METHODS: The authors report a case complicated by L5 bilateral pedicle fractures and rapidly progressive spondylolisthesis at the L5-S1 segment very early after a single-level PLIF for L4-5 isthmic spondylolisthesis. Meyerding grade III anterolisthesis was observed at L5-S1 segment by 3 months after the initial surgery. Additional surgery was performed, and the fixation was extended to L4-ilium. Fracture healing was observed at 6 months postoperatively.
CONCLUSIONS: This complication may have been caused by abnormal local shear forces on the posterior neural arch of L5 vertebra and L5-S1 intervertebral disc, which were triggered by the fusion surgery for L4 shear-type spondylolisthesis. L4 sagittal vertical axis is considered a reasonable parameter representing lumbosacral sagittal imbalance with an anteriorly shifted loading axis and may be a candidate for the predictive parameters of this rare complication.
方法:作者报告了一例在L4-5峡部裂性腰椎滑脱的单级PLIF治疗后,在L5-S1节段早期并发L5双侧椎弓根骨折和快速进行性腰椎滑脱的病例。在初次手术后3个月,在L5-S1段观察到MeyerdingIII级前裂。进行了额外的手术,固定延伸至L4-髂骨。术后6个月骨折愈合。
结论:该并发症可能是由于L5椎骨和L5-S1椎间盘后神经弓的局部剪切力异常引起的,由L4剪切型腰椎滑脱的融合手术触发。L4矢状垂直轴被认为是表示腰骶骨矢状不平衡的合理参数,具有前移的载荷轴,并且可能是这种罕见并发症的预测参数的候选。