PDF(Pubmed)
Abstract：
BACKGROUND: Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology remains unclear. This report describes this rare complication and proposes a possible etiology focusing on the lumbosacral sagittal imbalance characterized by an anteriorly shifted lumbar loading axis.
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.
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.
摘要：
背景：单级后路腰椎椎间融合术（PLIF）或经椎间孔腰椎椎间融合术（TLIF）是L4-5峡部裂性腰椎滑脱的常用手术方法。L4-5PLIF/TLIF术后L5-S1节段快速进行性腰椎滑脱的L5椎弓根骨折非常罕见，病因尚不清楚。本报告描述了这种罕见的并发症，并提出了一种可能的病因，重点是腰s矢状失衡，其特征是腰椎负荷轴前移。
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。
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。
