年龄及融合术式与腰椎后路融合术后邻近节段退变性疾病再手术的关系

目的:探讨患者初次手术时年龄及融合术式与腰椎后路融合术后邻近节段退变性疾病再手术的关系。方法:从2013年3月～2017年3月在我院脊柱外科接受腰椎后路融合术治疗的患者中,选取腰椎后路融合术后发生邻近节段退变性疾病且再次进行手术治疗的113例患者作为再手术组,初次手术时年龄49～79岁(56.4±2.1岁),其中接受后路椎体间融合术(PLIF)67例,后外侧腰椎融合术(PLF)23例,经椎间孔椎体间融合术(TLIF)21例;随访时间9～42个月(24.6±1.1个月)。同时,匹配226例腰椎后路融合术后未发生邻近节段退变性疾病的患者作为对照组,初次手术时年龄46～82岁(57.1±1.1岁),其中接受PLIF 97例,PLF 45例,TLIF84例,随访时间为9～48个月(24.9±0.6个月)。对两组患者接受融合术前和末次随访时(2017年12月)进行腰痛VAS和腰椎JOA评分。应用卡方检验、t检验比较两组患者的初次手术时年龄、性别分布、婚姻情况、文化程度、体质指数(BMI)、融合术式、融合节段个数、椎板是否切除及是否悬浮固定的分布差异,利用Logistic回归分析初次手术时年龄及融合术式与腰椎后路融合术后邻近节段退变性疾病再手术的关系。结果:单因素分析结果显示,两组间性别分布、婚姻情况、文化程度、BMI的差异无统计学意义(P0.05),但初次手术时年龄、融合术式、融合节段个数、椎板是否切除及是否悬浮固定的差异有统计学意义(P0.05)。Logistic回归分析显示,两组患者的年龄分布差异有统计学意义,其OR值为1.23,95%CI为1.12～3.56;两组患者接受PLF、TLIF对比接受PLIF的分布的差异有统计学意义,其OR值及95%CI分别为0.76(0.34～0.89)、0.68(0.25～0.82)。调整融合术式、融合节段个数、椎板是否切除及是否悬浮固定等变量后,初次手术时年龄≥60岁对比60岁的患者,a OR值为2.54,95%CI为1.23～3.56;调整年龄、融合节段个数、椎板是否切除及是否悬浮固定等变量后,接受PLF、TLIF的患者对比接受PLIF的患者,融合术后发生邻近节段退变性疾病需要再次手术的风险均明显降低,其a OR值及95%CI分别为0.54(0.42～0.77)、0.47(0.34～0.83)。再手术组和对照组末次随访时的腰痛VAS评分、腰椎JOA评分与术前比较均有统计学差异(P0.05),且再手术组末次随访时腰痛VAS评分和腰椎JOA评分均优于对照组,差异有统计学意义(P0.05)。结论:接受腰椎后路融合术治疗的患者年龄越大,术后发生邻近节段退变性疾病需要再次接受手术治疗的可能性也越大。同时,接受PILF比PLF、TLIF更可能导致术后邻近节段退变性疾病再手术。     

腰椎后路手术椎间融合器应用的专家共识

正椎间融合器(interbody fusion cage)联合椎弓根钉棒系统实施腰椎后路减压融合内固定术是治疗腰椎退变性疾病如腰椎管狭窄症、腰椎滑脱症、腰椎间盘突出症合并腰椎不稳等的常用手术方法,包括后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)和经椎间孔入路腰椎椎间融合术(trans-foraminal interbody fusion,TLIF),     

同节段出口根减压对严重腰椎间盘脱出症治疗的影响

目的研究同节段出口根减压对严重腰椎间盘脱出手术效果的影响,探讨同节段出口根减压与腰椎术后邻近节段退变的关系。方法选择70例严重腰椎间盘脱出症患者,将其随机分为两组,所有患者均行腰椎后路全椎板减压植骨融合内固定术。实验组:术中对双侧同节段出口根进行充分减压;对照组:未对同节段出口根进行减压。对两组进行JOA评分,测量术后腰椎动力位像上手术邻近节段椎间隙高度和椎间活动度。结果实验组与对照组JOA改善指数比较有统计学意义(P<0.05),两组间术前与术后椎间高度差及邻近节段椎间活动度变化比较无明显统计学意义(P>0.05)。结论对于严重腰椎间盘脱出症患者行腰椎后路椎间融合术+同节段出口根减压术,可以有效缓解腰腿痛症状,并且术后6个月内不会增加邻近节段退变的危险。     

Dynesys动态中和内固定系统的生物力学机制研究进展

腰椎退变性疾病主要包括腰椎间盘突出、腰椎管狭窄、腰椎节段性不稳、退变性椎体滑脱及退行性脊柱侧凸等,保守治疗通常无效,往往需要手术干预.Dynesys动态中和内固定系统(dynamic neutralization system,Dynesys)作为一种后路非融合内固定装置,目前已被广泛用来治疗腰椎退变性疾病.与传统融合术不同的是,它能够在提供稳定内固定的基础上,有效改善固定节段的应力传导,保留固定节段的活动度(range of motion,ROM),减小临近节段退变疾病(adjacent segments degeneration,ASD)的发生率.现通过阅读相关文献,将Dynesys系统的设计理念及其生物力学机制研究现状综述如下.     

WavefleX动态稳定系统治疗腰椎退变性疾病的早期临床观察

背景：长期以来,脊柱融合术一直是治疗腰椎间盘退变疾病的“金标准”,但是坚强的后路固定器械和椎间融合牺牲了腰椎的活动度,并造成应力集中,往往导致固定相邻节段椎间盘的退变,并且一部分相邻节段的退行性变可引起临床症状,影响预后,成为脊柱内固定术后一个潜在的长期并发症。目的：探讨WavefleX动态稳定系统治疗腰椎间盘退变性疾病的初步临床疗效。方法：回顾分析2009年11月至2011年12月,我院应用WavefleX系统治疗腰椎间盘退变性疾病34例,男16例,女18例,年龄35～72岁,平均（54．84±7．9）岁。根据椎间盘退变程度,采用椎管减压、椎间融合或不融合、植入WavefleX系统固定。观察手术前后简化McGill疼痛评分（SF-MPQ）、疼痛视觉类比（VAS）评分、Oswestry功能障碍指数（ODD,整个腰椎以及动态固定节段的活动范围（ROM）,节段融合情况。结果：术后随访4～32个月,平均（17．0±1．6）个月。手术时间80～210min,平均（160．04±7．4）min,术中出血量150～700ml,平均（300．0±813）ml。术后SF-MPQ、VAS评分、ODI明显改善,与术前相比差异具有统计学意义（P〈0．05）。手术前后腰椎及动态固定节段ROM无明显减低（P〉0．05）。结论：WavefleX系统是治疗腰椎间盘退变性疾病的一种安全、有效的外科方法,对病变节段能提供稳定力学环境,同时保留部分活动度,利于缓解椎间盘退变,对邻近节段活动度影响不大,可能延缓邻近椎间盘退变。     

腰椎椎间融合固定术治疗退变性腰椎间盘突出症临床观察

目的探讨腰椎后路椎弓根钉内固定、椎间融合术,治疗退变性腰椎间盘突出症的近远期疗效。方法对采用腰椎后路椎间融合固定治疗退变性腰椎间盘突出症79例的临床资料进行分析。结果随访时间9～24个月,术后腰椎JOA评分22～29分,平均26分,治疗后评分改善优良率达86.7%。Denis腰痛分级评分:P1 36例(46%),P2 24例(30%),P3 19例(24%)。结论腰椎后路椎弓根钉内固定、椎间融合术,治疗退变性腰椎间盘突出症的近远期疗效满意。     

微创与开放经椎间孔腰椎间融合术后邻近节段退变的比较

目的研究两种手术方式治疗腰椎间盘突出伴不稳术后出现邻近节段退变的情况。方法将115例L4~5椎间盘突出伴不稳行腰椎后路椎间融合术患者根据手术方式分为经椎间孔腰椎间融合术(TLIF)组(开放组,53例)和微创经椎间孔腰椎间融合术(MIS-TLIF)组(微创组,62例)。手术前后评测邻近椎间盘Pfirrmann评分及椎间隙高度变化,术后通过Seo评分系统评估椎间小关节受损情况,应用疼痛VAS评分及ODI评分评估临床疗效,评估术后邻近椎间盘的退变情况。结果患者均获得随访,时间6~48个月。VAS评分及ODI评分:术后3 d微创组明显低于开放组,差异有统计学意义(P0.01);术后1年两组比较差异无统计学意义(P0.05)。术后多裂肌横截面积减少的程度及多裂肌脂肪化程度微创组明显小于开放组,差异有统计学意义(P0.01)。手术对腰椎椎间关节的损伤开放组明显高于微创组,差异有统计学意义(P0.05)。邻近节段退变的发生与多裂肌功能减退及小关节突退变具有相关性(P0.01)。结论 MIS-TLIF治疗腰椎间盘突出伴不稳较开放TLIF可以更好地保护椎旁肌及小关节突的完整性,且术后近期邻近节段退变的发生率低。     

Dynesys动态固定系统在临床应用中的新进展

传统的腰椎融合术已被广泛地应用于治疗腰椎退变性疾病,然而,最近对腰椎融合术后产生的并发症的关注越来越多.比如,腰椎椎体活动度(range of motion,ROM)的减少,持续性的下腰痛(low back pain),邻近节段退变(adjacent segment degeneration,ASD),自体髂骨移植的供骨区并发症等都有大量文献报道[1-3].近些年来,腰椎非融合技术作为治疗腰椎退变性疾病的一种新型方式,已经逐渐被许多脊柱外科医生所关注.国内外学者相继研究了许多非融合技术来治疗腰椎退变性疾病,主要有人工颈椎间盘、人工腰椎间盘、人工髓核和腰后路动态置入装置等.其中Dynesys动态固定系统(dynamic neutralization system,Dynesys)是目前临床上应用较广泛的一种腰椎后路动态固定系统.现就有关文献综述如下.     

后路腰椎椎间融合术对邻近节段退变的影响

目的 腰椎融合术改变了腰椎的生物力学环境,使邻近节段应力集中,本研究就后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)对邻近节段退变(adjacent segment degeneration,ASD)的影响进行探讨.方法 2002～2006年,采用PLIF治疗腰椎退...     

老年人退变性下腰疾患的手术治疗

目的探讨老年人退变性下腰疾患的手术适应症、内固定及融合节段的选择、围手术期等问题。方法回顾2001年～2005年手术治疗105例退变性下腰疾病,包括腰椎间盘突出,退变性腰椎管狭窄,退变性腰椎侧弯,退变性腰椎不稳,退变性腰椎滑脱,采用腰椎后路减压、椎弓根螺钉系统固定、后路椎体间植骨融合术。结果术后随访3～24月,疗效评定按日本骨科学会(JOA)下腰痛评分法评定,术前平均3.8分,术后平均13.6分。术后平均改善率89%,全组优良率91%.结论老年人退变性下腰疾病的外科治疗中,术前了解患者的精神心理状况,掌握好手术的适应症,合理有效的手术减压、融合、内固定,可提高融合率,缓解症状,使病人早期康复。     

Comparison of sagittal contour and posterior disc height following interbody fusion: threaded cylindrical cages versus structural allograft versus vertical cages

OBJECTIVE: Segmental restoration of sagittal contour is recognized as critical for improved long-term success following instrumented lumbar fusions. As such, the use of wedged implants has become more popular. Few studies exist to assess the postoperative lordotic and disc height changes following these varied techniques in spinal fusion. An observational radiographic study examining lumbar sagittal contour and posterior intervertebral disc space height following posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) was conducted using vertical cages (VCs), wedged structural allograft (WSA), and threaded cylindrical cages (TCCs). METHODS: Forty-nine consecutive patients (59 spinal segments) were evaluated following single- or two-level interbody fusion with either stand-alone TCCs (n = 18 levels), WSA with posterior transpedicular compression instrumentation (n = 25 levels), or VCs with posterior transpedicular compression instrumentation (n = 16 levels). Standing lumbar radiographs were measured by two independent observers preoperatively, immediately postoperatively (within 1 week), at 6-week follow-up (range 4-8 weeks), and postoperatively (at 1-year follow-up) for segmental lordosis at each level undergoing posterior interbody arthrodesis and posterior intervertebral disc space height to assess indirect nerve root decompression. RESULTS: At the 1-year follow-up, postoperative lordosis was improved in the VC group (+5.3 degrees ; P < 0.005), whereas it decreased in the WSA group (-0.9 degrees ; P = 0.407) and TCC group (-3.5 degrees ; P < 0.005). The posterior disc space height decreased in the VC group (-0.5 mm; P = 0.109), whereas it increased for both the WSA group (+1.2 mm; P = 0.05) and the TCC group (+0.8 mm; P = 0.219). CONCLUSIONS: PLIF with stand-alone TCC and PLIF (or TLIF) with WSA and posterior transpedicular instrumentation results in an increased posterior disc height and thus improved indirect nerve root decompression. PLIF (or TLIF) with VC and posterior transpedicular instrumentation results in an overall decrease in posterior disc height. However, TCC and WSA resulted in a loss of lumbar lordosis, whereas VC resulted in an increase in lumbar lordosis.     

微创经椎间孔椎间融合术治疗腰椎退行性疾病

目的 探讨微创经椎间孔椎间融合术(TLIF)治疗腰椎退行性疾病的方法及疗效.方法 2005年1月至2006年12月,采用微创TLIF治疗腰椎退行性疾病31例(微创TLIF组),年龄4l～63岁,平均53.6岁.其中腰椎间盘突出症合并腰椎管狭窄7例,腰椎间盘突出症合并腰椎不稳16例,腰椎滑脱症8例.手术采用后路旁正中切口,在METRx X-Tube下置入双侧或单侧椎弓根钉,单枚矩形cage斜向45°椎间融合.统计手术时间、术中出血量、输血量、术后引流量、疼痛视觉模拟评分(VAS)值及术前、术后JOA评分,影像评估椎弓根钉位置及椎间融合情况,并与同期采用常规TLIF治疗的33例患者(常规TLIF组)进行比较.结果 微创TLIF组4例采用单侧椎弓根钉固定,平均手术时间199 min,平均术中出血量359 ml,平均输血量32 ml,术后平均引流量81 ml,术后72 h VAS值平均2.37.常规TLIF组3例采用单侧椎弓根钉固定,平均手术时间156 min,平均术中出血量589ml,19例输血,平均输血量122 ml,术后平均引流量120 ml,VAS值4.65,两组比较差异具有统计学意义.微创TLIF组4枚常规TLIF组2枚螺钉偏出.平均随访18.4个月,微创TLIF组1例发生cage移位,两组无椎弓根钉断裂、松动.JOA评分及改善率两组差异无统计学意义.结论 微创TLIF组织损伤小,术后康复快,长期疗效与常规方法相当.     

Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability

OBJECTIVES: Multiple different approaches are used to treat lumbar degenerative disc disease and spinal instability. Both anterior-posterior (AP) reconstructive surgery and transforaminal lumbar interbody fusion (TLIF) provide a circumferential fusion and are considered reasonable surgical options. The purpose of this study was to quantitatively assess clinical parameters such as surgical blood loss, duration of the procedure, length of hospitalization, and complications for TLIF and AP reconstructive surgery for lumbar fusion. METHODS: A retrospective analysis was completed on 167 consecutive cases performed between January 2002 and March 2004. TLIF surgical procedure was performed on 124 patients, including 73 minimally invasive and 51 open cases. AP surgery was performed on 43 patients. Patients were treated for painful degenerative disc disease, facet arthropathy, degenerative instability, and spinal stenosis. RESULTS: The mean operative time for AP reconstruction was 455 minutes, for minimally invasive TLIF 255 minutes, and open TLIF 222 minutes. The mean blood loss for AP fusion surgery was 550 mL, for minimally invasive TLIF 231 mL, and open TLIF 424 mL. The mean hospitalization time for AP reconstruction was 7.2 days, for minimally invasive TLIF 3.1 days, and open TLIF 4.1 days. The total rate of complications was 76.7% for AP reconstruction, including 62.8% major and 13.9% minor complications. The minimally invasive TLIF patients group had the total 30.1% rate of complications, 21.9% of which were minor and 8.2% major complications. There were no major complications in the open TLIF patients group, with 35.3% minor complications. CONCLUSIONS: AP lumbar interbody fusion surgery is associated with a more than two times higher complication rate, significantly increased blood loss, and longer operative and hospitalization times than both percutaneous and open TLIF for lumbar disc degeneration and instability.     

Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results

A prospective analysis of consecutive cases of lumbar fusion using the unilateral transforaminal posterior lumbar interbody fusion (TLIF) technique with pedicle screw fixation. The objective of the study was to assess the clinical and radiographic outcome of TLIF and describe the technique and indications in the treatment of degenerative disease of the lumbar spine. Forty patients treated with TLIF for degenerative diseases of the lumbar spine were followed up for a minimum of 2.5 years (mean: 36 months; range: 30-42 months). Twenty-three patients had degenerative disc disease alone, 13 had associated isthmic or degenerative spondylolisthesis, and 4 had recurrent disc herniations at the L4-L5 level. Thirty-six (90%) had solid fusions radiographically at latest follow-up. Seventy-nine percent had excellent or good clinical outcomes. Our patients demonstrated high fusion rates and patient satisfaction.     

单节段棘突间Coflex动态固定系统与后路椎间植骨融合术治疗腰椎间盘退行性变的疗效比较

[目的]对Coflex棘突间动态固定系统在治疗腰椎间盘退行性变中的应用进行短期疗效评价,比较其与PLIF传统方法疗效差异。[方法]回顾性分析2008年12月～2010年4月采用Coflex动态固定系统治疗腰椎间盘退行性变的病例28例,男性13例,女性15例;年龄48～69岁,平均56.7岁。病史10～54个月,平均20.4个月。随访12～22个月。后路椎间植骨融合术:32例患者,男性14例,女性18例;年龄46～72岁,平均60.8岁。通过VAS评分、Oswestry功能障碍指数(ODI)和影像学分析来评价其疗效。[结果]与PLIF组相比,Coflex组术前及末次随访VAS腰痛评分、术前及末次随访ODI、术前手术节段及上邻节段ROM差异无统计学意义。Coflex组末次随访手术节段ROM较PLIF组大,差异具有统计学意义。Coflex组末次随访手术上邻节段ROM较PLIF组小,差异具有统计学意义。[结论]Coflex在治疗腰椎间盘退行性变中,对维持脊柱单元运动稳定性、缓解腰椎间盘突出症的根性症状具有积极的作用。     

Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

OBJECT: A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance. To the authors' knowledge, there has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters. The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis. METHODS: The medical records and radiographs of 32 patients undergoing ALIF and 25 patients undergoing TLIF from between 2000 and 2004 were retrospectively reviewed. Clinical data and radiographic measurements, including preoperative and postoperative foraminal height, local disc angle, and lumbar lordosis, were obtained. Statistical analyses included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed. RESULTS: Our results indicate that ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The ALIF procedure increased foraminal height by 18.5%, whereas TLIF decreased it by 0.4%. In addition, ALIF increased the local disc angle by 8.3 degrees and lumbar lordosis by 6.2 degrees, whereas TLIF decreased the local disc angle by 0.1 degree and lumbar lordosis by 2.1 degrees. CONCLUSIONS: The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.     

Coflex^TM在腰腿痛治疗中的初步观察

目的初步探讨Coflex^TM治疗腰腿痛的临床疗效。方法 2007年12月至2009年6月,采用Coflex^TM治疗腰椎管狭窄症和椎间盘突出症患者22例,男12例,女10例;年龄39～60岁,平均43岁。椎管狭窄症14例,椎间盘突出症8例。手术方式分为3种：单节段Coflex18例、连续双节段Coflex 2例、单节段PLIF＋Coflex 2例。所有患者手术前后均进行Oswestry功能障碍指数评分（ODI）和疼痛视觉评分（VAS）。影像学观察指标包括X线中立位椎间隙中点、后缘高度,动力位手术节段椎体间活动度。结果所有患者均获得随访,随访时间3～9个月,平均5.4个月。ODI分值术前平均66.2±9.1,术后降至15.3±7.5（P〈0.05）;VAS平均分值由术前的5.6±0.6下降到术后1.8±0.4（P〈0.05）。术后未出现感染、脑脊液漏、植入物脱落等相关并发症。X线检查见手术节段椎间活动度下降（P〈0.05）,椎管狭窄病例椎间隙高度有所恢复（P〈0.05）,椎间盘突出病例椎间隙略有塌陷（P=0.053）。结论 Coflex^TM作为近来应用于临床的一种新技术,对于椎间盘突出症、椎管狭窄症的近期疗效满意,可恢复椎管狭窄病例的椎间隙高度,保持一定椎间活动度,短期相关并发症较少。但由于临床应用时间短、病例数量少,其适应证的选择以及长期疗效尚需进一步探索。     

Posterior lumbar interbody fusion

Posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) create intervertebral fusion by means of a posterior approach. Both techniques are useful in managing degenerative disk disease, severe instability, spondylolisthesis, deformity, and pseudarthrosis. Successful results have been reported with allograft, various cages (for interbody support), autograft, and recombinant human bone morphogenetic protein-2. Interbody fusion techniques may facilitate reduction and enhance fusion. The rationale for PLIF and TLIF is biomechanically sound. However, clinical outcomes of different anterior and posterior spinal fusion techniques tend to be similar. PLIF has a high complication rate (dural tear, 5.4% to 10%; neurologic injury, 9% to 16%). These findings, coupled with the versatility of TLIF throughout the entire lumbar spine, may make TLIF the ideal choice for an all-posterior interbody fusion.     

Contralateral radiculopathy after transforaminal lumbar interbody fusion

Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative spondylolisthesis and degenerative disc disease. Opposite side radiculopathy after the TLIF procedure has been recognized in this institution but has not been addressed in the literature. We present a case of opposite side radiculopathy after the TLIF procedure. We believe that this complication is related to asymptomatic stenosis on the contralateral side that is unmasked by the increased lordosis of the TLIF. The authors recommend increasing both disc height and foraminal height when choosing an interbody graft, and possibly decompressing the opposite foramen when preoperative MRI demonstrates foraminal stenosis.

     

选择性神经根阻滞辅助定位在多节段腰椎退行性疾病治疗中的应用

目的探讨选择性神经根阻滞术在多节段腰椎退行性疾病中的定位诊断作用及临床疗效。方法对2016年1月至2018年12月中国人民解放军第一七一医院骨科收治的因不能准确定位而行选择性神经根阻滞的多节段腰椎退行性疾病患者27例的临床资料进行回顾性分析。男15例,女12例;年龄(68.7±5.1)(55~78)岁。多节段腰椎间盘突出症8例,多节段腰椎管狭窄症7例,多节段腰椎间盘突出合并椎管狭窄症12例。对所有患者均行选择性神经根阻滞术确定责任间隙后采取不同手术方式治疗经皮侧路椎间孔镜手术13例,经皮后路椎间孔镜手术4例,微创经椎间孔入路腰椎椎体间融合术(TLIF)7例,开放TLIF 3例。记录术前、术后3 d、术后3个月及末次随访时的疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)并进行比较。采用SPSS 22.0软件对数据进行统计学分析。结果27例患者均获得随访,随访(28.1±5.1)(17~36)个月。VAS评分术后3 d、术后3个月和末次随访分别为3.4±1.1、3.1±1.2和2.3±1.1,与术前6.2±1.8相比差异均有统计学意义(P=0.03,0.02,0.02);ODI评分术后3 d、术后3个月和末次随访分别为28.1±11.2、20.5±9.7和16.7±5.2,与术前69.6±17.9相比差异均有统计学意义(P=0.02,0.02,0.01)。结论对于术前难以准确定位的腰椎多节段退行性疾病患者,选择性神经根阻滞是一种简单有效的确定责任间隙的方法。