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首页> 外文期刊>Spine >Vertical instability in spondylolisthesis: a traction radiographic assessment technique and the principle of management.
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Vertical instability in spondylolisthesis: a traction radiographic assessment technique and the principle of management.

机译：腰椎滑脱的垂直不稳定性：牵引射线照相评估技术和管理原则。

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摘要

STUDY DESIGN: Lateral radiographs of the lumbar spine were taken of 40 patients with lumbar spondylolisthesis. These radiographs were taken in the neutral, flexion, and extension positions for both erect and recumbent postures, and also in the prone and supine positions with traction applied via a traction table. OBJECTIVES: To define and demonstrate the presence of "vertical instability" in spondylolisthesis, and to determine the most useful radiographic views for clinical purposes and analysis of the surgical principle. SUMMARY OF BACKGROUND DATA: Lateral radiographs of patients in flexion and extension are widely used to obtain quantitative and qualitative data on lumbar spondylolisthesis. Changes in lumbar disc height and segmental translation in a group of patients with spondylolisthesis have been demonstrated with the addition of traction and compression. METHODS: Lateral and flexion extension radiographs of the lumbosacral spine in 37 patients with spondylolisthesis taken in standing and recumbent positions and under pelvic traction in the prone or supine positions were suitable for analysis. The changes in disc area, intervertebral kyphotic slip angle, and amount of anteroposterior shift (olisthesis) were measured from the radiographs using a computer digitizer. The disc area was normalized against the area of the superior vertebra, and the amount of anteroposterior shift was normalized against the anteroposterior width of the superior vertebra. Inter- and intraobserver error was found to be negligible, and results were analyzed by paired t test. RESULTS: Maximum slip angle, maximum olisthesis, and minimum normalized disc area were found with the subject under erect flexion. Conversely, prone traction and recumbent extension produced minimum slip angle, whereas the lowest anteroposterior shifts were seen with the subject under prone and supine traction. Prone traction also resulted in a significantly larger normalized disc area than any other posture. The change in kyphotic slip angle between erect flexion and prone traction is correlated with the change in normalized olisthesis and disc area. CONCLUSIONS: Erect flexion and prone traction radiographs represent the extremes of subluxation and reduction of the olisthesis, respectively, and the change in olisthesis seen between these extremes is correlated with the change in disc area and the intervertebral slip angle. Vertical laxity of the affected functional spinal unit resulting from disc degeneration produces laxity in the ligaments and disc anulus, allowing olisthetic motion. Restoration of disc height in turn restores tension to the soft tissues around the disc and results in a spontaneous reduction of the subluxation. Restoration and maintenance of disc height with a spacer or interbody fusion therefore is recommended as a goal in the treatment of spondylolisthesis. When spondylolytic spondylolisthesis involves a posterior column deficiency, additional reconstruction of this column with posterior instrumentation is recommended. Application of the traction radiographic technique in planning for spondylolisthesis reduction is discussed along with the technique of stabilization.
机译：研究设计：对40例腰椎滑脱患者进行腰椎侧位X线照相。这些射线照片是在中立，屈曲和伸展姿势下进行的，用于直立和斜卧姿势，也适用于俯卧和仰卧位，并通过牵引台施加牵引力。目的：定义和证明脊柱滑脱症中“垂直不稳定性”的存在，并确定最有用的放射学影像，以用于临床目的和分析手术原理。背景数据摘要：屈伸患者的侧位X线照片广泛用于获得腰椎滑脱的定量和定性数据。通过增加牵引力和压迫力，可以证明一组腰椎滑脱患者腰椎间盘高度的变化和节段性翻译的改变。方法：对37例腰椎滑脱患者的站立和斜卧位以及在俯卧或仰卧位的骨盆牵引下进行腰椎侧位和屈伸X线片的分析。使用计算机数字化仪从X光片测量椎间盘面积，椎体后凸滑移角和前后移位量（骨质增生）的变化。椎间盘面积相对于上椎骨的面积标准化，前后移位量相对于上椎骨的前后宽度标准化。发现观察者间和观察者间的误差可忽略不计，并通过配对t检验分析结果。结果：受试者在直立屈曲状态下发现最大滑移角，最大骨质疏松和最小标准化椎间盘面积。相反，俯卧牵引和横卧伸展产生最小的滑移角，而在俯卧和仰卧牵引下受试者的前后移位最低。俯卧牵引也导致椎间盘标准化面积明显大于其他任何姿势。直立屈曲和俯卧牵引之间的后凸滑移角的变化与归一化骨质和椎间盘面积的变化相关。结论：直立屈曲和俯卧位X光片分别代表了半脱位的半脱位和复位，并且在这两个极端之间观察到的脱位的改变与椎间盘面积和椎间滑移角的变化有关。椎间盘退变导致受影响的功能性脊柱单位的垂直松弛，使韧带和椎间盘环松驰，从而引起骨质运动。椎间盘高度的恢复又恢复了椎间盘周围软组织的张力，并导致半脱位的自发减少。因此，建议使用垫片或椎间融合器恢复和维持椎间盘高度是治疗腰椎滑脱的目标。当脊柱裂性脊柱滑脱症涉及后柱缺乏症时，建议使用后路器械进一步重建该柱。讨论了牵引放射线照相技术在脊椎滑脱复位计划中的应用以及稳定技术。

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