tailieunhanh - Thoái hóa trượt đốt sống: Chẩn đoán và điều trị

Trượt đốt sống thoái hóa thường được thấy ở mức L4-5. Việc khiếu nại phổ biến nhất là đau lưng, nhưng sự ra đời của các triệu chứng chân, chẳng hạn như claudication và hội chứng chân bồn chồn, thường là lý do để tìm kiếm sự chú ý của y tế chuyên ngành. Bảo thủ điều trị thường là đủ | Degenerative Spondylolisthesis Diagnosis and Treatment John W. Frymoyer MD Abstract Degenerative spondylolisthesis is most often seen at the L4-5 level. The most common complaint is back pain but the advent of leg symptoms such as claudication and restless legs syndrome is often the reason for seeking specialized medical attention. Conservative treatment usually suffices extended bed rest is of little value. The 15 of patients who are surgical candidates are those with clinical signs and symptoms of cauda equina abnormality progressive muscular weakness or progressive incapacitating radicular pain or claudication. The author advocates pedicle-to-pedicle decompression with preservation of the articular facets as the essential operation. The indications for fusion have been debated but recent prospective studies show improved outcomes after fusion. The risk of significant morbidity associated with laminectomy and fusion increases as a function of age and magnitude of operation therefore careful patient selection for surgical intervention is vital. J Am Acad Orthop Surg 1994 2 9-15 Spinal stenosis is thought to be a growing potentially major health problem for the elderly population. In this age group degenerative spondylolisthesis may be the most common cause of spinal stenosis. Although the structural defect was first recognized over a century ago in anatomic specimen the associated clinical syndrome was not described until Macnab s classic article 1 in which he correlated the symptoms signs radiographic findings and treatment. His proposed nomenclature was spondylolisthesis with an intact neural arch but soon thereafter degenerative spondylolisthesis became the preferred term. Degenerative spondylolisthesis can be found in classifications of spondylolisthesis spinal stenosis and segmental instability indicating that the clinical presentation is varied. The basic structural deformity involves forward displacement of a lumbar vertebra usually L-4 on L-5 Fig. 1 . The