with the results achieved in seven patients; the follow-up ranged from 2 to 12 years. The relative simplicity of the technique is stressed; and the technical problems likely to be encountered, together with the modifications of the basic technique necessary to cope with them, are noted. When conservative methods have been tried without success and the patient has a lesion at one or more levels and is less than 30 years old at presentation, then the technique described will give predictable results with regard to union of the defect and patient function.     

Repair of lumbar spondylolysis using Morscher material: 14 children followed for 1-5 years

We evaluated the results of spondylolysis repair in children and adolescents with the Morscher system. 14 patients (8 girls) with symptomatic spondylolysis unresponsive to closed treatment were operated on. Mean age at operation was 12 (7-15) years. The average follow-up was 33 (16-66) months. Results were assessed clinically according to the Henderson classification and radiographically. Clinical results were excellent in 9 patients, good in 4 and poor in 1. Radiographs showed that fusion was obtained in 12 patients, it was doubtful in 1 and 1 patient had non-union. Loosening of the screw on one or both sides was noted in 8 patients and necessitated removal of the osteosynthesis material which, however, did not alter the final outcome. The satisfactory results obtained in our series are similar to those reported in the literature.     

Repair of lumbar spondylolysis using Morscher material: 14 children followed for 1-5 years

We evaluated the results of spondylolysis repair in children and adolescents with the Morscher system. 14 patients (8 girls) with symptomatic spondylolysis unresponsive to closed treatment were operated on. Mean age at operation was 12 (7-15) years. The average followup was 33 (16-66) months. Results were assessed clinically according to the Henderson classification and radiographically. Clinical results were excellent in 9 patients, good in 4 and poor in 1. Radiographs showed that fusion was obtained in 12 patients, it was doubtful in 1 and 1 patient had non-union. Loosening of the screw on one or both sides was noted in 8 patients and necessitated removal of the osteosynthesis material which, however, did not alter the final outcome. The satisfactory results obtained in our series are similar to those reported in the literature.     

SOCON系统治疗腰椎峡部裂

目的探讨和评估SOCON系统在治疗腰椎峡部裂的价值和作用及手术适应证。方法对9例峡部裂病例行峡部修整、局部植骨、SOCON系统固定。结果9例随访6-26个月,平均8.5个月。所有患者腰腿痛等症状完全消失,4例Ⅰ度滑脱均获得了满意复位。腰椎X线片均提示峡部已骨性融合,未出现椎弓根螺钉、椎板钩松动、断裂。结论SOCON系统是一种具有一定复位功能的节段性内固定器,其操作简单、安全,并发症少;但应正确掌握好其手术适应证。     

峡部植骨治疗腰椎椎弓峡部裂和腰椎滑脱

介绍一种治疗腰椎椎弓峡部裂合并轻度腰椎滑脱的手术方法。手术通过在峡部及关节突关节处植骨使快部缺损得到直接修复并使腰椎获得稳定。共治疗46例98处病变，随访7个月～4年2个月，平均13个月。94处获得骨性融合，占95．9％。计优28例，良15例，可3例。作者认为峡部植骨修复融合术与其他融合术式相比，对腰椎的正常生理活动范围干扰及手术创伤均较小，操作技术亦相对简单，对于青少年及多节段推弓峡部裂患者尤为适合，但要求植骨确实可靠，以防骨不连发生。     

单纯性腰椎椎弓根狭部裂的手术治疗

目的对单纯性腰椎椎弓根狭部裂手术治疗适应证,手术方式的选择进行探讨。方法16例无椎体滑脱的单纯性椎弓根狭部裂行手术治疗。根据患者的年龄、椎间盘退变及椎体稳定性情况,分别行椎弓根峡部局部减压植骨＋椎弓根钉钩系统内固定,或后路减压椎弓根钉内固定＋后路（或前路）椎体间植骨治疗。并对术后临床症状的改善,椎体的稳定性进行观察。结果所有病例术后症状均有明显的改善。术后3个月评价12例为优,4例为良,有效率100％。腰腿痛JOA评分平均提高8分。随访6～14个月,脊柱稳定性良好。结论对有临床症状的单纯性椎弓根狭部裂行手术治疗有良好的临床效果,手术方式的选择应根据患者的情况综合考虑。