Surgical versus non-surgical treatment for the staging of spondylolisthesis: systematic review and meta-analysis

Аннотация

discovery through imaging tests performed for other Objective: To evaluate the limits of conservative pathological causes. It affects the general population treatment compared to surgical treatment. with an incidence of 4-8% and twice as high as that of Methodology: Information was searched using the men, relatively common in the pediatric population. Pubmed database using the keywords: 1,2,3 "developmental", "spondylolisthesis", "classification", Anatomically, the spine plays an important role in the "surgical", "treatment", "graft", "fusion", "Gaines". The stability and general balance in the coronal and sagittal search was restricted to articles in English, French and planes of the spine, given by the integrity of the osteo Portuguese. After selection, 05 articles were consulted discoligamentous complex. Thus, the lumbosacral level for analysis and construction of the study. of stability depends on the spatial orientation of the 5th Results : Surgical treatment proved to be more lumbar vertebra in relation to the sacrum, lumbosacral effective in assessing pain in studies in which the angle, sacral slope and pelvic incidence, and an intact patients were children and adolescents. Conservative osteo discoligamentous complex. Therefore, the treatment, in the majority of studies, was not effective involvement of the pathology causes deformation of in terms of improving mental health and consequently the sacral in growing children, which can have an improving the quality of life experienced by the patient. impact on the development of the locomotor Conclusion: Conservative treatment is indicated as the system.,2,3 first choice in most cases, leaving the invasive option As for complementary exams, simple radiographs in the for residual symptoms or advanced degrees of orthostatic position are sufficient and well indicated to anatomical involvement, and it is worth noting that the diagnose the disease in cases with a lower degree of surgical procedure is shown in the evaluation of pain, slippage. Bone scintigraphy is useful in identifying acute mental health and quality of life in the studies in which fractures and pseudarthrosis in old fusion areas, aiding the patients were children and adolescents. in the prognosis. 3D computed tomography allows the identification of compression of nerve roots by soft tissues and the identification of bone inside and outside Keywords: spondylolisthesis; developmental; the spinal canal. And magnetic resonance imaging treatment; classification; review; reduction; fusion. allows the assessment of disc degeneration, which may be useful for determining the extreme upper limits of INTRODUCTION: fusion and assisting in the therapeutic procedure.2,3,4 It was first described in 1782 as an anterior prominence There are many therapeutic options for of the sacrum that causes narrowing of the birth canal, spondylolisthesis: limitation of activities, exercises, supposedly caused by a subluxation in the 5th lumbar especially hip flexion, immobilization, repair of the vertebra over the 1st vertebral column of the sacral isthmic defect, fusion, decompression with/without spine. It evolved 12 years later to the term fusion, and finally, partial/total reduction and fusion. spondylolisthesis of Greek origin, which corresponds to This leads to the classic orthopedic dilemma: surgical or “slippage,” which affects the anatomical region of the conservative treatment? Thus, the general criteria for spine and has an etiology that is not well established indication for surgical treatment include persistent pain with a multifactorial origin, namely mechanical, or neurological symptoms in the face of good hormonal and hereditary factors. Spondylolisthesis is conservative application, progression of the slippage the anterior or posterior slippage or displacement of greater than 30%, a degree of slippage at presentation one vertebra over another and may be a unilateral or equal to or greater than Meyerding grade 3, and the bilateral lesion of the isthmus without slippage of the existence of a cosmetic deformity associated with vertebra, and is called spondylolysis. ¹ postural and gait difficulties. Overall, only 20% of patients with symptomatic spondylolisthesis require The clinical presentation is variable and extensive in surgical treatment.3,4,5,6 view of the possibility of anatomical involvement: 1. minimal vertebral slippage with exuberant symptoms Although conservative approaches are successful in The American Journal of Medical Sciences and Pharmaceutical Research 81 https://www.theamericanjournals.com/index.php/tajmspr The American Journal of Medical Sciences and Pharmaceutical Research children and adolescents, during development there was restricted to articles in English, French and are more presentations of spondylolisthesis with a high Portuguese. After selection, 05 articles were consulted degree of slippage or with progression of the lesion, for analysis and construction of the study. therefor