PDF(Pubmed)
Abstract：
BACKGROUND: Ehlers-Danlos syndrome (EDS) and its connective tissue laxity often result in high-grade lumbosacral spondylolisthesis. Patients present with debilitating symptoms and neurological deficits. Reports of surgical techniques in non-EDS patients for the treatment of high-grade lumbosacral spondylolisthesis mainly described an open approach, multilevel fusions, and multiple stages with different circumferential approaches. Sagittal adjusting screws (SASs) can be used in a minimally invasive (MI) fashion, allowing intraoperative reduction.
METHODS: A 17-year-old female with EDS presented to the authors\' institute with severe lower back and left L5 radicular pain in 2017. She presented with a left foot drop and difficulty ambulating. Magnetic resonance imaging showed grade IV L5-S1 spondylolisthesis. She underwent lumbar fusion for intractable back pain with radiculopathy. Intraoperatively, percutaneous SASs and extension towers were used to distract the L5-S1 disc space and reduce the spondylolisthesis. MI transforaminal lumbar interbody fusion was completed with significant symptomatic relief postoperatively. The patient was discharged to home 3 days postoperatively. Routine follow-up visits up to 3 years later demonstrated solid fusion radiographically and favorable patient-reported outcomes.
CONCLUSIONS: The authors used SASs in a MI approach to successfully correct and stabilize grade IV spondylolisthesis in an EDS patient with a favorable long-term patient-reported outcome.
METHODS: A 17-year-old female with EDS presented to the authors\' institute with severe lower back and left L5 radicular pain in 2017. She presented with a left foot drop and difficulty ambulating. Magnetic resonance imaging showed grade IV L5-S1 spondylolisthesis. She underwent lumbar fusion for intractable back pain with radiculopathy. Intraoperatively, percutaneous SASs and extension towers were used to distract the L5-S1 disc space and reduce the spondylolisthesis. MI transforaminal lumbar interbody fusion was completed with significant symptomatic relief postoperatively. The patient was discharged to home 3 days postoperatively. Routine follow-up visits up to 3 years later demonstrated solid fusion radiographically and favorable patient-reported outcomes.
CONCLUSIONS: The authors used SASs in a MI approach to successfully correct and stabilize grade IV spondylolisthesis in an EDS patient with a favorable long-term patient-reported outcome.
摘要：
背景：Ehlers-Danlos综合征（EDS）及其结缔组织松弛常导致高度腰骶部滑脱。患者表现为衰弱症状和神经功能缺损。非EDS患者手术技术治疗高级别腰骶部腰椎滑脱的报告主要描述了开放入路，多层次融合,和具有不同圆周方法的多个阶段。矢状调节螺钉（SASs）可以以微创（MI）方式使用，允许术中复位。
方法：2017年，一名患有EDS的17岁女性患者出现严重的下背部和左L5神经根疼痛。她左脚下垂，行走困难。磁共振成像显示IV级L5-S1滑脱。她接受了腰椎融合术治疗患有神经根病的顽固性背痛。术中,经皮SASs和延伸塔用于分散L5-S1椎间盘间隙并减少腰椎滑脱。MI经椎间孔腰椎椎间融合术完成，术后症状明显缓解。患者术后3天出院回家。直到3年后的常规随访显示了放射学上的固体融合和患者报告的良好结果。
结论：作者在MI方法中使用SASs成功地纠正和稳定了EDS患者的IV级腰椎滑脱，并具有良好的长期患者报告结果。
方法：2017年，一名患有EDS的17岁女性患者出现严重的下背部和左L5神经根疼痛。她左脚下垂，行走困难。磁共振成像显示IV级L5-S1滑脱。她接受了腰椎融合术治疗患有神经根病的顽固性背痛。术中,经皮SASs和延伸塔用于分散L5-S1椎间盘间隙并减少腰椎滑脱。MI经椎间孔腰椎椎间融合术完成，术后症状明显缓解。患者术后3天出院回家。直到3年后的常规随访显示了放射学上的固体融合和患者报告的良好结果。
结论：作者在MI方法中使用SASs成功地纠正和稳定了EDS患者的IV级腰椎滑脱，并具有良好的长期患者报告结果。
