Resumen

OLIVEIRA, Vânia et al. Espondilolise e espondilolistese ístmica de grau I no adolescente: Análise retrospectiva de 30 casos. Rev. Port. Ortop. Traum. [online]. 2014, vol.22, n.3, pp.284-294. ISSN 1646-2122.

Aim: the spondylolysis and grade I isthmic spondylolisthesis are causes of low back pain in adolescents. Both are associated with fatigue fracture of the pars interarticularis, induced by repeated hyperextension movements. In the literature there is no consensus about the benefits of the surgical treatment in these patients, often athletes, and the controversy extends to the best surgical technique to perform. The authors describe the surgical technique they systematically use and analyse outcome. Material and methods: from 2004 and 2013, retrospectively were analysed 30 adolescents, 12 spondylolysis and 18 grade I isthmic spondylolisthesis, operated by the same surgeon for a isthmic reconstruction with iliac autograft and temporary posterior pedicle fixation. The following parameters were evaluated: isthmus reconstitution, complications, pain (VAS), function (ODI) and patients’ satisfaction. Results: the mean age was 16.3 years (range 13-18) and follow-up 23.5 months (range 14-48). Consolidation occurred in 100% of cases. The VAS decreased from 7.48 to 0.38 (p<0.0001) and ODI improved from 38.55% to 1.59% (p<0.0001), moderate to minimal disability. The instrumentation was removed after one year post isthmic reconstitution in all patients. In total, 63.3% of patients were athletes and all of them returned to their previous competition level. There was no listhesis progression or significant complications. Patients are satisfied and would repeat treatment. Conclusion: the fusion techniques present good clinical results but are associated with loss of segment mobility and adjacent level disease. Compared with dynamic techniques, this technique recommended by the authors enables not only effective isthmic reconstitution as shows superior clinical outcomes in the medium term, which overcomes the need for second surgery to remove instrumentation. The isthmic reconstitution with autograft and temporary posterior pedicle fixation in spondylolysis or isthmic spondylolisthesis grade I obtained excellent clinical results and high rate of bone defect healing. The authors advocate this technique even in elite athletes.

Palabras clave : Isthmus lysis; spondylolysis; isthmic spondylolisthesis; back pain; adolescents; isthmic reconstitution; athletes.

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