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1.
Treatment of high-grade isthmic and dysplastic spondylolisthesis in children and adolescents remains a challenge. Surgical treatment of spondylolisthesis has been recommended in adolescents with pain refractory to nonoperative modalities, slippage progression, or > 50% slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. In this report, we describe 5 cases of high-grade isthmic and dysplastic spondylolisthesis in adolescents and review the literature on surgical treatment for this entity. Operative records, charts, x-rays, and Scoliosis Research Society outcome questionnaires (SRS-22) were retrospectively evaluated for 5 consecutive patients diagnosed with and treated for high-grade spondylolisthesis. Each patient received treatment consisting of decompression, reduction, and circumferential fusion with transpedicular and segmental fixation from a posterior approach. Two patients had transient L5 nerve root deficit, which resolved within 3 months. Reduction benefits include a decrease in shear stresses (and resulting decreased rates of postoperative pseudarthrosis and slip progression), restoration of sagittal alignment and lumbosacral spine balance, and improvement in clinical deformity.  相似文献   

2.
High-grade dysplastic spondylolisthesis is extremely rare and always involves the L5-S1 level. It is attributed to congenital dysplasia of the superior articular process of the sacrum. It can remain asymptomatic for a long time and can progress to a more severe grade of olisthesis and spondyloptosis. Surgical treatment has varied from posterior-only in situ fusion to anterior and posterior fusion with complete reduction. Three cases of symptomatic high-grade (4th and 5th grade) dysplastic spondylolisthesis treated surgically with reduction and fusion are presented. Interbody fusion at the level of olisthesis is crucial.  相似文献   

3.
Surgical management is indicated for children and adolescents with spondylolysis and low-grade spondylolisthesis (< or =50% slip) who fail to respond to nonsurgical measures. In situ posterolateral L5 to S1 fusion is the best option for those with a low-grade slip secondary to L5 pars defects or dysplastic spondylolisthesis at the lumbosacral junction. Pars repair is reserved for patients with symptomatic spondylolysis and low-grade, mobile spondylolisthesis with pars defects cephalad to L5 and for those with multiple-level defects. Screw repair of the pars defect, wiring transverse process to spinous process, and pedicle screw-laminar hook fixation are surgical options. The ideal surgical management of high-grade spondylolisthesis (>50% slip) is controversial. Spinal fusion has been indicated for children and adolescents with high-grade spondylolisthesis regardless of symptoms. In situ L4 to S1 fusion with cast immobilization is safe and effective for alleviating back pain and neurologic symptoms. Instrumented reduction and fusion techniques permit improved correction of sagittal spinal imbalance and more rapid rehabilitation but are associated with a higher risk of iatrogenic nerve root injuries than in situ techniques. Wide decompression of nerve roots combined with instrumented partial reduction may diminish the risk of neurologic complications. Pseudarthrosis and neurologic injury presenting as L5 radiculopathy and sacral root dysfunction are the most common complications associated with surgical management of high-grade spondylolisthesis.  相似文献   

4.
目的探讨腰5椎体Ⅱ度以上峡部裂性滑脱的手术治疗策略。方法 2003年8月~2008年10月,应用经椎间孔腰椎间融合(transforaminal lumbar interbody fusion,TLIF)技术,以小关节突为中心椎管减压、椎间隙松解撑开复位、椎弓根钉棒系统补充复位固定、椎间隙打压植骨联合椎间融合器技术治疗腰5椎体Ⅱ度以上峡部裂性滑脱26例。结果经18~36个月(平均30个月)随访,滑脱椎体复位无丢失,椎间隙高度维持良好,下腰椎生理弧度恢复正常,椎弓根螺钉无断裂、松动,融合器无移位、沉降。25例获骨性融合。根据NaKai评分标准,优良率为84.6%。结论采用TLIF技术治疗腰5椎体Ⅱ度以上滑脱,神经根管减压是影响疗效的关键因素,滑脱椎体复位有利于神经根减压以及椎间融合率的提高,椎体间融合是维持长期疗效的基础。  相似文献   

5.
The literature is confusing as to the need for anterior column fusion in the surgical treatment of patients with high-grade dysplastic spondylolisthesis. The current authors present an analysis of consecutive pediatric patients treated surgically for high-grade spondylolisthesis with and without anterior column structural support with emphasis on fusion rates, segmental kyphosis correction, and functional outcomes. Thirty-seven surgical procedures were done in 31 patients for Meyerding Grade 3 or Grade 4 isthmic dysplastic spondylolisthesis. Patients were separated into two groups based on whether they had structural anterior column support (tricortical autogenous iliac crest) in addition to posterior fusion surgery. Group 1 consisted of 18 patients treated only with posterior surgery without anterior structural support (11 patients were treated with L4-sacrum posterior in situ fusion and seven patients were treated with posterior instrumented reduction with decompression and posterior fusion), and Group 2 consisted of 19 patients who had a reduction and circumferential fusion including anterior structural support. All patients had new radiographs taken at the time of followup (average, 3.1 years, range, 2 years-10 years 1 month) and completed a functional outcome questionnaire. The incidence of pseudarthrosis was 39% (seven of 18 patients) in Group 1 and 0% (0 of 19) in Group 2. All seven patients who had pseudarthrosis achieved solid fusion with a second procedure involving circumferential fusion with anterior column structural grafting. Outcomes regarding pain after treatment, function, and satisfaction were high in those patients who achieved solid fusion regardless of surgical procedure.  相似文献   

6.
A radiographic suvey has been carried out of 147 first-degree relatives of forty-seven patients treated in Edinburgh for spondylolisthesis of the fifth lumbar vertebra; twelve patients had the dysplastic (congenital) type and thirty-five an isthmic defect. The survey identified 19 per cent of relatives with spondylolysis, and index patients with each type of spondylolisthesis had relatives with the opposite type. Index patients with the dysplastic form had a higher proportion of affected relatives (33 per cent) than had those with the isthmic type (15 per cent), but both figures were significantly in excess of the estimated frequency for the general population of under 1 per cent and 5 per cent respectively. Spina bifida occulta at the fifth lumbar or first sacral level or both, and lumbosacral segmental defects were commoner amongst all individuals with spondylolysis than amongst unaffected relatives (dysplastic form 94 per cent, isthmic type 32 per cent, unaffected relatives 7 per cent). However, there was no single instance of a neural tube defect (anencephaly, spina bifida with or without meningocele, other generalised vertebral anomalies or spinal dysraphism) amongst 826 first-, second- or third-degree relatives. It is concluded that the developmental defects of the vertebrae associated with spondylolysis are not aetiologically related to the neural tube defects. The one in three risk of spondylolysis to near relatives of patients with the dysplastic form of spondylolisthesis is emphasised in order that the deformity in their sibs and children can be recognised at any early age.  相似文献   

7.
STUDY DESIGN: An analysis of consecutive pediatric patients treated surgically for high-grade spondylolisthesis by one of three surgical procedures with emphasis on complications and functional outcomes. OBJECTIVE: Complications, radiographic results and patient-assessed function, pain, and satisfaction were assessed among three surgical procedures. SUMMARY OF BACKGROUND DATA: The existing literature is in disagreement about whether it is better to fuse without instrumented reduction or to use instrumentation and reduce high-grade dysplastic spondylolisthesis. METHODS: Thirty-two patients had 37 surgical procedures for Meyerding Grade 3 or 4 isthmic dysplastic spondylolisthesis. Eleven patients were treated with an in situ L4-sacrum posterior fusion without decompression (Group 1), 7 had posterior decompression with posterior instrumentation and posterior fusion (Group 2), and 19 patients had reduction and a circumferential fusion procedure (Group 3). All patients had new radiographs taken at time of follow-up (average, 3.1 years; range, 2 years-10 years, 1 month) and completed a functional outcome questionnaire. RESULTS: The incidence of pseudarthrosis was 45% (5 of 11) in Group 1, 29% (2 of 7) in Group 2, and 0% (0 of 19) in Group 3. All seven who had pseudarthrosis had small L5 transverse process surface area (< 2 cm2; P = 0.004). Only one patient had a neurologic deficit (unilateral extensor hallucis longus weakness) at time of follow-up. There were no significant differences among the groups in function, pain, and satisfaction in patients in whom solid fusion was obtained, but the scores were highest in Group 3. CONCLUSIONS: In situ fusion surgery in patients with high-grade spondylolisthesis with small L5 transverse processes (surface area, < 2 cm2) results in a high rate of pseudarthrosis. Circumferential procedures result in the highest rate of fusion and are effective in achieving fusion in those patients with established pseudarthrosis. The use of long (> 60 mm) iliac screws bilaterally (n = 21) in addition to bicortical sacral screws (four-point sacral-pelvis fixation) along with anterior column fusion reduces the risk of instrumentation failure in a decompression and reduction procedure. Outcomes of function, pain, and satisfaction are excellent in those in whom fusion is achieved. The risks in circumferential fusion-reduction procedures are acceptable.  相似文献   

8.
H Al-Khawashki  M Wasef Al-Sebai 《Spine》2001,26(23):E542-E546
STUDY DESIGN: Four cases of combined dysplastic and higher-level isthmic spondylolisthesis were studied. OBJECTIVE: To attempt to understand the possible etiology of this unreported combination. SUMMARY OF BACKGROUND DATA: Dysplastic spondylolisthesis is thought to be hereditary. It is believed that isthmic spondylolisthesis, the more common type, is acquired. Multiple spondylolysis and spondylolisthesis have been reported, but no cases of combined dysplastic and isthmic spondylolisthesis. METHODS: The global and segmental Cobb angles of the lumbar vertebrae and sagittal vertical alignment were measured in four patients who presented with lower back pain and varying degrees of pain radiation to the lower limb. Posteroanterior and lateral radiographs were taken with patients standing barefooted. Three of the patients underwent surgery. The fourth patient refused surgery. RESULTS: The global and segmental Cobb angles were found significantly increased in these patients. Increased segmental extension angles were clearer at the levels above the dysplastic vertebrae and at the level of the isthmic defect. Large anterior translation of the thorax was noted in all cases. CONCLUSIONS: The authors believe that this unusual combination may have resulted from hyperlordosis occurring above the dysplastic vertebrae, which caused increased stresses that led to the isthmic defect. This combination should be investigated in patients with dysplastic spondylolisthesis and hyperlordosis.  相似文献   

9.
Spondylolysis and spondylolisthesis are often diagnosed in children presenting with low back pain. Spondylolysis refers to a defect of the vertebral pars interarticularis. Spondylolisthesis is the forward translation of one vertebral segment over the one beneath it. Isthmic spondylolysis, isthmic spondylolisthesis, and stress reactions involving the pars interarticularis are the most common forms seen in children. Typical presentation is characterized by a history of activity-related low back pain and the presence of painful spinal mobility and hamstring tightness without radiculopathy. Plain radiography, computed tomography, and single-photon emission computed tomography are useful for establishing the diagnosis. Symptomatic stress reactions of the pars interarticularis or adjacent vertebral structures are best treated with immobilization of the spine and activity restriction. Spondylolysis often responds to brief periods of activity restriction, immobilization, and physiotherapy. Low-grade spondylolisthesis (< or =50% translation) is treated similarly. The less common dysplastic spondylolisthesis with intact posterior elements requires greater caution. Symptomatic high-grade spondylolisthesis (>50% translation) responds much less reliably to nonsurgical treatment. The growing child may need to be followed clinically and radiographically through skeletal maturity. When pain persists despite nonsurgical interventions, when progressive vertebral displacement increases, or in the presence of progressive neurologic deficits, surgical intervention is appropriate.  相似文献   

10.
Surgical management is the accepted treatment choice for grade III or IV spondylolisthesis, and many satisfactory clinical and radiologic follow-up results have been reported. Very little, however, has been written about long-term results in preteenage patients in whom dysplastic spondylolisthesis has been treated nonoperatively, especially in those who have > or =50% displacement of the fifth lumbar vertebra on the sacrum. We report an unusual case of spontaneous stabilization of severe dysplastic spondylolisthesis in an 8-year-old girl who presented with grade III spondylolisthesis of L5-S1 and was followed up for >14 years in the absence of surgical intervention. On presentation, she complained of a restriction in forward bending and tightness of hamstrings, but she was undisturbed in her daily activities. Initial radiographs showed severe dysplastic spondylolisthesis; however, magnetic resonance imaging (MRI) performed at age 9 years showed that the amount of listhesis was much less than that seen in the initial radiograph. Routine radiographic follow-ups were chosen over early operative measures until she became a teenager. There was no change in the slip, and unusually a gradual ossification of the cartilaginous promontory of the S1 and the posterior lip of the L5 was observed. At 22 years old, the patient is asymptomatic and not conscious of her cosmetic appearance. Surgical treatment has generally been indicated for patients with grade III or IV spondylolisthesis, because slippage progression has been noted in most reported cases. However, MRI may be a tool for predicting which dysplastic spondylolisthesis cases are more likely to progress and therefore circumvent surgical intervention, while maintaining an excellent outcome.  相似文献   

11.

Introduction

Comparison of lumbosacral dysplasia between normal individuals and patients with low and high grade spondylolisthesis has not been done previously. The objective of this study is to evaluate the relationship between lumbosacral dysplasia and severity of slip in young patients with lumbosacral spondylolisthesis.

Methods

Postero-anterior and lateral radiographs of 120 normal individuals and 131 patients with developmental spondylolisthesis (91 low and 40 high grades) were reviewed. Quantitative evaluation of lumbosacral dysplasia was done using 6 criteria involving the degree of laminar dysplasia, degree of facet dysplasia, size of L5 transverse processes, L5/S1 disc height, type of sacral doming and L5 lumbar index. Subjects were categorized as having no/low, moderate or severe dysplasia based on the total dysplasia score. Comparisons in total dysplasia score between normal, low grade and high grade groups were performed and the correlation between degree of dysplasia and percentage of slip was assessed.

Results

Most normal individuals (88.3%) had no/low dysplasia; most patients with low grade spondylolisthesis (61.5%) had moderate dysplasia, while most patients with high grade spondylolisthesis (72.5%) had severe dysplasia. There was a significant difference in dysplasia between normal individuals and patients with spondylolisthesis. Dysplasia also varied significantly between low and high grade spondylolisthesis. There was a strong positive correlation (r = 0.63) between severity of dysplasia and percentage of slip.

Conclusion

There is a significant relationship between the severity of spondylolisthesis and lumbosacral dysplasia, with mainly no/low dysplasia observed in controls and increasing total dysplasia scores in higher grades of spondylolisthesis. In addition, a variable degree of dysplasia was found within groups with low or high grade spondylolisthesis, suggesting that different subgroups of patients exist with regard to dysplasia. Thus the degree of dysplasia varies in spondylolisthesis and it is possible that different grades of dysplasia could relate to different prognoses or outcomes with treatment.  相似文献   

12.
重度腰椎滑脱脊柱序列功能重建   总被引:12,自引:0,他引:12  
目的 探讨重度腰椎滑脱外科处理的策略.方法 重度腰椎滑脱患者42例,男24例,女18例;年龄27~68岁,平均46岁.滑脱程度按Meyerding分类:Ⅲ度26例,Ⅳ度16例.术中根据病变的分类及影像学特点采用不同的减压和复位方法,椎间植入cage或骨块.手术前后测量腰骶段一骨盆参数.采用视觉模拟评分法(VAS),对患者进行疗效评定.结果 所有患者均获得随访,随访时间12~48个月,平均31个月.33例(78.6%)解剖复位,6例(14.3%)从Ⅳ度复位至Ⅰ度,3例(7.1%)从Ⅳ度复位至Ⅱ度.无一例发生感染及神经根损伤.40例(95.2%)椎间植骨融合良好;2例(4.7%)形成假关节并出现螺钉断裂.3例(7.1%)出现短暂神经根性疼痛,均于7~10 d后恢复.无螺钉松动、退出.腰椎前凸角由术前72.4°±14.1°恢复至术后61.6°±9.2°(P=0.042),骶骨倾斜角由54.3°±7.2°恢复至44.6°±5.7°(P=0.043),骨盆倾斜角由16.3°±3.3°恢复至12.4°±2.9°(P=0.027),骨盆入射角由66.5°±13.8°缩小至62.2°±9.3°(P=0.059).术后各随访时间点VAS评分均较术前显著降低,但不随时间延长而增大.结论 应根据腰椎滑脱的病因选择不同的减压方法.腰骶段-骨盆参数与腰椎滑脱程度、转归密切相关.术前应制定有关参数的恢复计划.  相似文献   

13.
Traditional radiographic analysis of spondylolisthesis focuses on the regional sagittal deformity at the lumbosacral junction. Pelvic morphology has also been cited as an important factor that contributes to the development of high-grade spondylolisthesis. However, the importance of global sagittal balance of the spine and pelvis in patients with spondylolisthesis has been emphasized recently. Patients with this condition can develop abnormal sagittal spinopelvic balance; restoration of sagittal spinal alignment can improve their health-related quality of life. Reduction has been used to restore alignment, but its role in the management of high-grade spondylolisthesis is controversial. None of the current classification systems take sagittal sacropelvic and spinopelvic balance into account. Improved understanding of the relationship between the spine and pelvis has led to the development of a new classification system that incorporates analysis of spinopelvic balance in the radiographic assessment. This new system may aid surgeons in identifying patients who would benefit from a partial reduction procedure.  相似文献   

14.
The surgical management of high-grade spondylolisthesis in adults remains challenging and controversial. Symptomatic patients often present with severe pain, neurologic deficits, or deformity. Although there are several surgical options, the decision to proceed with decompression and fusion depends on the patient's presenting symptoms and degree of instability. Posterolateral pedicle screw-rod fixation has improved rates of arthrodesis compared with traditional in situ fusions. Nevertheless, complications with operative management of high-grade spondylolisthesis can be severe.  相似文献   

15.
Spondylolisthesis, the anterior or posterior displacement of one vertebra on another, usually affects the lumbar region. Five percent of the population has one of the five classes of spondylolisthesis, which include dysplastic, isthmic, degenerative, traumatic, and pathologic spondylolisthesis. This article focuses on the dysplastic type, which makes up 14% to 21% of all spondylolisthesis. Dysplastic spondylolisthesis usually causes no symptoms in children; pain usually begins in adolescence. The key to diagnosis is the appropriate use of radiography in the evaluation of low back pain. This report describes a case involving a 21-year-old woman presenting with back pain to the family physician. Also, it details how the diagnosis was achieved and evaluates conservative and aggressive treatment options.  相似文献   

16.
The results of treatment of spondylolisthesis in 72 patients by reduction with the use of Harrington rods and circumferential fusion were reported. In dysplastic spondylolisthesis 75% satisfactory results and 83.4% spinal fusions were achieved, in stenotic spondylolistheses 80% and 85% respectively. The influence of operation on sacral bone position against lumbar spine could not be accurately traced with the aid of Wiltse radiological criteria. The authors consider arthrodesis "in situ" as insufficient procedure, especially in dysplastic type of spondylolisthesis. They recommend addition of anterior fusion that retains and stabilizes reduction being limited to single motoric unit of the spine.  相似文献   

17.
Treatment of spondylolisthesis and spondylolysis in children.   总被引:3,自引:0,他引:3  
There are 2 fairly common types of spondylolisthesis in children - dysplastic and isthmic. The dysplastic type is secondary to congenital defects at the lumbosacral joint. The isthmic is usually due to a fatigue fracture of the pars interarticularis but there is also an hereditary element in this type. Most children with spondylolisthesis never develop significant symptoms and even of those who do, the vast majority can be treated without surgery. If symptoms persist or if further olisthesis is occurring, a one-level spinal fusion done through a paraspinal approach is recommended. It is most important not to allow olisthesis to develop to the point that the child shows the cosmetically undesirable stigmata characteristic of the condition. Solid fusion can be obtained in every case and will stop further slip.  相似文献   

18.
邵珂  吉立新 《中国骨伤》2019,32(3):283-287
峡部裂性腰椎滑脱症是一种常见的脊柱退行性疾病,严重影响人们的生活质量。目前腰椎滑脱的手术治疗指征已基本形成共识,针对该病的手术方案主要是峡部修补、椎管减压、滑脱复位、脊柱融合,治疗原则主要是缓解神经压迫、恢复脊柱稳定,但对于各环节实施的具体方式及程度仍存在较大争议。开放手术能够对严重峡部裂腰椎滑脱进行彻底的减压、复位、融合,重建脊柱的稳定性,但手术创伤过大,而微创手术则可以减少对椎旁软组织的损伤,同时减少术中失血量,缩短术后住院及康复时间,降低术中、术后相关并发症的发生率,因而近年来也受到了越来越多临床医生的推崇,但对于重度峡部裂腰椎滑脱的治疗效果欠佳。现就近年来腰椎滑脱的手术治疗进展做一综述。  相似文献   

19.
62 children with spondylolisthesis were examined. Functional anatomical studies on 25 growing human spines were performed to analyse their macro morphological behavior before and after spondylolisthesis. The progression of spondylolisthesis is explained as growth disturbance. The high incidence of spina bifida occulta in spondylolisthesis is a mechanical induced osteochondrosis of the dorsal arc. The different morphology of the spondylolisthesis in children depends mostly of the age of the beginning of this disease. The differentiation between the dysplastic and spondylolytic isthmic type of spondylolisthesis is not indicated. Pour prognosis is expected in young children with kyphosis and high ventral dislocation in the involved segment.  相似文献   

20.
椎弓根钉系统结合椎间融合治疗严重腰椎滑脱   总被引:9,自引:2,他引:9  
目的评价椎弓根钉内固定系统结合椎间融合治疗严重腰椎滑脱的临床效果。方法2002—2007年应用后路椎弓根钉内固定系统结合椎间融合器治疗32例重度(Meyerding分级Ⅲ和Ⅳ度)腰椎滑脱患者,椎间隙Cage植骨。随访时采用Suk标准判断融合情况,并根据神经损害体征、腰部活动功能和对职业的影响等指标进行疗效评价。结果随访6~36个月,平均22.5个月,优良率90.6%,融合率84.4%,平均腰椎滑脱率由术前的57.3%降低到术后的12.2%。术后并发脑脊液漏2例,暂时性单侧根性疼痛2例,足背皮肤麻木伴轻度的踝关节背屈肌力减弱3例,Cage下沉5例,平均下沉1.1mm。结论椎弓根钉内固定系统结合Cage椎间植骨融合器是治疗严重腰椎滑脱的一种比较安全有效的手术选择。  相似文献   

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