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Abstract(s)
A espondilolistese consiste na translação de uma vértebra sobre a seguinte, em direção anterior ou posterior e geralmente a nível de L5-S1. Nos adolescentes atletas é uma patologia para a qual ainda não existe um algoritmo de tratamento, o que se traduz numa abordagem distinta por parte de cada médico quando confrontado com estes casos. A incidência verifica-se aumentada neste grupo em particular, dado que praticam atividades que implicam movimentos de hiperextensão, tendo como consequência a manifestação mais acentuada de dor lombar. Caso não seja tratada, a espondilolistese torna-se uma patologia com manifestações incapacitantes para o adolescente atleta. Para uma otimização da decisão terapêutica, a espondilolistese é classificada em vários graus, o que permite reconhecer quais serão aqueles com maior probabilidade de progressão. Para todos os graus de espondilolistese, é recomendado iniciar o tratamento conservador. Quando não se observam resultados positivos, após um período mínimo de seis meses de tratamento, é considerado o tratamento cirúrgico. A escolha varia entre artrodese in situ (geralmente sem redução) para os casos menos graves, ou quando associada a espondilólise, uma reconstrução da lesão na pars é o mais indicado, porque permite mobilidade deste segmento da coluna.
Relativamente aos casos que apresentem graus de deslize superiores a 50%, sintomas neurológicos que afetem a qualidade de vida ou progressão da espondilolistese, é geralmente necessário o tratamento cirúrgico. As técnicas de fusão com fixação e estabilização têm apresentado bons resultados a longo prazo, no entanto são procedimentos complexos, com possíveis complicações, pelo que a decisão de qual a melhor técnica cirúrgica deve ser bem ponderada e esgotados todos os recursos conservadores previamente a esta decisão.
Todavia, são necessários mais estudos, com follow-up a longo prazo que comparem a melhor abordagem terapêutica realizada nesta população, de modo a diminuir o tempo de recuperação e permitir um retorno ao desporto de forma saudável e segura.
Spondylolisthesis consists in the translation of one vertebra over the next, in anterior or posterior direction and usually at the L5-S1 level. In the adolescent athletes it still remains a pathology for which there is no treatment algorithm, which translates into a distinct approach by each physician when confronted with these cases. Therefore, the incidence is increased in this particular group, since they practice activities that involve hyperextension movements, resulting in a more pronounced manifestation of low back pain. If left untreated, spondylolisthesis becomes a pathology with disabling manifestations for the adolescent athlete. In order to optimize the therapeutic decision, the spondylolisthesis is classified into several degrees, which allows to recognize which types are at greater risk of progression. For all grades of spondylolisthesis, it its recommended to start non-surgical treatment. If after a minimum of six months of treatment, no positive results are observed, surgical treatment is considered. The choice varies between arthrodesis in situ (usually without reduction) for less severe cases, or when associated with spondylolysis, a reconstruction of the lesion in the pars is the most indicated, because it allows mobility of this segment of the spine. For those cases with degrees of slip greater than 50%, neurological symptoms that affect the quality of life or with progression of spondylolisthesis, surgical treatment is usually necessary. The techniques of fusion with fixation and stabilization have shown good results in the long term, however they are complex procedures, with possible complications, such as pseudarthrosis and nerve compression. Ultimately the choice of the best surgical technique should be well thought and only after experimenting all the non-surgical resources prior to this decision. However, further studies are needed, with long term follow-up, comparing the best therapeutic approach performed in this population, in order to decrease recovery time and allow a healthy and safe return to sports.
Spondylolisthesis consists in the translation of one vertebra over the next, in anterior or posterior direction and usually at the L5-S1 level. In the adolescent athletes it still remains a pathology for which there is no treatment algorithm, which translates into a distinct approach by each physician when confronted with these cases. Therefore, the incidence is increased in this particular group, since they practice activities that involve hyperextension movements, resulting in a more pronounced manifestation of low back pain. If left untreated, spondylolisthesis becomes a pathology with disabling manifestations for the adolescent athlete. In order to optimize the therapeutic decision, the spondylolisthesis is classified into several degrees, which allows to recognize which types are at greater risk of progression. For all grades of spondylolisthesis, it its recommended to start non-surgical treatment. If after a minimum of six months of treatment, no positive results are observed, surgical treatment is considered. The choice varies between arthrodesis in situ (usually without reduction) for less severe cases, or when associated with spondylolysis, a reconstruction of the lesion in the pars is the most indicated, because it allows mobility of this segment of the spine. For those cases with degrees of slip greater than 50%, neurological symptoms that affect the quality of life or with progression of spondylolisthesis, surgical treatment is usually necessary. The techniques of fusion with fixation and stabilization have shown good results in the long term, however they are complex procedures, with possible complications, such as pseudarthrosis and nerve compression. Ultimately the choice of the best surgical technique should be well thought and only after experimenting all the non-surgical resources prior to this decision. However, further studies are needed, with long term follow-up, comparing the best therapeutic approach performed in this population, in order to decrease recovery time and allow a healthy and safe return to sports.
Description
Keywords
Adolescente Atleta Espondilolistese Lombalgia Tratamento