单侧小关节分级切除对同节段腰椎间孔形态影响的实验研究

[目的]了解单侧腰椎小关节分级切除对不同运动状态下同节段腰椎间孔形态变化的影响机制.[方法]取8例新鲜尸体脊柱腰段完整标本,依次进行分级切除L4j的后部结构,造成5种减压情况,依次测量加载前后各组L4、5椎间孔高度及最大、最小宽度值并比较分析.[结果]①完整组标本负载荷状态下,L4、5椎间孔各孔径均减小而且变化存在显著性差异;以扭力矩加载时,L4、5椎间孔高度及最大、最小宽度分别在中立位、后伸、同侧弯状态下三者均显著减小,在前屈、对侧弯状态下明显增大;②在中立位、后伸位和同侧弯体位负载时,当腰椎单侧小关节切除大于1/2后,L4、5椎间孔孔径均有显著性差异.[结论]在外科操作进行后部结构切除手术时,尤其是小关节切除手术应严格掌握指征.     

腰椎间盘突出症骨性椎间孔的测量分析

目的研究腰椎间盘突出症骨性椎间孔的病理变化规律,探讨腰椎间孔狭窄的发病机制。方法对100例无下腰痛病史及腰椎畸形的人群(正常组)和59例L4～5椎间盘突出症患者(L4～5突出组)拍摄标准腰椎X线侧位片。在侧位片上分别测量L3～4及L4～5椎间隙高度、椎间孔高度、椎间孔上部宽度;采用"同身法"处理后进行统计分析。结果 L4～5突出组病变椎间隙高度、椎间孔高度和椎间孔上部宽度均较正常组明显变小(P<0.001);椎间孔高度与椎间隙高度变化正相关;椎间孔上部宽度与椎间孔高度变化正相关。结论 L4～5椎间盘突出症患者的病变节段骨性椎间孔高度和上部宽度明显变小,腰椎间孔有效空间明显减少;椎间孔的高度随腰椎间盘退变的加重而减小;腰椎间盘退变对腰椎间孔上部宽度无直接影响;腰椎间孔高度和上部宽度的变化有关联性。     

不同颈椎间盘手术对邻近下位椎间孔影响的生物力学研究

目的探讨C5、6人工椎间盘置换、椎间盘摘除、前路椎间融合内固定后对邻近下位椎间孔形态改变的影响,为临床应用颈人工椎间盘置换提供理论依据。方法新鲜成人尸体颈椎标本11具,标本节段包括C3～T1椎体及其椎间盘。11具标本按测试先后顺序分成C5、6完整组、髓核摘除组、置换组及椎间融合内固定组,在0.75、1.50 Nm载荷下测量前屈和后伸状态邻近下位椎间孔高度、宽度的改变,并比较加载前后组内及组间的变化范围（range of variety,ROV）。结果各组颈椎标本在0.75 Nm和1.50 Nm前屈下,C6、7的椎间孔高度、宽度明显增加,在后伸下显著下降,且差异均有统计学意义（P〈0.01）。各组在0.75、1.50 Nm两级载荷下,组内比较位移变化明显,差异有统计学意义（P〈0.01）。在两种负载下,完整组、髓核摘除组与置换组在前屈和后伸状态下,组间两两比较邻近下位椎间孔高度和宽度ROV差异无统计学意义（P〉0.05）;融合组明显高于其余3组,且差异有统计学意义（P〈0.05）。在两种载荷的同组和同状态下,高度和宽度ROV比较差异均有统计学意义（P〈0.01）。结论实验初步证明颈人工椎间盘置换符合颈椎正常的生物力学要求;颈椎间孔屈曲时增大,后伸时减小;椎间融合可能是引起颈椎退变和/或退变加速的原因之一,亦可能是神经根型颈椎病和椎孔外臂丛神经卡压的原因之一。     

棘突撑开与小关节、椎间孔形态变化关系的初步实验研究

目的 观察棘突撑开程度与小关节移位、椎间孔形态变化的关系.方法 使用6具新鲜腰椎尸体,制作标本,保留关节突周围关节囊韧带及棘间韧带,通过分别撑开L3/4,L4/5棘突,测量相应节段小关节间相对位移、椎间孔高度及宽度改变.结果 棘突撑开2 mm、4 mm后,L3/4、L4/5腰椎间孔高度增大、小关节位移改善均有明显差异,椎间孔宽度的改变在撑开2 mm无明显差异,在撑开4 mm时宽度增大有统计学差异.结论 棘突撑开能有效改善小关节位移、增加椎间孔高度,但对于椎间孔宽度的增加需要撑开足够距离.     

不同体位X线片上腰椎间孔的变化及在经皮椎间孔镜手术中的意义

目的 :测量腰椎间孔在中立、过伸和过屈侧位X线片上的变化,探讨不同体位下椎间孔的变化以及在经皮椎间孔镜手术中的意义。方法:选取2014年12月~2015年10月因腰腿痛来我院行腰椎X线检查的患者100例,其中男性58例,女性42例;在每位患者腰椎中立、过伸和过屈侧位X线片上测量各腰椎间孔的高度、宽度和腰椎前凸角度,并根据腰椎活动度(中立位-过屈位腰椎前凸角)进行分组(10°、10°~20°及20°组)统计。采用单因素方差分析和Pearson相关分析,比较各椎间孔测量参数在不同体位时的变化,以及各椎间孔高度和宽度的变化与不同腰椎活动度的关系。结果:中立位时,腰椎间孔平均高度为20.2±3.7mm(15.0~22.7mm),宽度为13.7±2.7mm(6.7~10.8mm),自上而下各腰椎间孔高度和宽度呈降低趋势。过伸位时各腰椎间孔高度、宽度较中立位减少,但无显著性差异(P0.05),过屈位时各腰椎间孔高度、宽度较中立位和过伸位增加,并有显著性差异(P0.05)。与腰椎活动度10°和10°~20°两组相比,在腰椎活动度20°组内,L1~L5节段椎间孔高度及L2~L5节段椎间孔宽度显著增加,且有统计学差异(P0.05)。结论 :屈曲位时腰椎间孔高度和宽度较中立及过伸位时明显增加,而且椎间孔高度及宽度随着腰椎前屈角度增加而增大。     

腰椎神经根冠状位、矢状位和轴位MR扫描定位诊断腰椎椎间孔狭窄症

 目的 探讨腰椎神经根冠状位、矢状位和轴位 MR 扫描定位诊断腰椎椎间孔狭窄症的可行性和有效性。方法回顾性分析 2006 年 6 月至 2011 年 6 月共 21 例腰椎椎间孔狭窄患者的相关资料,男 10 例,女 11 例;年龄 36~65 岁, 平均 45.6 岁。病史 6~36 个月,平均 9.4 个月。5 例表现为腰痛伴单侧下肢痛,16 例为单侧下肢痛。根据腰椎侧位 X 线片测量椎间隙和椎间孔高度并行腰椎神经根冠状位、矢状位和轴位 MR 扫描检查,了解神经根周围组织结构的改变,定位诊断神经根受压部位;并通过手术证实影像学诊断的准确性。结果 21 例患者中 9 例为椎间盘突出导致椎间孔狭窄,12 例为椎间盘弥漫性膨出合并关节突关节增生、肥大导致椎间孔狭窄;21 例均为下腰椎椎间孔横向狭窄,20 例为 L4,5 椎间孔狭窄,造成 L4 神经根受压;1 例为 L5S1 椎间孔狭窄,造成 L5 神经根受压。经手术探查证实与术前定位诊断完全符合,符合率为 100%（21/21）。术后 20 例患者下肢疼痛症状完全缓解,1 例下肢疼痛症状缓解不满意。结论 腰椎神经根冠状位、矢状位和轴位 MRI 扫描方法能准确定位诊断椎间孔狭窄,为确定手术方案提供了准确的影像学依据。     

椎间孔区的解剖观测及其在腰椎滑脱症中的临床意义

目的观察下腰椎椎间孔和椎间孔外的形态,初步探讨其在腰椎滑脱症腰腿痛发病机制中的作用。方法选取10具新鲜的正常成年尸体脊柱标本的腰骶段,解剖椎间孔测量上下径和前后径,再按Meyerding分级系统将腰椎标本人为地形成滑脱模型后,观察椎间孔的变化。结果神经根在下腰椎滑脱椎体椎间孔内卡压的同时,对相邻神经根存在较明显的牵拉。结论由于椎体及椎间孔内的退变,对椎体滑脱行手术强行复位可能会使血管和神经根受挤压与牵拉。     

腰椎间孔内神经根卡压的相关研究进展

腰神经根自硬膜囊发出之后，向外下方行走，经过椎间孔离开椎管。神经根在任何位置受到机械性卡压均会引起几乎相同的根性症状，神经根与椎间孔及其周围软组织的解剖关系十分密切，因此椎间孔形态的改变同样也可导致神经根的卡压，其发生率约为10%［1］。椎间盘退变、高度丢失是引起椎间孔形态改变的主要原因，但遗憾的是这并没有在临床上得到充分的认识和足够的重视，由此导致的诊断失误和治疗失败并不罕见［2］。腰椎间孔的解剖形态有一定的特殊性，国外的研究方法很多，本文就有关腰椎间孔形态及其与腰椎间盘高度、神经根之间的解剖关系…     

微创经椎间孔腰椎椎间融合术的应用解剖学研究

目的:探讨微创经椎间孔腰椎椎间融合(TLIF)术的解剖要点及手术方法.方法:在40套正常腰椎MRI片上测量与TUF手术人路相关的解剖学参数,包括:手术切口旁开中线距离(m)、手术路径长度(n)、手术通道倾斜角(α).根据测量结果在5具人尸体标本上模拟微创通道下TLIF,切除上下关节突后显露硬膜囊及上位出口神经根,用卡尺测量硬膜囊边缘以外的椎间盘宽度(a)及神经根下缘到人字缝顶点的距离(b).结果:手术切口距中线距离为3.78±1.38cm,手术通道内倾斜角平均15.8°±3.3°,不同腰椎节段无统计学差异(P＞0.05).手术路径长度为5.89±2.14cm(4.98～7.62cm).在多裂肌和最长肌之间存在疏松软组织肌肉间隙,通过该间隙可以比较容易地将微创通道放置到小关节突附近.在微创通道下切除小关节突进入椎间孔获得的"矩形区域"可显露椎间盘的有效宽度分别为:L3/4 11.3±3.1mm,L4/5 13.1±2.6mm,L5/S1 14.1±3.8mm:各腰椎上位出口神经根下缘与同节段腰椎人字缝的距离分别为:L3/4 17.7±3.5mm,L4/5 16.7±3.8mm,L5/S1 15.6±4.0mm.结论:在椎膀肌存在一个天然的组织间隙,可以很容易将工作管道放置到小关节附近,在上下小关节下方有一个安全的椎间盘"矩形区域",在该区域内切除椎间盘和置人融合器时不需牵拉硬膜囊和神经根.     

腰椎间盘高度与椎间孔相关的解剖学研究

目的动态观察腰椎间盘高度丢失、造成腰椎间孔狭窄和神经根压迫的形态学变化,为临床诊断和治疗提供解剖学依据。方法采用6具正常成人腰椎解剖标本(L1-S1),腰椎间盘正常自然高度为对照组(A组);用同一标本行腰椎间盘切除,椎间隙分别插入4、3、2和1mm厚度的硅胶垫片,并且轴向施加压力,为4个实验组(B、C、D、E组)。然后动态观察和测量腰椎间孔大小与神经根受压迫的情况。结果直接观察和测量结果显示A组神经根位于椎间孔的上1/2;脊神经前根直径由L1(1.1±0.3)mm逐渐增大到L5(2.0±0.9)mm;脊神经后根直径由L1(2.0±1.1)mm逐渐增大到L5(3.8±0.4)mm;背根神经节最大直径由L1(3.9±0.8)mm逐渐增大到L5(7.1±0.9)mm。在椎间孔矢状面上脊神经前根位于背根神经节的腹侧5或7点钟处。B组全部腰椎间孔矢状径缩小,但是神经根未受压迫。C组L3,4、L4,5和L5S1椎间孔出现垂直狭窄,椎间盘膨出将神经根向头侧抬起,上位椎体的椎弓根下缘下移,神经根和脊神经节受到垂直方向压迫。D组L4,5和L5S1神经根和脊神经节受到来自前方的腰椎间盘和后方黄韧带以及下位腰椎的上关节突的横向压迫。A组与E组相比较,神经根袖与硬膜囊的夹角L3由33.6°±6.5°增大到39.7°±7.1°,L4由29.3°±7.5°增大到40.1°±5.2°和L5由20.1°±5.3°增大到46.2°±7.3°。结论下腰椎间盘高度≤3mm可以作为椎间孔狭窄诊断的参考标准。对于非手术失败的病例,手术行椎间孔减压,恢复椎间隙高度以及腰椎稳定性是治疗椎间孔狭窄的关键。     

椎间孔及椎间孔外腰椎间盘突出症的手术治疗

目的 比较三种没术式在椎间孔及椎间孔外腰椎间盘突出症治疗中的优、缺点,探讨各自的最佳适应证。方法对本院１９９２年８月－１９９８年４月间手术治疗的３４例椎间孔及椎间孔外腰椎间盘突出症病例进行随访,了解其术后症状改善情况,并同时摄Ｘ线片观察手术对局部稳定性的影响,平均随访２９个月。结果 经峡部外缘入路手术１９例,手术时间平均６２分钟,平均出血量５８ｍｌ,手术总优良率９３％。经椎板、峡部关节突切除途径５     

腰椎间孔狭窄症的MRI图像分析与临床意义

目的:通过对腰椎旁矢状位MRI图像的分析,探讨影响腰椎间孔形态、孔内神经根周围环境的主要因素,寻找在腰椎旁矢状位MRI图像上评价腰椎间孔狭窄症(LPS)的主要量化指标。方法:2007年1月至2009年8月接受MRI检查,并经手术证实为LPS的35例MRI图像进行系统回顾性分析,其中男27例,女8例;年龄35～82岁,平均54.5岁;病史4个月～8年,平均32个月。同时与37例正常腰椎间孔的MRI图像作对比性研究,观察两组资料矢状位MRI图像上L4,5、L5S1椎间孔有效空间的垂直径、上位矢状径、根孔比例,分析引起LPS的主要因素。结果:LPS组L4,5、L5S1椎间孔有效空间的垂直径、上位矢状径小于正常组,椎间孔有效空间的根孔比例大于正常组。腰椎间盘、纤维环后外侧突出,黄韧带肥厚是LPS的主要软组织性因素;关节突关节、椎体后外缘终板平面增生肥大,骨赘突入椎间孔是LPS的主要骨性因素;神经根的水肿、粘连是LPS的主要根性因素,且多种因素往往复合存在。结论:软组织性、骨性、根性因素的复合引起LPS,MRI检查可以充分显示LPS的解剖形态及引起LPS的病理改变,腰椎间孔有效空间的上位矢状径、垂直径、根孔比例可以作为腰椎旁矢状位MRI图像上评价LPS的量化指标。     

Effects of Gravity-Facilitated Traction on lntervertebral Dimensions of the Lumbar Spine*

The purpose of this study was to determine the effects of gravity-facilitated traction (inversion) on intervertebral dimensions of the lumbar spine. Fifteen normal male subjects were fully inverted for a period of 10 minutes. Vertebral separation was measured on lateral roentgenograms both pre- and postinversion by outlining the margins of the intervertebral bodies both anteriorly and posteriorly and the greatest vertical heights of the intervertebral foramina. Fine point engineering calipers were used to facilitate measurements. A student t-test for paired data was used to determine significance of separation between lumbar segments, following 10 minutes of inversion. The alpha level was set at 0.05 for statistical significance. Gravity-facilitated traction produced increased separation at all levels measured. Significant increases in total mean anterior separation, total mean posterior separation, and total mean intervertebral foraminal separation were determined. Mean anterior separation was significant at all levels except L3-L4. Mean posterior separation was significant at all levels except L1-L2 and L5-S1. Mean intervertebral foraminal separation was significant at all levels but L5-S1. If increases in intervertebral dimensions play a role in the relief of low back syndrome, then gravity-facilitated traction may be an effective moda1i;y in the treatment of this condition. J Orthop Sports Phys Ther 1985;6(5):281-288.     

Coflex系统治疗退行性腰椎管狭窄症

 目的 探讨Coflex系统治疗退行性腰椎管狭窄症的初步临床疗效。
方法 2008年3月至2009年8,采用腰椎后路椎管减压棘突间植入Coflex系统治疗退行性腰椎管狭窄症患者26例,男11例,女15例;年龄45～78岁,平均65.4岁。L_3,4节段7例,L_4,5节段13例,L_3,4合并L_4,5节段6例。术前MRI和CT扫描证实L_3,4和（或）L_4,5节段黄韧带增厚,关节突关节骨质增生,合并椎间盘突出致中央椎管及侧隐窝狭窄,神经根或马尾受压。应用eFilm及CAD软件测量术前及术后3个月、12个月手术节段椎间隙前缘高度、后缘高度、活动度,术前、术后椎管面积;采用日本骨科学会评分标准（Japanese Orthopaedic Association,JOA）进行功能评估。
结果 全部病例随访12～24个月,平均15个月。术后患者腰腿疼痛症状均明显缓解,日常生活能力改善。JOA评分由术前平均（15.46±4.30）分改善至术后3个月（24.50±1.58）分,责任节段椎管面积由术前平均（218.4±16.2）mm 2增加至术后（264.6±9.9）mm 2。单节段椎间隙前缘高度无明显变化,椎间隙后缘高度较术前增加,随时间延长高度有所下降。术后手术节段仍保留一定的活动度,但较术前明显下降。Coflex系统无松动、断裂及脱出。
结论 Coflex系统治疗退行性腰椎管狭窄症可较好地维持相应节段的稳定性,安全可行,近期疗效满意。     

椎间打压植骨联合棘突椎板复合体回植内固定治疗退变性腰椎不稳症

目的研究椎间打压植骨联合棘突椎板复合体回植内固定治疗退变性腰椎不稳症的手术方法,以期为临床提供一种更为理想的手术模式。方法 1998年1月-2010年10月,采用后路椎管减压、椎间打压植骨联合棘突椎板复合体回植、后路椎弓根钉棒系统内固定术治疗退变性腰椎不稳症患者48例。男26例,女22例;年龄52～76岁,平均62.4岁。病程7个月～25年,平均6.5年。单节段不稳22例,L3、41例,L4、510例,L5、S111例;多节段不稳26例,L3、4、L4、5及L5、S15例,L2、3及L3、42例,L3、4及L4、510例,L4、5及L5、S19例。合并椎间盘突出32例,椎管狭窄46例,退变性脊柱侧弯16例。手术前后采用日本骨科学会(JOA)评分、植骨椎间隙融合、椎间隙高度及腰椎前凸角变化情况评定疗效。结果患者切口均Ⅰ期愈合;术中、术后未出现神经损伤、螺钉断裂、伤口感染等并发症。48例均获随访,随访时间1～6年。植骨椎间隙融合时间12～18周,平均16.2周。脊柱滑移或退变性侧弯得到纠正,基本恢复脊柱的正常序列。术前、术后6个月及末次随访时手术节段椎间隙高度分别为(5.2±2.3)、(11.9±2.0)、(11.6±2.1)mm;JOA评分分别为(3.2±2.1)、(12.8±1.6)、(13.6±1.2)分;腰椎前凸角分别为(—20.5±10.5)、(30.5±8.5)、(31.2±5.6)°。术后各指标均较术前显著改善,差异有统计学意义(P<0.05);术后6个月与末次随访时比较差异无统计学意义(P>0.05)。术后6个月根据JOA改善率评定,获优36例,良10例,可2例,优良率95.8%。结论椎间打压植骨联合棘突椎板复合体回植内固定治疗退变性腰椎不稳症,手术方法有效可行,稳定性好,融合率高,是一种接近于解剖性重建的椎管成形术。     

正常人腰椎间盘的MRI测量及其临床意义

目的:为国人开展腰椎间盘人工髓核假体(prostheticdicsnucleus,PDN)置换术提供影像解剖学资料。方法:对56例正常人的腰椎间盘(男44例,女12例)MRIT2加权像中髓核矢状径、横径,椎间隙前、中、后高度进行了测量。所选PDN假体为目前统一规格:前后径为12mm,高度分别为5mm、7mm、9mm。结果:髓核矢状径、横径及椎间隙高度均数之间无明显性别差异(P>0.05)。髓核矢状径均大于12mm,但大于24mm在L2/3中为23.2%,L3/4中21.4%,L4/5中21.4%,L5/S1中16.1%。椎间隙后高较低,5mm~9mm者在L2/3中为85.7%,L3/4中82.1%,L4/5中82.1%,L5/S1中58.9%,大于9mm者L2/3中0%,L3/4中1.8%,L4/5中1.8%,L5/S1中3.6%。结论:国人中大多数人腰椎间盘内仅可容纳单枚PDN假体,适合高度为5mm或7mm,可因人而异选择。     

Changes in the lumbar foramen following anterior interbody fusion with tapered or cylindrical cages.

BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) using both cylindrical and tapered threaded interbody cages has been shown to restore disc height, reduce segmental motion, and relieve low back pain. The effectiveness of these stand-alone cage designs in restoration and maintenance of intervertebral foraminal dimensions has received little attention. PURPOSE: To investigate the effects of anterior implantation of cylindrical and tapered interbody cages on morphologic changes of the lumbar neuroforamen and maintenance of foraminal dimensions under dynamic loading. STUDY DESIGN/SETTING: A biomechanical study using bovine calf spine model to compare the deformation of foraminal space after ALIF with either tapered cages or cylindrical cages. METHODS: Sixteen fresh calf spines were randomly assigned to undergo ALIF at the L3-L4 level using either two threaded cylindrical or two tapered cages. Lumbar spines were subjected to unconstrained loading in flexion, extension, and lateral bending. Rotation of the L3-L4 segment and dynamic deformation in foraminal height were obtained through a motion analysis system, and compared between the two cage groups. Foraminal dimensions were assessed before and after tapered or cylindrical cage implantation with digitized measurement of bilateral foraminal molds. RESULTS: Regardless of cage design, anterior implantation of cages increased neuroforaminal area by 17% (p=.0005) and increased the foraminal height by 9% (p=.0004) in the neutral unloaded position. In dynamic loading conditions, foraminal height was significantly stabilized in all loading directions by the cylindrical cages (p=.01) and on both sides during lateral bending by the tapered cages (p<.03). Foraminal stabilization provided by either cage was most prominent in the direction of lateral bending (26-37% of the intact values), while cylindrical cages also provided substantial stabilization in flexion (26% of the intact value). Significant linear relationships were found between foraminal height and residual fusion segment motion under dynamic loading conditions. CONCLUSION: Results from this bovine model biomechanical study indicate that stand-alone anterior interbody fusion cages with either tapered or cylindrical design are effective in restoring neuroforaminal height and stabilize the spine to withstand foraminal deformation during daily loading. The degree of stabilization was influenced substantially by the loading direction, to a lesser degree by the cage type, and was strongly dependent on the segment mobility. Although bovine lumbar spine is widely accepted for comparative studies, direct clinical interpretation should be made with caution owing to the anatomical differences from human.     

Microscopic anterior foraminal decompression combined with anterior lumbar interbody fusion

Background context

Anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) provides successful surgical outcomes to isthmic spondylolisthesis patients with indirect decompression through foraminal volume expansion. However, indirect decompression through ALIF followed by PPF may not obtain a successful surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or foraminal sequestrated disc herniation. Thus far, there has been no report of foraminal decompression through anterior direct access in the lumbar spine.

Purpose

This study aims to describe the new surgical technique of microscopic anterior foraminal decompression and to analyze the clinical outcomes and radiologic results of the microscopic anterior decompression during ALIF followed by PPF.

Study design/Setting

We conducted a multisurgeon, retrospective, clinical series from a single institution.

Patient sample

This study was carried out from March 2007 to July 2010 and included 40 consecutive patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by posterior osteophyte or foraminal sequestrated disc herniation undergoing microscopic anterior foraminal decompression during ALIF followed by PPF.

Outcome measures

The visual analog scales (VAS) of back and leg pain and the Oswestry disability index were measured preoperatively and at the last follow-up.

Methods

Postoperative computed tomography and magnetic resonance imaging measured whether decompression of neural structure had been made and morphometric change of the foramen and the amount of resected bone. Moreover, segmental lordosis, whole lumbar lordosis, disc height, and degree of listhesis were measured through X-ray examination before the operation and at the last follow-up; we also verified whether fusion had been achieved.

Results

Successful decompression was confirmed in both patients with foraminal stenosis caused by posterior osteophyte and those with foraminal sequestrated disc herniation. Clinically, compared with before the surgery, the VAS (leg and back) and the Oswestry disability index significantly decreased at the last follow-up (p=.000). With regard to radiology, at the last follow-up all patients had bone fusion on X-ray examination, and an increase in disc height, a reduction in the degree of listhesis, an increase in segmental lordosis, and an increase in whole lumbar lordosis were significant in both groups (p=.000) compared with before the surgery. Foraminal volume, foraminal width, and foraminal height also significantly increased postoperatively compared with before the operation (p=.000). The height, width, and dimension of resected body were 4.61±1.05 mm, 7.92±1.42 mm, 17.15±4.96 mm², respectively, in patients with foraminal stenosis caused by a posterior osteophyte, and 3.88±0.92 mm, 6.8±1.29 mm, and 13.12±2.25 mm², respectively, in patients with foraminal sequestrated disc.

Conclusions

The microscopic anterior foraminal approach provides successful foraminal decompression. Combined with ALIF and PPF, this approach shows a good surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or those with foraminal sequestrated disc herniation.