针灸治疗腰椎间盘突出症伴疼痛的效果研究

目的:探讨针灸治疗腰椎间盘突出症伴疼痛的效果。方法:研究对象为2018年1-12月于我院接受治疗的腰椎间盘突出症伴疼痛患者78例,以随机数表法分为对照组与研究组,各39例。对照组采取常规牵引治疗,研究组在此基础上应用针灸治疗。治疗1个月后评价两组临床疗效,并对比两组治疗前后疼痛评分。结果:研究组治疗总有效率为97.44%(38/39),高于对照组的79.49%(31/39)(P<0.05);治疗后研究组VAS评分低于对照组(P<0.05)。结论:针灸治疗腰椎间盘突出症伴疼痛疗效确切,能够有效改善症状,降低疼痛程度,值得临床推广。     

Current strategies for the restoration of adequate lordosis during lumbar fusion

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.     

脊柱推拿对腰椎间盘突出症患者脑功能活动的影响

目的观察脊柱推拿治疗对腰椎间盘突出症患者脑功能活动的影响。方法招募11例腰椎间盘突出症患者，8例受试者完成了研究。所有患者接受6次腰部脊柱推拿治疗，并在脊柱推拿治疗前、后对患者进行颅脑功能核磁共振成像检测，评估患者脑功能活动的改变及与疗效关系。结果4例腰椎间盘突出症患者脊柱推拿治疗有效，4例无效。脊柱推拿有效患者治疗前、后产生视觉模拟评分（VAS）为50分时的疼痛压力值分别为（7.43±1.47）kg和（10.53±0.55）kg（ P < 0.05），而无效患者的则无明显差异（ P＞0.05）。颅脑功能核磁共振成像检测结果提示，脊柱推拿治疗有效患者的脑功能活动以抑制为主，抑制区域主要位于右侧前额叶及小脑区域；而脊柱推拿治疗无效患者的脑功能活动以增强为主。 结论脊柱推拿能够影响腰椎间盘突出症患者的脑功能活动，其治疗有效患者的抑制区域主要在额叶及小脑。     

Severe lumbar spinal stenosis combined with Guillain-Barré syndrome: A case report

BACKGROUNDGuillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARYA 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSIONGBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.     

腰椎旁神经阻滞联合全凭静脉全身麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响

目的观察腰椎旁神经阻滞联合全凭静脉全身麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响。方法选取2018年1月—2019年8月我院收治的行髋关节置换术患者115例,根据手术麻醉方法的不同分为观察组60例和对照组55例,观察组予腰椎旁神经阻滞联合全凭静脉全身麻醉,对照组仅予全凭静脉全身麻醉。比较两组麻醉前(T0)、麻醉后10 min(T1)、麻醉后30 min(T2)、术毕(T3)时平均动脉压、心率、去甲肾上腺素及肾上腺素水平变化,术后清醒镇静效果和苏醒时间,以及两组手术期间不良反应发生情况。结果观察组T1、T2、T3时平均动脉压、心率与T0时比较虽略有升高,但差异无统计学意义(P>0.05);对照组T1、T2、T3时平均动脉压、心率与T0时比较均升高,且以T2时平均动脉压、心率最高,T3时又回落至T1时水平,差异有统计学意义(P<0.05)。T1、T2、T3时观察组平均动脉压、心率均低于对照组(P<0.05)。T1、T2、T3时两组去甲肾上腺素、肾上腺素均较T0时升高,且观察组相同时间点去甲肾上腺素、肾上腺素水平低于对照组,差异均有统计学意义(P<0.05或P<0.01)。观察组术后唤醒时警觉/镇静评分低于对照组,苏醒时间明显短于对照组,差异均有统计学意义(P<0.05)。两组手术期间总不良反应发生率比较差异无统计学意义(P>0.05)。结论腰椎旁神经阻滞联合全凭静脉全身麻醉用于髋关节置换术可有效防止患者血流动力学指标的波动,减轻手术应激反应程度,术后苏醒快,术后苏醒质量佳,且未增加手术期间不良反应的发生。     

经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析

目的 探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗腰椎间盘突出症并发硬脊膜撕裂的处理方法及预后。方法 回顾性分析2016年3月至2017年1月采用PETD治疗的236例腰椎间盘突出症的病例资料。结果 236例中，3例发生硬脊膜撕裂，发生率为1.3%(3/236)。2例术中诊断，其中1例术中转为显微镜下修补硬脊膜，1例术中未做处理；1例术后诊断，在显微镜下完成硬脊膜修补。3例随访12个月，末次随访时视觉模拟量表评分从术前8.0分降至1.7分，Oswestry功能障碍指数从82.1%降至17.8%，均无神经功能障碍等后遗症；改良MacNab评分2例为优，1例为良。结论 硬脊膜撕裂是PETD较为少见的并发症，应根据术中和术后情况，采取综合治疗措施，总体预后良好     

Classic type intradural extramedullary ependymoma of the lumbar spine: A new case report of a usual tumour in an unusual location

Classic type intradural extramedullary (IDEM) ependymomas of the lumbar spine are rare entities. Only two such cases have previously been reported in the literature. Here the authors report a new case and describe radiological, surgical and histological findings as well as review the literature. Unlike previously encountered lumbar IDEM ependymomas, this case was an incidental finding and surgically managed on the grounds of radiological progression over 8 years.     

A prospective study of non-surgical versus surgical treatment for lumbar spinal stenosis without instability

ObjectiveEven if analyzed through meta-analyses or systemic reviews ensued lately, we could say that at least it is inconclusive which of the surgical or non-surgical treatment to lumbar spinal stenosis is better particularly in short to intermediate-term. This study compared non-surgical and surgical outcomes in surgical candidates for lumbar spinal stenosis (LSS).MethodsSurgical candidates for LSS were prospectively screened. Patients were offered the option to be enrolled in a randomized cohort, an observational cohort, or not to participate. Patient-reported outcomes were evaluated at baseline, and at 1, 3, 6, and 12 months. The primary outcomes were measures of pain and functional outcomes such as the Korean version of the Oswestry Disability Index (K-ODI), the EuroQol 5-Dimension instrument (EQ-5D), and 36-Item Short-Form Health Survey (SF-36).ResultsOne hundred and ten patients were enrolled in the randomized cohort and 37 patients in the observational cohort. Among them, 97 patients received non-surgical treatment, and 50 patients underwent surgical treatment. At 12 months, the non-surgical treatment group had less improvements in the primary outcome measures of back pain (mean change: non-surgery, 2.34 vs. surgery, 3.99), leg pain (2.92 vs. 3.40), K-ODI (5.12 vs. 8.31), EQ-5D utility index (0.19 vs. 0.25), and EQ-5D VAS (9.68 vs. 16.0). Most SF-36 section parameters also showed less improvement in the non-surgical treatment group than in the surgical treatment group throughout the 12-month follow-up.ConclusionsIn LSS patients without instability, non-surgical treatment resulted in less pain improvement and functional recovery through 1 year.     

Longitudinal clinical outcomes after full-endoscopic lumbar discectomy for recurrent disc herniation after open discectomy

ObjectiveFull-endoscopic lumbar discectomy (FELD) is a minimally invasive surgical option for recurrent lumbar disc herniation (LDH). Nonetheless, patients’ clinical outcomes may be poorer after surgery for recurrent LDH than for primary LDH. Therefore, we compared patients’ longitudinal clinical outcomes after FELD for recurrent LDH or primary LDH.MethodsThe medical records of patients who underwent FELD for primary LDH (group A) or recurrent LDH (group B) were retrospectively reviewed. The inclusion criteria were: 1) single-level LDH or recurrent LDH at L4-5 or L5-S1, 2) age ≤60 years, 3) previous open discectomy (group B), and 4) ≥6 months of follow-up. In total, 244 patients (group A, 211; group B, 33) were included. Clinical outcomes (Oswestry Disability Index [ODI]; visual analogue pain score for the back and leg [VAS-B] and [VAS-L]) over 24 months of follow-up were compared between groups with a linear mixed-effects model.ResultsAll clinical outcomes significantly improved from pre-operation to 3 months postoperatively (p < 0.01), and the improvement was maintained for 24 months postoperatively in both groups. The clinical outcomes of groups A and B were not significantly different during 24 months follow-up (ODI, p = 0.94; VAS-B, p = 0.11; and VAS-L, p = 0.48). The reoperation rate was 3.3% in group A and 3.0% in group B, but the overall complication rate was higher in group B (9.8%) than in group A (6.6%).ConclusionThe longitudinal clinical outcomes after FELD for recurrent LDH may not be poor as feared. However, the higher complication rate in patients undergoing FELD for recurrent LDH should be noted.     

A new lumbar fixation device alternative to pedicle-based stabilization for lumbar spine: In vitro cadaver investigation

Context: To evaluate the stability provided by a new bilateral fixation technique using an in vitro investigation for posterior lumbar segmental instrumentation.

Design: Experimental cadaver study. In this study, we propose an alternative technique for a posterior lumbar fixation technique called “inferior-oblique transdiscal fixation” (IOTF).

Setting: Study performed at Engineering Center for Orthopedic Research Exellence (ECORE) in Toledo University-Ohio.

Participants: Six human lumbar cadaveric specimen used in this study.

Interventions: In this study, we propose an alternative technique for a posterior lumbar fixation technique called “inferior-oblique transdiscal fixation” (IOTF). As a novel contribution to the classical technique, the entry point of the screw is the supero-lateral point of the intersecting line drawn between the corpus and the pedicle of the upper vertebra. This approach enables the fixation of two adjacent vertebrae using a single screw on each side without utilizing connecting rods.

Outcome Measures: Flexion (Flex), extension (Ext), right and left lateral bending (LB & RB), and right and left axial rotation (LR & RR), and the position data were captured at each load step using the Optotrak motion measurement system and compared for IOTF and posterior transpedicular stabilization.

Results: The Posterior stabilization system (PSS) and IOTF significantly reduced the ROM of L4-L5 segment compared to intact segment’s ROM. During axial rotation (AR) IOTF fused index segment more than PSS. Besides this, addition of transforaminal lumbar interbody fusion (TLIF) cage improved the stabilization of IOTF system during flexion, extension and lateral bending. Whereas, PSS yielded better fusion results during extension compared to IOTF with and without interbody fusion cages.

Conclusions: We hypothesized that the new posterior bilateral system would significantly decrease motion compared to the intact spine. This cadaver study showed that the proposed new posterior fusion technique IOTF fused the index segment in a similar fashion to the classical pedicle screw fusion technique.