腰维管狭窄症的病理生理学研究进展

腰椎管狭窄症是由于椎管狭窄导致马尾神经或/和神经根受压所出现的一组综合征。脊椎随年龄增大而发生退行性变化,从而引起一系列病理解剖和病理生理改变。除狭窄外,异常的脊椎可进一步增加神经压迫的程度。随着退行性改变和神经压迫程度的发展,椎管狭窄症的症状出现或加重,但症状的严重程度与影像学上神经压迫的程度并不完全呈正相关关系。1　腰椎管狭窄症的分类腰椎管狭窄症分为先天性椎管狭窄(发育性椎管狭窄)、后天性椎管狭窄(获得性椎管狭窄)和混合性椎管狭窄[1]。先天性狭窄常见于软骨发育不良或其他身材矮小综合征(ｓｈｏｒｔ-ｓｔａ…     

腰骶神经根造影封闭的应用

目的探讨神经根造影封闭对腰椎间盘突出症和椎管狭窄症的诊疗意义。方法,对５９例根性症状明显者作选择性神根造影。结果６例穿刺失败,４１例显影异常,于造影后即作封闭,观察６个月无感染和神经根损伤。神经根异常图像在椎间盘突出多为椎体上缘或小关节突出缘充盈缺损中继,椎管狭窄时以边缘不整像为主,根据封闭提示对多节段椎间盘突出作单节段有限于术。结论该方法可作为椎间盘突出 及椎管狭窄的影像和功能诊断手段,封闭有一     

腰椎间盘突出症手术后马尾神经损伤综合征

目的：探讨腰椎间盘突出症手术引起马尾神经损伤的机理及预防；方法：对10例患者进行综合分析，根据症状体征影像学资料诊断，并进行手术探查进一步确诊，同时进行椎管及神经根管减压；结果：术后对患者进行随访，术后患者有不同程度的恢复。结论：腰椎间盘突出症手术引起马尾神经损伤综合征的病理基础是腰椎管及或神经根管狭窄，以及治疗的错误加重了发病的机率。     

腰椎管狭窄症

腰椎管狭窄症是指构成椎管、神经根管的骨或纤维结构，由于退变等因素造成其容积或形态的变化，并产生椎管内容纳的神经、马尾及血管等受压，所致的相应临床表现，是导致腰腿痛或腰痛的常见病之一。自Verbiest(1954)首先提出“腰椎管狭窄症”这一疾病诊断，迄今为止骨科界对该病的病因、临床表现和治疗已有了较深刻的认识。腰椎管狭窄可     

腰椎管狭窄症病理学研究进展

腰椎管狭窄症病理学研究进展尚培中，张振海综述吴琦审校腰椎管狭窄症是由先天或后天原因造成的中央椎管及神经根管口径缩小，导致马尾及神经根受压而产生的临床综合征。椎间盘突出和其它软组织占位通常不列入椎管狭窄症而独立诊断。［１］近年来，随着研究的不断进展，人...     

腰椎管狭窄症病理形态学基础及椎管造影表现

腰椎管狭窄症是由先天或后天原因造成的中央椎管、神经根管及椎间管容量减少，导致马尾及神经根受压而产生临床症状的一组综合征。椎间盘突出及其它软组织占位性病变通常不视为椎管狭窄症’‘’。近年来，随着研究的不断进展，人们对该症的病理形态学基础及椎管造影表现有了更全面、深入的认识。l黄韧带肥厚黄韧带是中央椎管后外侧壁和神经根管后壁的重要组成部分，主要由弹性纤维构成，连接相邻椎骨的推板和椎间小关节，大致可分为两部分：内侧部位于椎板之间，参与构成中央椎管的后壁和后外侧壁，该处韧带自上一椎骨椎板的前下线连接到下…     

腰椎管狭窄症的治疗(综述)

腰椎管狭窄症的发生,是由于腰椎管、神经根管或椎间孔这些管腔的一个或全部发生狭窄时,压迫椎管内的马尾或脊神经根而造成的。造成狭窄的原因,常由于骨质或软组织的变化,如椎管中心型狭窄,主要由于椎板肥厚、黄韧带肥厚或伴有椎间盘突出,或由于小关节骨关节炎,增生的关节突向椎管内挤压。而周缘型狭窄(指在神经根管内或椎间孔发生的     

腰椎管狭窄合并神根松弛症的临床与影像学特点分析

目的探讨腰椎管狭窄合并神经根松弛症(Redundant nerve roots,RNRs)患者的临床及影像学特点。方法回顾性分析自2014-01-2015-12本院手术治疗的腰椎管狭窄症患者298例,依据磁共振T2序列腰椎椎管内马尾神经迂曲团状的信号影,分成单纯椎管狭窄组195例,椎管狭窄合并RNRs组103例。比较两组在年龄、性别、椎管狭窄水平及RNRs等方面的临床及影像学特点。结果两组患者性别差异统计学意义(P0.05),但椎管狭窄合并RNRs组的年龄显著高于单纯椎管狭窄组(P0.05),提示年龄较大者更易合并RNRs;椎管狭窄合并RNRs组的L2-L4节段椎管狭窄比例更高(P0.05),提示该节段椎管狭窄者更易合并RNRs。位于椎管狭窄节段水平之上的马尾神经长度,显著大于狭窄节段水平之下者,提示其更易发生RNRs(P0.05)。结论高龄、狭窄段L2-L4的腰椎管狭窄患者,以及狭窄节段水平之上的马尾神经更易合并RNRs。     

脊髓造影对腰椎滑脱症手术方法选择的意义

目的：探讨脊髓造影对腰椎滑脱症患者手术方法选择的意义。方法：对43例腰椎滑脱症患者术前行脊髓造影检查，根据患者症状，体征及脊髓造影检查结果要用三种不同的手术方法：（1）脊髓造影显示椎管通畅，神经根充盈良好者采用后路椎弓根肉固定，椎板、枘突间植骨，共11例：（2）兴髓造影显示一侧神经根充盈欠佳，椎管部分狭窄，进行切开复位、骨固定，症状侧半椎板减压或神经根管扩大加横突间小关节突外侧植骨，对侧椎板，横突间植骨，共10例；（3）脊髓造影表现椎管完全梗阻，双侧神经根充盈欠佳，进行切开复位，内固定，全椎板减压和神经根管扩大，横突间小关节突外侧植骨或加椎间融合、共22例。结果：所有患者均获得随访，随访时间12-28个月，平均19.1个月，神经功能评定按照JOA评分标准，术后神经功能改善率76%。参考候树勋等疗效评价标准，临床优良率为86.1%。结论：脊髓造影对腰椎骨脱症患者椎管减压、植骨方式的选择有重要参考价值。     

腰椎管狭窄症的外科治疗（附113例临床分析）

将１１３例腰椎管狭窄症分为马尾型、神经根型和混合型，采用选择性椎管减压术治疗。３１例马尾型行广泛椎板切除和双侧椎板扩大开窗术，５４例神经根型单侧或双侧神经根管减压术，２８例混合型单侧或双侧椎板和神经根管同时减压术。经五年以上随访疗效满意率９１％。本文着重讨论影像学和术中所见的病理改变和选择性椎管减压术的方法和优点。     

Redundant nerve roots of the cauda equina: clinical aspects and consideration of pathogenesis

In order to investigate the clinical significance of redundant nerve roots of the cauda equina (RNR) and their pathogenesis, the following studies were performed: 1) examination of 1,256 myelograms of patients with lumbar disease; 2) clinical analysis of 55 patients with RNR and 75 without RNR; 3) electrophysiological examination of 9 patients with RNR; and 4) anatomical and histopathological examination of 6 autopsy cases. RNR were found in 42% of patients with severely constricted spinal canals. In comparing patients with RNR and those without RNR, RNR were found in older patients, these patients exhibited a longer period from the onset of the symptoms to the time of myelographic manifestation, and they caused more severe signs and symptoms. The spatial distribution of redundant nerve roots and the extent of degeneration of nerve fibers in redundant nerve roots indicated the close causal relationship between RNR and constriction of the spinal canal. As the pathogenesis of RNR, the authors suggest a squeezing force from the constricted spinal canal acting on the nerve roots.     

Redundant nerve roots in patients with degenerative lumbar spinal stenosis

Extensive fundamental and clinical investigations have been performed concerning redundant nerve roots (RNR) and the pathogenesis of cauda equina claudication (CEC) in degenerative lumbar canal stenosis (DLCS). These investigations consisted of (1) anatomic observations on RNR in 117 fixed cadaveric specimens, (2) myelographic study in 117 patients with or without DLCS, (3) operative observation on neural elements with special reference to the cauda equina in 56 DLCS patients (including a postoperative follow-up), and (4) electrophysiologic tests using spinal cord action potential recording under walking load preoperatively and intraoperative measurement of nerve conduction velocity of RNR. The RNR have neuronal losses resulting from a longer duration stenosis that suggests a sort of friction neuritis. Complicated factors contribute to the pathogenesis of CEC and the development of root gripping, such as the magnitude of RNR, the extent of the stenosis, a narrowed sac, age-dependent axial shortening of the spinal canal, and dynamic or postural factors. In cases with severe RNR, satisfactory operative results can be obtained only after thorough decompression with dural incision.     

Syndrome of redundant nerve roots of the cauda equina. Apropos of 2 cases

Redundant nerve roots of the cauda equina (RNR) are considered to be extremely rare. This finding was reported for the first time in 1953 by Verbiest and since then several articles have being published on this subject. In an extensive review of the literature we have found 60 cases of RNR, 54 cases of which were operated including two new cases that we report in the present article. The RNR consist of elongated, tortuous and serpiginous nerve roots of the cauda equina. This disorder mainly affects males and the clinical history ranges from few months to three decades. The illness often start by a low back pain or sciatica associated or not with weakness or parasthesia of the lower limbs. There is sometimes a medullar claudication with gait ant sphincters disturbances. The electromyogram shows signs of chronic denervation and there is a high protein level in the CSF exam. X-rays of the lumbosacral spine show spondylarthrosis generally associated with a narrow spinal canal. The diagnosis is made by a lumbar myelogram which shows a partial or complete block of the column contrast. Serpentine defects suggest an arteriovenous medullar malformation, but the aortic angiogram is normal. At the opening of the dura-mater there is a sudden extrusion of the roots which are under pressure. The elongated roots are generally knotten or curled. One or several roots are very long but their diameter and aspect are normal. The treatment includes a decompressive lumbar laminectomy associated with a decompressive duroplasty.(ABSTRACT TRUNCATED AT 250 WORDS)     

The narrow lumbar spinal canal or lumbar spinal stenosis.

Narrow lumbar spinal canal or lumbar spinal stenosis is a not uncommon problem. Thirty-two patients with this disorder have been treated surgically at the Ochsner Medical Center between 1963 and 1973. The best method of diagnosis is a careful history and second is roentgenographic evidence, particularly the myelogram. The surgical treatment consists of total laminectomy and foraminotomy to insure complete decompression of the nerve roots. Eighteen patients have been followed from 14 to 44 months. Sixteen of the 18 considered their operations a success.     

Redundant nerve roots of the cauda equina caused by lumbar spinal canal stenosis.

To investigate pathogenesis of redundant nerve roots of the cauda equina, which were concomitant with severe lumbar spinal canal stenosis, six cadavers were examined anatomically and histopathologically, and quantitative analysis of nerve fibers was performed. In this anatomic study, it was observed that all the redundant nerve roots passed through the constriction of the spinal canal. No significant pathologic change was detected in the spinal ganglia and in the spinal cords except for the posterior column, in which dorsal redundant roots were entering. Redundant nerve roots of unequal length also were observed in the anatomic study. The spatial distribution of redundant nerve roots and the extent of degeneration of nerve fibers in them were established by these histopathologic and quantitative studies. These facts indicated a close causal relationship between redundant nerve roots and constriction of the spinal canal, and that the pathogenesis of redundant nerve roots was a squeezing force acting on the nerve roots at the area of spinal canal constriction.     

退变性腰椎椎管狭窄症的病理变化及诊断治疗

本文报告１４６例退变性腰椎椎管狭窄症，其目的在于：探讨腰椎退变与椎管狭窄的关系，退变性椎管狭窄的临床特点及其治疗方法问题。本组全部经手术治疗，椎管扩大减压包括侧隐窝扩大，充分暴露受压神经根和硬膜囊是提高治疗效果重要措施，维持腰椎稳定是外科治疗重要内容。１３２例随访，平均３８个月，优良者１１２例（８４．８％）。研究表明，退变性腰椎管狭窄症，除中央椎管狭窄外，神经根管（包括侧隐窝）狭窄更多见。在外科治疗时必须注意这种病理变化特点，避免遗漏，影响手术效果。     

选择性神经根阻滞在腰椎有限手术中的应用

目的：总结选择性神经根阻滞在腰椎有限手术中的临床应用结果。方法：2008年1月至2012年10月,对68例多平面腰椎管狭窄症患者采用选择性神经根阻滞,其中男47例,女21例;年龄45～80岁,平均56岁。神经根阻滞后64例为阳性患者进行了腰椎有限手术,另4例封闭后症状减轻不明显为阴性,难以确定手术平面或引起症状的神经根,放弃了手术治疗。术后采用Macnab腰腿痛手术治疗评定标准进行疗效评定。结果：神经根阻滞操作过程顺利,未发生与神经根阻滞相关的并发症,术后无神经损伤并发症。术后随访16～45个月,平均32个月。术后根据Macnab腰腿痛手术治疗评定标准进行疗效评定,优44例,良18例,差2例。结论：对腰椎管狭窄症的手术治疗重点应放在压迫引起症状的部位,而对无症状的部位不做预防性减压操作。应用神经根阻滞能准确判断责任椎与疼痛源,提高腰椎有限手术的疗效。     

Diagnosis of nerve root compression. Myelography, computed tomography, and MRI.

Current technology and published studies support the preferential use of MRI in the diagnosis of cervical myelopathy. In cervical radiculopathy, data support the use of either contrast-enhanced CT or MRI. We prefer MRI as the initial diagnostic test because of the obvious advantage of its noninvasive nature. Similar to myelography, MRI permits visualization of the entire cervical canal and spinal cord. Unlike routine CT, MRI visualizes the spinal cord and nerve roots in two planes and is better in detecting unsuspected pathology at other cervical segmental levels. Because the quality of MRI scans in the cervical spine is subject to more variation than in the lumbar spine, anticipated pathology is sometimes not clearly visualized by cervical MRI. Under such circumstances, we obtain a water-soluble myelogram followed by contrast-enhanced CT. Because inaccurate radiographic diagnosis is one of the identifiable causes of poor outcome in surgical therapy for cervical spondylosis, accurate visualization of pathology in terms of its location, nature, and extent is imperative before performing decompressive cervical spine surgery.     

退变性腰椎管狭窄症的手术治疗

目的探讨退变性腰椎管狭窄症（degenerative lumbar spinal stenosis,DLSS）手术治疗方法。方法回顾性分析2003年1月至2011年1月我院185例退变性腰椎管狭窄症手术治疗病例。其中神经根管狭窄6例,中央管狭窄179例。单节段狭窄者96例,双节段狭窄者55例,3个节段狭窄者34例。采用单纯开窗减压者6例,后路全椎板切除减压、后外侧植骨融合、内固定70例,后路全椎板切除减压、椎体间植骨融合、内固定109例。根据日本矫形外科学会腰腿痛评分系统（15分）进行术前和术后的疗效评价。结果 185例患者获得8～72个月随访,平均随访时间19.5个月。三种手术方法术后平均改善率分别为77.9%、78.8%和79.5%,优45例,良120例,可20例,优良率为89.2%。术后并发脑脊液漏6例。结论根据DLSS患者病情和影像学检查结果,确定狭窄的部位和节段,对神经根管狭窄者,采用单纯开窗减压;对中央管狭窄者,采用全椎板切除减压、椎体间植骨融合和/或后外侧植骨融合、椎弓根系统内固定,尤其是对于合并腰椎节段性不稳定、退变性滑脱、侧弯和后凸者,可获得满意的疗效。     

Lumbar spinal stenosis. Radiographic diagnosis with special reference to transverse axial tomography.

Spinal stenosis due to malalignment and/or hypertrophy of the bony margins of the spinal canal is a recognized cause of cauda equina compression and nerve root entrapment. The plain lumbosacral spine roentgenograms reveal the number of lumbar vertebrae, their alignment, their interpedicular distances, the height of the intervertebral disk spaces and the presence of osteophyte formation. It correlates poorly with encroachment on the spinal canal. The transverse axial tomogram directly demonstrates a cross-section of the spinal canal and will show abnormal areas of bone encroachment usually arising from hypertrophied lamina and articular processes. These narrow the posterior portion of the spinal canal and encroach on the lateral recesses. This examination does not demonstrate soft tissue hypertrophy and the stenosis may be even greater than what is apparent due to the bony encroachment. The myelogram expresses how the narrowed spinal canal affects the dural sac and its contained cauda equina. Not infrequently there is an associated herniated disk.