Abnormal Spinal Anatomy in 27 Cases of Surgically Corrected Spondyloptosis: Proximal Sacral Endplate Damage as a Possible Cause of Spondyloptosis
Abnormal Spinal Anatomy in 27 Cases of Surgically Corrected Spondyloptosis: Proximal Sacral Endplate Damage as a Possible Cause of Spondyloptosis
复制标题
27例手术矫正脊椎下垂的脊柱解剖异常：近端骶骨终板损伤是脊椎下垂的可能原因
DOI：
10.1097/01.brs.0000155572.72287.92
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发表时间：
2005
期刊：
影响因子：
3
通讯作者：
R. Gaines
中科院分区：
文献类型：
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作者：
W. Yue;W. Brodner;R. Gaines
研究设计。回顾性研究。目标。回顾我们治疗的脊椎下垂病例的发现，并对脊椎下垂的可能原因进行假设。背景资料摘要。尽管脊柱滑脱是一种相对常见的疾病，但脊椎下垂（V级脊柱滑脱）是罕见的。众所周知，儿童期和/或青少年时期的发展性脊柱滑脱患者会发展为脊柱下垂，但导致进展的确切因素尚不清楚。方法。1979年至2002年间，27例颈椎病患者接受了L5切除和L4复位至S1的手术治疗。在治疗过程中，通过临床和放射学手段对手术表现进行了详细观察。具体研究了6个解剖参数（关节间部缺损、L5或骶节段脊柱裂、L5 - s1关节突关节发育不良、L5 - s1椎间盘退变、L5的梯形形状和骶骨近端变圆）。结果。关节间部缺损24例（88.9%），关节突发育不良16例（59.2%），脊柱裂24例（88.9%），椎间盘退变25例（92.6%），L5梯形20例（74.1%），S1近端舍入27例（100%）。结论。骶骨近端终板变圆是患者唯一不变的异常解剖特征。儿童期晚期和青春期早期对骶骨近端和骶骨生长板的损伤，类似于导致布朗特病的骨骺损伤，以及股骨骨干骨骺滑动似乎是导致发育性椎体滑脱发展为脊柱下垂的关键因素。
Study Design. Retrospective review. Objectives. To review the findings in the cases of spondyloptosis we have treated and to postulate on the possible cause of spondyloptosis. Summary of Background Data. Spondyloptosis (Grade V spondylolisthesis) is rare, even though spondylolisthesis is a relatively common condition. While it is known that progression to spondyloptosis occurs in patients with developmental spondylolisthesis in their childhood and/or adolescent years, the precise factors leading to progression are not known. Methods. Between 1979 and 2002, 27 patients with spondyloptosis were treated surgically with L5 resection and reduction of L4 onto S1. During the treatment process, detailed observations of the surgical findings were made through clinical and radiologic means. Six anatomic parameters (pars interarticularis defects, spina bifida of the L5 or sacral segments, dysplasia of the L5–S1 facet joints, L5–S1 disc degeneration, trapezoidal shape of L5, and rounding of the proximal end of the sacrum) were specifically studied. Results. Pars interarticularis defects were present in 24 patients (88.9%), facet dysplasia in 16 patients (59.2%), spina bifida in 24 patients (88.9%), disc degeneration in 25 (92.6%), trapezoidal L5 in 20 patients (74.1%), and rounding of the proximal end of S1 in all 27 patients (100%). Conclusions. Rounding of the proximal sacral endplate was the only constant abnormal anatomic feature in the patients. Damage to the proximal sacrum and sacral growth plate during late childhood and early adolescence, similar to the epiphyseal injury that produces Blount’s disease, and slipped capital femoral epiphysis seem to be key factors permitting the progression of developmental spondylolisthesis to spondyloptosis.
Sakamaki T：“小儿腰椎滑移和畸形的发病机制。使用新的大鼠体内模型进行放射学和组织学研究”脊柱。
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