Đstmik spondilolisteziste cerrahi yaklaşımlar

Istmik spondilolistezis genel populasyonda %4-8 oranı ile en fazla görülen listezis tiplerinden biridir. Nöral arkın pars interartikülarisinde meydana gelen değişiklikler veya defektler istmik spondilolistezisin oluşumuna neden olmaktadır. Mekanik, genetik ve hormonal faktörler bu değişim sürecinde etkili olabilmektedir. Klinik bulgular, spinal deformiteler veya nörolojik yapıların basısına bağlı oluşmaktadır. Konservatif tedavi denenebilmekle birlikte, tedaviye yanıt alınamayan ağrı, nörolojik bulgularda kötüleşme durumunda cerrahi müdahale gerekebilmektedir. Cerrahi seçenekler arasında; nöral dekompresyon, kemik füzyon, enstrümanlı stabilizasyon-füzyon seçenekleri sayılabilir.

Surgical approaches in isthmic spondylolisthesis

Isthmic spondylolisthesis is one of the most common types of spondylolisthezis in 4-8% of general population. The changes or defects occur in the pars interarticularis of neural arch may cause the formation of isthmic spondylolisthezis.Mechanic, genetic and hormonal factors may be effective during this alternation process. Clinical signs may ocur according to the spinal deformities or compression of neurological structures. Although conservative treatment may be attempted, surgical treatment may be required in the patients with pain despite medical treatment or progression of neurological symptoms. The alternative surgical techniques include; neural decompression, bone fusion, stabilization with instrumentation-fusion.

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1. Spivak JM, Kummer FJ, Chen D et all. Intervertebral foramen size and volume changes in low grade, low dysplasia isthmic spondylolisthesis. Spine. 2010; 20 (35):1829-1835.
2. Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66:699-707.
3. Grobler LJ, Wiltse LL. Classification, non-operative, and operative treatment of spondylolisthesis, in Frymoyer JW (ed): The adult Spine: Principles and Practice. New York, Raven Pres. 1991; 2:1655-1704.
4. Whitesides TE, Horton WC, Hutton WC et al. Spondylolytic spondylolisthesis. A study of pelvic and lumbosacral parameters of possible etiologic effect in two genetically and geographically distinct groups with high occurence. Spine. 2005;30:12-21.
5. Meyerding HW: Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371–377.
6. Newman PH: Degenerative spondylolisthesis. Orthop Clin N Am. 1975;6:197–198.
7. Ganju A. Isthmic spondylolisthesis. Neurosurg Focus 2002;13(1):1-6.
8. Winn H.R.Youmans Neurological Surgery . Ed: Winn HR. 6th edition. Reames DL, Shaffrey CI. Pediatric spondylolisthesis. 2011 vol 3 Chapter 286:2935-2946. 1. 9.Wiltse LL, Rothman SLG: Spondylolisthesis: classification, diagnosis,and natural history. Semin Spine Surg. 1989;1:78–94.
9. Marchetti PG, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In : Bridwell KH, Dewald RL, Hammerberg KW et al (eds) The Textbook of Spinal Surgery, 2nd edn. Philadelphia,PA: Lippincott-Raven. 1997;1211-54.
10. Lamartina C, Zavatsky JM, Petruzzi M, Specchia N. Novel concepts in the evaluation and treatment of high- dysplastic spondylolisthesis. Eur Spine J. 2009;18:133- 142.
11. Park SJ, Lee CS, Chung SS, Kang KC, Shin SK. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Operative Neurosurgery. 2011;68:355-363.
12. Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Jt Surg Br. 1970; 52:432-437.
13. Scott JHS The Edinburg repair of isthmic (Group II) spondylolysis. J Bone Jt Surg Br. 1987;69:491.
14. Giudici F, Minoia L, Archetti M, Corriero AS, Zagra A. Long-term results of the direct repair spondylolisthesis. Eur Spine J. 2011;20:115-120. of
15. Deguchi M, Rapoff AJ, Zdeblick TA. Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord. 1998;11:459-64.
16. Swan J, Hurwitz E, Malek F, et al. Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion. Spine J. 2006;6:606-14.
17. Remes V, Lamberg T, Tervahartiala P, et al. Long-term outcome after posterolateral , anterior, and circumferential fusion for hign-grade isthmic spondylolisthesis in children and adolescents: magnetic resonance imaging findings after average of 17-year follow up. Spine. 2006;31:2491-9.
18. Kaneda K, Satoh S, Nohara Y, et al. Distraction rod instrumentation with posterolateral fusion in isthmic spondylolisthesis. 53 cases followed for 18-89 months. Spine. 1985;10:383-9.
19. Petraco DM, Spivak JM, Cappadona JG, et al. An anatomic evalluation of L5 nerve stretch in spondylolisthesis reduction. Spine. 1996;21:1133-8.
20. Benli IT, Cicek H, Kaya A. Comparison of sagittal plane realignment and reduction with posterior instrumentation in developmental low or high dysplastic spondylolisthesis. Kore J Med Sci. 2006;52:151-69.
21. “Jagannathan J, Sansur CA, Oskouian RJ Jr, Fu KM, Shaffrey CI. Radiographic restoration of lumbar alignment after transforaminal lumbar interbody fusion. Neurosurgery. 2009;64(5):955-963.
22. Poussa M, Schlenzka D, Seitsalo S, Ylikoski M, Huri H, Osterman K. Surgical treatment of severe isthmic spondylolisthesis in adolescents: reduction or fusion in situ. Spine. 1993;18:894-901.
23. Moller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesis: a prospective randomized study: part I. Spine. 2000;25:1711-1715.