Abstract
Objective. To analyze present-day variants of surgical treatment of L5 spondylolisthesis in children. Material and Methods. The outcome analysis of surgery for L5 spondylolisthesis in 26 patients aged 10 to 17 years was performed. Two patients had Grade I spondylolisthesis, 7 patients – Grade II, 6 – Grade III, 7 – Grade IV, and 4 patients had spondyloptosis. The paper presents variants of surgical treatment for spondylolisthesis in children depending on a degree of L5 displacement, clinical manifestation of disease, and neurological disorders. The posterior approach was used in all patients. The surgery restored spinal canal anatomy, physiological relations within impaired segment, and trunk balance, reducted clinical manifestations, and eliminated neurological disorders. Results. Complete reduction of L5 vertebra was achieved in patients with Grade I–III spondylolisthesis, reduction to Grade II–III - in patients with Grade IV and spondyloptosis. Pain and radicular syndromes regressed in 2–3 days and 2–3 weeks after surgery, respectively. Patients with lower limb monoparesis and contractures showed a regression of neurological deficit and restoration of phisiological range of motions within 1–1.5 months after surgery. Conclusion. The choice of treatment technique for L5 spondylolisthesis depends on vertebra displacement degree, occurrence of segmental instability, intensity of clinical manifestations and neurological symptoms.
Highlights
The paper presents variants of surgical treatment for spondylolisthesis in children depending on a degree of L5 displacement, clinical manifestation of disease, and neurological disorders
Symptomatic and asymptomatic spondylolysis and spondylolisthesis in young adults // Int. Orthop
Summary
Анализ современных вариантов оперативного лечения спондилолистеза L5 позвонка у детей. Проведен анализ оперативного лечения 26 пациентов 10–17 лет со спондилолистезом L5 позвонка. У двух из них имелся спондилолистез тела L5 позвонка I степени, у семи – II, у шести – III, у семи – IV, у четырех – спондилоптоз. Представлены варианты оперативного лечения спондилолистеза у детей в зависимости от степени смещения тела L5 позвонка, клинической картины заболевания и неврологических нарушений. В ходе операции достигалось воссоздание анатомии позвоночного канала, восстановление нормальных физиологических взаимоотношений в патологическом сегменте, баланса туловища, купирование клинических проявлений и ликвидация неврологических нарушений. При спондилолистезе I–III степени достигалась полная редукция L5 позвонка. У пациентов с нижним монопарезом и контрактурами отмечался регресс неврологических нарушений и восстановление физиологического объема движений в течение 1–1,5 мес. Выбор варианта лечения при спондилолистезе L5 позвонка зависит от степени смещения тела позвонка, наличия сегментарной нестабильности, выраженности клинических проявлений и неврологических нарушений.
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