Postoperative instability after laminoplasty for cervical myelopathy with spondylolisthesis

OBJECTIVE: 76 patients who underwent laminoplasty for cervical spondylotic myelopathy were investigated regarding the impact of preoperative and postoperative degenerative spondylolisthesis on their neurologic outcome. METHODS: Radiographs were obtained 1 year postoperatively to investigate range of motion (ROM), lordotic curvature, and postoperative spondylolisthesis. RESULTS: By 1 year after surgery, 85% of those spondylolistheses present preoperatively had either resolved or improved on neutral lateral radiographs. The cross-sectional area of the spinal cord at the site of spondylolisthesis was measured using preoperative computed tomography myelography. Clinical results were evaluated by the recovery rate using Japanese Orthopaedic Association score. Patients with posterior spondylolisthesis showed a significantly poorer postoperative recovery rate. Intervertebral ROM in patients with preoperative spondylolisthesis was reduced, whereas cervical alignment had not deteriorated after laminoplasty. The group with posterior spondylolisthesis showed a significant reduction in the cross-sectional area of the spinal cord at the site of spondylolisthesis. Postoperative spondylolisthesis appeared in 15 patients, 10 of whom had preoperative spondylolisthesis at an adjacent site. CONCLUSION: The cause of poorer surgical results of those patients with preoperative posterior spondylolisthesis appears to be related to a higher degree of spinal cord compression than with preoperative anterior spondylolisthesis.     

Lumbar spondylolisthesis

Summary The paper gives a survey, based on literature reports and our own experiences in 59 cases. According to Kilian (1853) spondylolisthesis is defined as ventral slipping of a vertebral body together with the pedicles. In pseudospondylolisthesis (Junghanns) the whole vertebra slips ventrally.Elongation of the isthmus of the pedicle or a cleft in the interarticular portion are prerequisites for spondylolisthesis. A dysplastic origin during childhood and adolescence is assumed. The relation of males to females is 2 1.Evolution of spondylolisthesis occurs during childhood and adolescence. The slipping process is finished in adults. Most often the condition is encountered in the lumbar, in particular in the lumbosacral, region. A third to one half of patients with spondylolysis (5–7%) demonstrate spondylolisthesis.Spondylolisthesis is usually an accidental finding, although the condition may lead to low back pain and sciatica. The earlier symptoms arise the gloomier usually is the prognosis. Very rarely a herniated disc is the cause of symptoms. Sciatica is mostly due to irritation of a nerve root by compression on the vertebral edge. Low back pain is caused by arthrogenic, pseudoarthrotic, and spondylotic degenerative disease.Diagnosis is established by AP, lateral, and oblique X-rays, and functional investigations. Myelogram and ossovenogram demonstrate compression of caudal sac and nerve roots.Conservative treatment consists of drugs and physical therapy, and cures one fifth of the patients. The best operative results are found after decompression and stabilisation (Cloward).Dedicated to Prof. Dr. Dr. h. c. H. W. Pia on the occasion of his 60th anniversary.     

Low-grade spondylolisthesis

Spondylolisthesis is an often painful condition affecting millions of people in North America with some ethnic variability. It is characterized by the displacement, usually anterior, of on vertebral body upon another. There are familial predispositions to having the lesion, and a family history of spondylolisthesis may raise one's clinical suspicion. Although the diagnosis is easily made on radiographic evaluation, the pathoetiology and appropriate treatment modality are not always as clear. In the absence of severe neurological symptoms or an unsafe component of instability, a trial of conservative management is reasonable and prudent. Nevertheless, surgical management is more efficacious for enduring symptomatic relief and restoration of physical function. Whereas assessment of postoperative radiographic results lends insight to surgical technique, the true barometer of treatment success is improvement in patient quality of life.     

急性创伤性腰椎滑脱

目的 探讨急性创伤性腰椎滑脱(acute traumatic spondylolisthesis，ATS)的临床特点。方法 1999年5月～2002年1月诊治7例急性创伤性腰椎滑脱患：1例症状轻行保守治疗，其余6例滑脱均行切开复位内固定植骨术。结果 7例获1～11年，平均5年2个月随访。临床疗效按Henderson标准评价：优6例，良1例。结论 与峡部崩裂滑脱相比，ATS伴软组织损伤与峡部骨折或小关节突骨折，绝大多数需手术治疗。     

Instability in spondylolisthesis

Anteroposterior translation as a sign of segmental instability was documented by traction-compression radiography in the majority of lumbar segments presenting lytic or degenerative spondylolisthesis with normal disc space height. Severity of lower back pain symptoms correlated with the degree of instability, but not with the amount of static spondylolisthetic displacement. Unstable spondylolistheses exhibited decreased viscoelastic behavior with creep, the degree of the vertebral displacement being dependent on the amount and duration of load. Disc degeneration and traction spurs seemed to be factors that may stabilize spondylolisthesis, even at an early age.     

Cervical spondylolisthesis.

A case is reported of cervical spondylolisthesis in a 12-year-old girl. The cervical spondylolisthesis has not progressed in the 2 years of observation.     

Degenerative spondylolisthesis.

Degenerative spondylolisthesis is one important type of spinal stenosis. The spinal canal stenosis varies in degree. This is the result of anterior slipping of the whole vertebra, usually L4 on L5. The clinical picture is not greatly different from that observed in the other types of lumbar canal stenosis. The surgical management involves decompression of the cauda equina by laminectomy. Often this is associated with arthrectomy to decompress the nerve roots. Extensive excision of the neural arch may result in further spinal instability for which spinal fusion is generally advisable.     

Preoperative reduction of spondylolisthesis

The treatment of SL, especially in some cases, is mostly surgical. This lesion can be considered an extremely localised kyphosis (only two vertebrae) or a localized (sub-)luxation: at most hearetically pre-operative reduction should represent the first stage of the treatment, also because reduction makes further surgery easier and enables us to obtain the best results. After a glance at the various surgical techniques that have been used in the past, we describe our method of preoperative reduction in case of severe SL, an improvement of Scaglietti's original technique. According to the parameters taken into consideration, spondylolisthesis (SL) of the 4th and, above all, the 5th lumber vertebrae can be considered, especially in severe cases, as kyphosis or displacement (or even dislocation in the case of ptosis). In SL-kyphosis the antero posterior axes of the contiguous vertebral bodies are no longer parallel but tend to over-impose one to the other anteriorly forming an open posterior angle of varying degrees. It is an extremely short kyphosis (only two vertebrae) but from all points of view, even therapeutic, it reflects the characteristics of all types of vertebral kyphosis. SL-subluxation or SL-luxation (ptosis) is characterized by the respectively partial or total loss of normal alignment between the vertebrae involved. This can be explained by the fact that nearly all those who have dealt with the problem of treating SL, especially of L5, always ask themselves beforehand if it is possible and/or opportune to eliminate or improve the condition before surgery. In other words the question of reduction (pre or intraoperative, partial or total) of more or less severe L5 SL is always considered by all authors, even if their conclusions are often in disagreement.     

Treatment of degenerative spondylolisthesis

The purpose of this article is to evaluate three surgical approaches to the treatment of degenerative spondylolisthesis. A review of 107 surgically treated cases were used to select a group of patients who met the following criteria: No previous spine surgery, no involvement in litigation, and no significant lesions at other levels of the spine. Adequate follow-up. The selected group of 47 surgically treated cases of degenerative spondylolisthesis had follow-up of 2-7 years. Three surgical approaches to the treatment of degenerative spondylolisthesis were analyzed. A relatively small patient group with a wide posterior decompression, at the level of the slip, sacrificing the articular processes had good to excellent results in only 33% of the cases. A second group with a midline posterior decompression with preservation of the articular processes had 80% good to excellent results after 2 years. The third group with a midline decompression and preservation of the articular processes had an added intertransverse process fusion between the olisthetic levels. This group had 90% good to excellent results. The conclusion is that a posterior decompression with preservation of the articular processes plus a transverse process fusion at the involved level is the preferred method of treatment for degenerative spondylolisthesis without regard to age.     

Isthmic spondylolisthesis in pycnodysostosis

Pycnodysostosis is an inborn skeletal syndrome manifested by short stature with a concomitant spinal deformity and by dense sclerotic fragile bones. We report a 35-year-old woman with pycnodysostosis and isthmic spondylolisthesis. Pycnodysostosis should be added to the differential diagnosis of spondylolisthesis.     

Etiology of spondylolisthesis.

The etiology of spondylolisthesis is multiple according to the type of the vertebral slipping. In fact all the following basic pathological processes may be involved: congenital malformation of the upper sacrum in the dysplastic spondylolisthesis; growth dysplasia of the vertebral arch in the "isthmic spondylolisthesis" where an hereditary background and mechanical stresses play a determining role; degenerative conditions of the intervertebral joints in "degenerative spondylolisthesis" of Newman or the "pseudospondylolisthesis" of Junghanns; infections and benign or malignant tumors destroying the articular bolt maintaining the vertebral line; traumatic lesions such as multiple fractures of the bony hook or much more rarely an isolated bilateral fracture of the pars interarticularis.