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Vol. 6. Issue 3.
Pages 196-200 (January 1995)
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Vol. 6. Issue 3.
Pages 196-200 (January 1995)
Espondilolistesis degenerativa lumbar. Resultados del tratamiento quirúrgico
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M. Clavel Escribano, R. Noboa Baquero, P. Clavel Laria
Servicio de Neurocirugía del Hospital General de Cataluña. Barcelona
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Resumen

De un total de 600 pacientes intervenidos quirúrgicamente de patología lumbar en los últimos 6 años, los autores estudian 19 pacientes con espondilolistesis degenerativa y arco neural intacto, con edades que oscilaban entre 54 y 78 años (con 11 de los pacientes superando los 65 años de edad) y un promedio ligeramente mayor de varones.

La sintomatología más frecuente era la claudicación intermitente neurógena y/o dolor ciático. El espacio, con diferencia, más frecuentemente afectado fue L4–L5 seguido de L3–L4. El diagnóstico fue confirmado con TAC y/o RNM y en algún caso con mielografía. La técnica quirúrgica de elección para esta patología es el abordaje microquirúrgico bilateral con amplia laminectomía, facetectomía medial y foraminotomía bilateral. En ocasiones ha sido preciso realizar también una discectomía.

En uno de los pacientes se asoció una artrodesis transverso sacra. Otro paciente, el más joven de la serie, fue reintervenido dos años más tarde por progresión de la espondilolistesis, colocándole placas, tornillos (Steffee) y jaulas de Brantigan (PLIF). Otra paciente inicialmente intervenida a los 60 años de edad fue reintervenida recientemente (a los 62 años) para ampliar la descompresión. En esta segunda ocasión se añadió una artrodesis transversa con tornillos pediculares.

El resto de pacientes no ha presentado en el período de seguimiento avance de la espondilolistesis. Clínicamente todos ellos mejoraron, en general de forma espectacular. No hubo complicaciones.

Palabras clave:
Espondilolistesis degenerativa lumbar
Tratamiento quirúrgico
Summary

From more than 600 patients operated in the last 6 years of lumbar pathology, 19 of them had degenerative spondylolisthesis with an intact neural arch. Their ages ranged between 54 and 78 years (11 of them were over 65 years of age) and slightIy more frequent in males.

The predominant clinical symptomatology was sciatic pain and intermittent neurogenic claudication. The most frequentIy affected interspace was L4–L5 followed by L3–L4. The diagnosis was confirmed by CT and/or MRI.

Our choice for treating this type of spondylolisthesis is a bilateral microsurgical approach with a wide laminectomy, facetectomies and foraminotomies. In sorne of the cases discectomy was also performed and in one of them an arthrodesis was done initially.

One patient –the youngest in the group– had late progression of the spondylolisthesis needing pedicle screws and PLIF with Brantigan's cages. Another patient who was initially operated when he was 60 years old has been recently reoperated to enlarge the decompression and perform a fusiono

All patients were improved and no complications ocurred in this small series.

Key words:
Degenerative Lumbar Spondylolisthesis
Surgical treatment

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