A STUDY ON THE NATURAL HISTORY OF SPONDYLOLYSIS AND SPONDYLOLYSTHESIS

The patients with spondylolysis or spondylolisthesis in the lumbar region, who had been cared not less than 10 years since they were first diagnosed as such, were studied in order to elucidate the natural history of these diseases. The subjects were 55 in all. The age of the patients ranged from 4 t...

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Published inJournal of The Showa Medical Association Vol. 48; no. 2; pp. 257 - 268
Main Author SAKAGAWA, Hajime
Format Journal Article
LanguageEnglish
Japanese
Published The Showa University Society 1988
昭和大学学士会
Online AccessGet full text
ISSN0037-4342
2185-0976
DOI10.14930/jsma1939.48.257

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Abstract The patients with spondylolysis or spondylolisthesis in the lumbar region, who had been cared not less than 10 years since they were first diagnosed as such, were studied in order to elucidate the natural history of these diseases. The subjects were 55 in all. The age of the patients ranged from 4 to 75 years old (40.5±15.9 years old on the average) at the time of first diagnosis. The period of time which had paseed since their first diagnosis ranged from 10 to 16 years (11.6±1.5 years on the average) . As a result, JOA score for clinical symptoms was improved from the average score of 24.7±2.3 at the time of first diagnosis to the average score of 27.1±2.8 at the time of this study, though no case was improved in the roentogenography. Only 4 cases (their score at the time of this study were 14, 17, 24, and 25, respectively) were found worse. The improvement in the score for the activitied of daily living contributed to the improving tendency at the time of this study. In conclusion, the conventional conservative therapy should be taken to treat the patients with spondylolysis, and preventive operation is not considered necessary even for the treatment of the patients with complication of spondylolysis and spondylolisthesis.
AbstractList The patients with spondylolysis or spondylolisthesis in the lumbar region, who had been cared not less than 10 years since they were first diagnosed as such, were studied in order to elucidate the natural history of these diseases. The subjects were 55 in all. The age of the patients ranged from 4 to 75 years old (40.5±15.9 years old on the average) at the time of first diagnosis. The period of time which had paseed since their first diagnosis ranged from 10 to 16 years (11.6±1.5 years on the average) . As a result, JOA score for clinical symptoms was improved from the average score of 24.7±2.3 at the time of first diagnosis to the average score of 27.1±2.8 at the time of this study, though no case was improved in the roentogenography. Only 4 cases (their score at the time of this study were 14, 17, 24, and 25, respectively) were found worse. The improvement in the score for the activitied of daily living contributed to the improving tendency at the time of this study. In conclusion, the conventional conservative therapy should be taken to treat the patients with spondylolysis, and preventive operation is not considered necessary even for the treatment of the patients with complication of spondylolysis and spondylolisthesis.
The patients with spondylolysis or spondylolisthesis in the lumbar region, who had been cared not less than 10 years since they were first diagnosed as such, were studied in order to elucidate the natural history of these diseases. The subjects were 55 in all. The age of the patients ranged from 4 to 75 years old (40.5±15.9 years old on the average) at the time of first diagnosis. The period of time which had paseed since their first diagnosis ranged from 10 to 16 years (11.6±1.5 years on the average) . As a result, JOA score for clinical symptoms was improved from the average score of 24.7±2.3 at the time of first diagnosis to the average score of 27.1±2.8 at the time of this study, though no case was improved in the roentogenography. Only 4 cases (their score at the time of this study were 14, 17, 24, and 25, respectively) were found worse. The improvement in the score for the activitied of daily living contributed to the improving tendency at the time of this study. In conclusion, the conventional conservative therapy should be taken to treat the patients with spondylolysis, and preventive operation is not considered necessary even for the treatment of the patients with complication of spondylolysis and spondylolisthesis. 腰椎分離症, 分離すべり症の自然経過を解明すべく初診後10年以上経過症例に対し検討を加えた.対象は, 55例で男性28例, 女性27例.初診時年齢は4～75歳 (平均40.5±15.9歳) , 経過期間は, 10～16年 (平均11.6±1.5年) , 調査時年齢は14～85歳であった.罹患椎は, 第5腰椎52例 (両側40例, 片側12例) , 第4腰椎2例 (両側1例, 片側1例) 第4, 5腰椎1例 (両側例) .初診時分離のみの症例は35例, 分離すべり症を呈していた症例は20例であった.初診時と調査時における自覚, 他覚症状及び日常生活動作について日整会腰痛治療判定基準 (以下, 日整会判定) を用い比較した.X線学的検査では, 関節突起問分離部の形態的分類およびその推移, 椎間板高の変化, すべり度の判定およびその推移, 罹患椎の不安定性の有無につき検討をくわえた.結果: 臨床症状は日整会判定で初診時平均24.7±2.3点であった臨床症状が調査時平均27.1±2.8点となっており55症例中51症例に改善または不変が認められ, 悪化例は4例 (調査時点数14, 17, 24, 25) のみであった.全体として自覚症状で平均1.0点, 他覚症状平均-0.05点, 日常生活動作では平均1.8点の改善度であり, 日常生活動作の改善が調査時における改善傾向に貢献していた.初診時および調査時に膀胱直腸障害を認めた症例はなかった.X線学的変化では, 初診時亀裂型を呈していた8症例中6例が偽関節型に移行していたが罹患部に癒合の認められた症例はなかった, 初診時分離すべり症を呈していた症例中すべり度が増大した症例は14例であり, 不変2例, 減少4例であった.一方, 新たなすべりの発生を5症例に認めた.椎間板高に関しては調査時, 全体として減少傾向にあった分離症, 分離すべり症との間に特別な関係は見いだせなかった.不安定性が判明した症例は10症例であった.臨床症状とX線学的変化の関係では特別な相関を示したものは認められなかった.以上より, 分離症に関しては, 従来通り保存的療法で経過をみるべきであり, 分離すべり症に関しても, 予防的手術は必要ないものと思われた.
Author SAKAGAWA, Hajime
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References_xml – reference: 15) 坂口義正: 日整会誌, 28: 595, 1954.
– reference: 8) 伊藤忠厚: 災害医学, 15: 887, 1972.
– reference: 27) 磯部憲二, 他: 日整会誌, 48: 768. 1974.
– reference: 14) 小田祐, 他: 臨整外, 17: 340, 1982.
– reference: 22) 大成清一郎, 他: 日整会誌, 35: 903, 1961.
– reference: 21) 遠藤邦工, 他: 日整会誌, 46: 842, 1972.
– reference: 4) 神中正一: 日整会誌, 4: 1, 1929/30.
– reference: 24) 尾股定雄, 他: 日整会誌, 48: 769, 1974.
– reference: 29) 河野左宙: あすへの整形外科展望'75, (初版) (伊丹康人, 他編) , p. 279. 金原出版, 東京, 1975.
– reference: 3) Schmorl: Dtsch., Z. Chir., 237: 422, 1923.
– reference: 9) 小宅三郎, 他: 日整会誌, 33: 550, 1959.
– reference: 16) 松田俊雄, 他: 整形外科 Mook. 33: 72, 1984.
– reference: 20) Wilste, L. L., et al.: J. Bone Joint Surg. [Am] , 57: 17, 1975.
– reference: 7) 土橋善蔵: 日整会誌, 46: 387, 1972.
– reference: 12) 楠本剛夫: 東女大誌, 48: 926, 1978.
– reference: 10) Saraste, H., et al.: Int. Orthop., 8: 163, 1984.
– reference: 19) 秋本毅: 新潟医会誌, 94: 621, 1980.
– reference: 30) Iwahara, T. and Hirabayasi, K.: J. Jpn. Orthop. Assoc., 36: 1049, 1963.
– reference: 18) 田島健, 他: 整形外科 Mook, 33: 58, 1984.
– reference: 11) Taillard, W.: Acta Orthop. Scand., 24: 115, 1954.
– reference: 23) 平林洌, 他: 日整会誌, 44: 706, 1970.
– reference: 26) Hirabayasi. K., et al.: J. Jpn. Orthop. Assoc., 45: 675, 1972.
– reference: 28) 山田弘明, 他: 日整会誘, 48: 768. 1974.
– reference: 5) 森崎直木, 他: 災害医学, 15: 878, 1972.
– reference: 6) 中川一刀: 日整会誌, 44: 99, 1970.
– reference: 13) 高山篤也, 他: 関東整災誌, 14: 29, 1983.
– reference: 25) 井上駿一, 他: 臨整外. 6: 371. 1971.
– reference: 1) Wilste, L.: Spinal Disorders (1st. Ed.) , (Ruge. D. and Wilste, L., Eds) , p.193, Lea and Fibiger, Philadelphia, 1977.
– reference: 2) Neugenbauer, F. L.: Zentralbl. Gynakol., 2: 260, 1888.
– reference: 17) 松井宜夫, 他: 整形外科 Mook, 33: 45, 1984.
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Title A STUDY ON THE NATURAL HISTORY OF SPONDYLOLYSIS AND SPONDYLOLYSTHESIS
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