Fusion after Bosworth spondylolisthesis

Bosworth spinal spondylolisthesis is used for surgical treatment of spondylolisthesis in children. Children with spondylolisthesis are displaced forward or backward by the vertebral arch due to rupture of the vertebral arch. The forward shifter is called the anterior spine slip; even if the shift is backward, it is called posterior spine slip; if there is no shift, the pedicle is cracked. The cause of the disease is thought to be related to factors such as congenital lamina isthral defect, trauma and isthmus developmental disorders. Children with spondylolisthesis occur mostly after the age of 10 and are most common at 14 years old. When the spine is slipped, it can often directly compress the spinal nerves or cause disc herniation, muscle spasm and ligament damage. It occurs in L5, which accounts for about 90%, sometimes in L3 to L4, and occasionally in C5 to C6. Lumbar spine slippery manifestations of trunk shortening, lumbar lordosis increased significantly, may have low back pain, severe cases may occur sciatica, skin sensory disturbances, limited bending activities, straight leg elevation test positive, knee and Achilles tendon The reflection is weakened or disappeared, and even the incontinence is incontinent, and the lower limbs are incomplete. Occurred in the cervical spine may have neck pain, muscle spasm, torticollis, restricted neck activity, and even difficulty swallowing. According to the X-ray film, according to the severity of the upper vertebral body relative to the lower vertebral body slip, the spondylolisthesis can be divided into I, II, III, IV, V degrees. The I degree slippery vertebral body is displaced forward to less than 25% of the anteroposterior diameter of the lower vertebral body, the second degree is 25% to 50%, the third degree is 50% to 75%, the IV degree is >75%, and the V degree is (the spine). Advance shift) is the complete separation of the superior vertebral body from the lower vertebral body. In the choice of treatment, for those who are not obvious, and the X-ray film is only shifted by one degree, non-surgical treatment is adopted, including restricting patient activity, back muscle massage, traction and brace fixation therapy. About 20% of patients with symptomatic spondylolisthesis need surgery. For patients with painful spondylolisthesis, the younger the patient, the more certain the indications for surgery and the better the surgical outcome. Sciatica is often the cause of surgical treatment in this type of patient. Spinal fusion, spinal fusion, internal fixation plus spinal fusion can be used according to different conditions. Treatment of diseases: pediatric spina bifida Indication Bosworth Spinal Spondy Fusion is suitable for: 1. Spine slips at 2 degrees or more, and has lower back, buttocks and thigh pain. 2. There are symptoms of sciatica. 3. There are hamstring tendons. 4. Although there are no obvious symptoms, but the spine slips off III degrees or more than III degrees. Contraindications 1. The spine slips off 1 degree and is asymptomatic. 2. The symptoms are not aggravated after non-surgical treatment. Preoperative preparation 1. Take a full spine X-ray positive lateral slice to determine the type and extent of spinal spondylolisthesis. In addition, conventional myelography or CT or MRI examination to understand the compression of the spinal canal and nerve roots. 2. Electrophysiological examination: to understand whether the spinal nerve root is damaged, and as a follow-up control. 3. Blood biochemical examination: blood CPK and liver and kidney function tests, to understand the basic conditions of the body. 4. Spinal traction: 2 weeks of preoperative traction, the paravertebral muscles, ligaments and facet joints are relaxed, which is conducive to intraoperative reduction. 5. Application of antibiotics: A sufficient amount of broad-spectrum antibiotics was given 24 hours before surgery. Surgical procedure Incision A median longitudinal incision was made after the spine, from the L3 spinous process to the S1 spinous process. 2. Reveal the lamina Cut the skin and subcutaneous tissue along the direction of the incision, cut L4S1, the supraspinous ligament, and peel off to both sides. The paravertebral muscles were pushed to the outside with a periosteal stripper against the spinous processes and under the periosteum until a partial transverse process was revealed. After the bilateral lamina is exposed, the incision is retracted with an automatic hook. The soft tissue attached to the intervertebral and spinous processes was then completely removed with a rongeur and a curette. 3. Laminectomy and "H" bone grafting The L4 spinous process lower pole and the S1 median upper iliac crest were partially removed, and then the L5 lamina was loosened and the L5 vertebral arch was removed and decompressed. If there is a symptom of nerve root compression before surgery, nerve root canal exploration must be performed to release the nerve root and relieve the root compression factor. Then, a rough surface is formed on the left part of the L4 and S1 lamina and the L5 pedicle, and the bone strip is formed on the rough surface with the autogenous tibia. Then use two towel clamps to lift and retract the L4 spinous process and the S1 median iliac crest. The H-shaped bone block is formed by the autogenous iliac bone and embedded in it. The bone graft can be placed in the broken bone block with the upper and lower spinous processes and the lamina. To enhance the bone healing process. 4. Close the incision Thoroughly stop bleeding, flush the wound with saline, and suture the incision layer by layer. complication Pseudoarticular formation is the main complication of this surgical procedure, mostly due to premature postoperative activity or intraoperative bone area and bone graft without rough surface. If there is poor healing of the bone graft, the bed time should be extended until the bone is healed firmly. If you still do not heal after half a year of observation, you must re-bone the bone.