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    • Is It Necessary to Extend Fusion to L4 when Correcting Pediatric L5-S1 Spondylolisthesis?

    Jiahao Jiao,Xiaohan Ye,Dong Guo,Jun Cao,Xuejun Zhang,Shengru Wang,Jianguo Zhang,Ziming Yao

    Journal of Neurosurgery Spine（2024）

    Capital Med Univ | Peking Union Med Coll Hosp

    Cited 1|Views39
    Abstract
    OBJECTIVE The objective of this study was to investigate whether extending fusion to L4 is imperative in the surgical treatment of pediatric L5-S1 spondylolisthesis. METHODS This retrospective analysis encompassed 68 pediatric cases of dysplastic L5-S1 spondylolisthesis who underwent posterior lumbar interbody fusion surgery at two hospitals. Patients were categorized into two groups based on the upper instrumented vertebra (group L4 and group L5). Data were collected from medical records and radiological images obtained preoperatively and at last follow-up. Radiographic parameters including slip percentage (SP), lumbar angle (SDSG-LSA), pelvic tilt (PT), Dubousset's lumbosacral angle (Dub-LSA), sacral slope (SS), and severity index (SI) were measured. Surgery-related data and complication data were also collected. The incidence rates of complications were compared, including those of neurological deficit, adjacent-segment instability (ASI), and other complications. ASI was defined as progression of slippage > 3 mm or posterior opening > 5(degrees) in the adjacent segment. Clinical outcomes were assessed with the numeric rating scale (NRS) and the Oswestry Disability Index (ODI) scores. The follow-up period for all patients lasted a minimum of 2 years. RESULTS Among all 68 patients, group L4 consisted of 15 patients and group L5 comprised 53 patients. The patients included in both groups had comparable baseline demographic characteristics and radiographic parameters. Postoperative SP and SDSG-LSA were significantly lower in group L5 (p < 0.05). No other postoperative radiographic differences were observed between groups. One patient in group L4 and 3 patients in group L5 experienced transient neurological deficits (p > 0.05). There were 13 cases of ASI in group L5 compared with none in group L4 (24.5% vs 0%, p > 0.05). Of the 13 patients with ASI, 4 underwent revision surgery due to L4-5 level instability and clinical symptoms. The remaining individuals exhibited no symptoms, and regular annual follow-up assessments are being conducted for all patients. The NRS and ODI scores at final follow-up did not exhibit any significant differences between the two groups. CONCLUSIONS Fusion to L5 could achieve comparable satisfactory results to fixation to L4, albeit with increased likelihood of ASI. Extension of fusion to L4 may not be necessary for most patients with pediatric L5-S1 spondylolisthesis.
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    spondylolisthesis,children,surgical approach,fusion level,adjacent-segment instability,degenerative
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    【要点】：该研究调查在治疗儿童L5-S1椎弓峡状骨折时是否必须将融合延长至L4。研究结果表明，对大多数患有儿童L5-S1椎弓峡状骨折的患者来说，将融合延长至L4可能是不必要的。
    

    【方法】：研究者对68例在两家医院接受后路腰椎间融合手术的儿童发育型L5-S1椎弓峡状骨折患者进行了回顾性分析，根据上部融合椎骨将患者分为L4组和L5组，收集了术前和最后随访的病历和放射学图像，测量了包括滑脱百分比、腰椎前凸、矢状垂直轴、骨盆入射角、脊柱畸形研究组发育不良腰椎骶骨角、骨盆倾斜度、杜布塞特腰椎骶骨角、骶骨斜率、严重指数等放射学参数，还收集了手术相关数据和并发症数据。
    

    【实验】：结果显示，L5组术后滑脱百分比和脊柱畸形研究组发育不良腰椎骶骨角显著低于L4组，两组之间其他术后放射学差异不明显。L5组有3名患者出现暂时性神经功能障碍，L4组有1名患者出现暂时性神经功能障碍，两组之间差异不大。L5组有13例相邻节段不稳，而L4组没有（24.5%对比0%，差异不大）。在13例相邻节段不稳的患者中，4名患者因L4-5节段不稳定和临床症状而接受了修订手术。其余患者没有症状，所有患者正在进行定期的年度随访评估。最终随访的数字评分量表和Oswestry功能障碍指数评分在两组之间没有显著差异。