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U
pdate
on
degenerative
spondylolisthesis
:
surgical
treatment
R
ev
A
ssoc
M
ed
B
ras
2014; 60(6):505
505
Accreditation
Update on degenerative spondylolisthesis: surgical treatment
A
tualização
em
espondilolistese
degenerativa
:
tratamento
cirúrgico
B
ernardo
WM, B
otelho
RV, F
oni
NO, G
otfryd
AO, H
errero
CFPS, J
efferson
D, M
eves
R, M
udo
ML, S
imões
RS,
Z
ylbersztejn
S
http://dx.doi.org/10.1590/1806-9282.60.05.0031. Is the use of bone substitutes such as BMP (bone
morphogenetic protein) safe and effective in lum-
bosacral arthrodesis?
a.
It is safe due to lack of complications.
b.
Complications include osteolysis and heterotopic os-
sification.
c.
The routine use is recommended in spondylolisthesis.
d.
Clinical results with iliac grafts are superior.
2. Bone substitutes are equal or superior to auto-
grafts in this situation?
a.
The removal of autologous bone graft from the iliac
bone is radiologically superior.
b.
Bone substitutes are contraindicated in this clinical
situation.
c.
The association of local bone graft (from the poste-
rior vertebral elements) and beta-tricalcium phos-
phate is a therapeutic option.
d.
The removal of autologous bone graft from the iliac
bone is clinically superior.
3. What is the most appropriate diagnostic study
in this clinical context?
a.
In the presence of symptomatic lumbar stenosis, the
most sensitive and specific radiologic examination is
computed tomography (CT).
b.
Plain radiographs in the standing position does not
determine the diagnosis.
c.
Magnetic Resonance Imaging (MRI) is more sensi-
tive and specific in identifying the narrowing of the
spinal canal.
d.
The most appropriate diagnostic test in this situa-
tion is plain radiography.
4. Is it necessary to refer the patient to arthrodesis
with use of rigid pedicle screws (non-dynamic)?
a.
Instrumentation does not increase fusion rate.
b.
Instrumented fusion produces less progression and
improved walking ability.
c.
A side effect of fusion is increased radicular pain.
d.
There is subjective improvement independent of sol-
id fusion.
5. How long should conservative treatment (non-
-surgical) be maintained?
a.
In treatment failure after 1 year of therapy.
b.
Medical and surgical treatments have similar results,
differing in required time.
c.
After 12 weeks of failure in conservative treatment.
d.
Spondylolisthesis is an absolute indication for sur-
gical treatment.