腰椎棘突间置入动态内固定Coflex系统治疗中年腰椎旋转不稳：近期腰椎稳定性评价

背景：腰椎棘突间动态内固定Coflex系统主要用于治疗轻度腰椎管狭窄病例,其适应范围是否可有进一步的扩大？ 目的：观察腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效。 方法：对腰椎旋转不稳的11例中年患者行Coflex内固定术,均为L4~5节段性不稳定。所有患者术前及术后均行日本骨科学会(JOA)评分;观测影像指标包括手术前术后椎间隙中立角,过伸角,过屈角和 L4~5活动度。观察手术时间,术中出血量。 结果与结论：全部患者随访6个月。Coflex置入时间平均72.6 min,平均出血85.7 mL。术后6个月随访时,JOA评分由术前14.45±2.42提高到21.00±2.24,差异有显著性意义(P < 0.05)。L4~5活动度由术前(13.18±2.04)°减少到(8.09±0.94)°,差异有显著性意义(P < 0.05)。提示腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效良好,腰椎稳定性有明显提高,中远期疗效尚待观察。     

显微镜下一侧入路双侧减压治疗老年腰椎管狭窄

目的 探讨采用显微镜下一侧入路双侧减压治疗老年腰椎管狭窄的安全性和有效性.方法 回顾分析2008年1月至2011年1月24例70岁以上腰椎管狭窄患者的临床资料,对比术前术后腰椎JOA和VAS评分和腰椎影像学检查结果,并对患者的满意度进行调查.结果 患者无神经损伤发生,围手术期无心脑血管事件等合并症出现,2例患者发生硬膜囊撕裂,1例患者发生伤口感染,平均住院时间为5.23 d.术后3个月腰椎JOA评分较术前显著提高,VAS评分较术前显著降低.术后1年患者满意度为92％,术后1年患者无腰椎失稳加重.结论 显微镜下一侧入路双侧减压是治疗老年腰椎管狭窄的理想手术方式.     

椎间融合器植入并双侧下关节突切除治疗退变性腰椎管狭窄症

背景：对退变性腰椎管狭窄治疗可行全椎板减压内固定置入、单侧或双侧开窗减压、后路全椎板减压等方法。但采取何种方式治疗中是否需行椎间融合器植入内固定目前还没有定论。 目的：评价以cage椎间植骨融合椎弓根内植入固定并腰后路全椎板及双侧下关节突切除减压、自体小关节骨质移植治疗退变性腰椎管狭窄症的效果。 方法：选择经3个月保守治疗无效的退变性腰椎管狭窄症患者41例,男23例,女18例,平均年龄60.3岁,行腰后路全椎板及双侧下关节突切除减压、自体小关节骨质及cage椎间植骨融合植入椎弓根内固定治疗,随访24个月,术前及术后随访时JOA评分评价患者疗效,放射学检查患者植骨融合情况及手术节段椎体稳定性。 结果与结论：随访时JOA评分较术前有明显提高(P < 0.01),临床优良率为90%;40例获得骨性融合,融合率98%,1例患者有腰椎不稳征象。术后均无内固定物松动、断裂等并发症发生,但有2例发生硬脊膜撕裂,1例发生椎弓根位置偏斜,1例假关节形成。结果提示腰后路全椎板及双侧下关节突切除减压、自体小关节骨质及cage椎间植骨融合植入椎弓根内固定治疗退变性腰椎管狭窄症具有良好的临床效果。     

置入棘突间稳定系统Wallis治疗腰椎退变性疾病：与单纯腰椎管减压的比较☆

背景：在早期,腰椎间盘退变性疾病的治疗临床常用髓核摘除或髓核摘除加刚性内固定融合技术,但是随着非刚性固定技术的发展,棘突间稳定系统固定和全椎间盘置换在脊柱非融合治疗中逐渐受到人们的重视,其优点日益突出。 目的：与单纯腰椎管减压相比,评价腰椎管减压并棘突间稳定系统Wallis置入固定治疗腰椎退变性疾病的效果。 方法：选择2007-12/2008-12华中科技大学附属同济医院骨科收治的腰椎退变性疾病患者40例,随机选取20例行单纯髓核摘除(对照组),20例行突出髓核摘除加棘突间稳定系统Wallis固定(实验组)。分别于置入后1周,1年对两组患者分别进行JOA评分、目测类比评分。 结果与结论：两组患者置入后1周JOA评分及目测类比评分差异均无显著性意义(P > 0.05);术后1年JOA评分及目测类比评分差异均有显著性意义(P < 0.05)。提示两术式即刻效果无差异,均取得良好的效果,此效果主要依赖于手术有效的减压。实验组中期效果明显优于乙组,主要是棘突间稳定系统Wallis发挥良好的生物学作用,有效缓解了患者残余的慢性下腰痛。 关键词：腰椎退变性疾病;椎管减压;棘突间稳定系统;硬组织植入物     

经皮椎板间入路完全内镜下手术治疗L_(4～5)椎间盘突出症

目的评价椎板间入路的完全脊柱内镜手术治疗L_(4~5)腰椎间盘突出症的临床效果。方法回顾性分析86例L_(4~5)腰椎间盘突出症病人的临床资料,采用经皮椎板间入路完全内镜手术治疗。比较手术前后下肢VAS和腰椎JOA评分。结果所有病人顺利完成手术,无严重并发症。术后6个月复发2例,再次手术摘除突出的椎间盘。所有病人术后3 d、6个月、12个月下肢VAS和腰椎JOA评分较术前差异有统计学意义(P0.05)。结论经皮椎板间入路完全内镜手术治疗L_(4~5)椎间盘突出症具有微创、术后恢复快等特点,可获得良好的临床疗效。     

腰椎小关节方向性与腰椎间盘突出症

背景：腰椎小关节及其对称性与腰椎间盘突出之间是否存在关系,文献报道争议很大。 目的：测量分析腰椎小关节方向性与腰椎间盘突出的关系。 方法：收集因腰腿痛行CT检查的169例患者,L4/5 腰椎间盘突出35例,L5/S1腰椎间盘突出67例,无间盘突出对照组67例。在CT终端机上选取L3~S1椎间隙的远侧椎体上终板层面,测量3个节段的腰椎小关节角。 结果与结论：① L4/5和L5/S1腰椎间盘突出组L3/4、L4/5、L5/S1每个节段腰椎小关节角左侧均大于右侧(P < 0.05);各组小关节前内侧角和后外侧角两侧相比差异均无显著性意义(P > 0.05)。②各节段腰椎小关节角、前内侧角、后外侧角3组之间比较没有显著性差异(P > 0.05)。③各组腰椎小关节角、后外侧角自L3/4至L5/S1节段均逐渐增大(P < 0.05);而前内侧角L4/5节段最大,L3/4节段最小(P < 0.05)。提示腰椎间盘突出与腰椎小关节角左右侧不相等有关;腰椎小关节角和后外侧角自L3/4至L5/S1逐渐更偏向冠状位,而内侧角在L4/5节段更偏冠状位,可能与腰椎管狭窄的发病有关。     

双通道椎间孔镜技术治疗腰椎管狭窄症的初步临床研究

目的初步探讨采用双通道椎间孔镜技术治疗退变性腰椎管狭窄症的临床疗效。方法回顾性分析5例采用双通道椎间孔镜技术治疗退变性腰椎管狭窄症病人的临床资料,统计病人的手术时长、出血量、住院时间等临床资料,术后通过Oswestry功能障碍指数(ODI)、腰椎日本骨科协会(JOA)评分及视觉模拟评分法(VAS)对治疗效果进行评价。结果 5例病人均顺利完成手术,手术时长(110.6±18.9) min,术中出血量(15.2±9.7) ml,住院时间(4.5±1.2) d。病人术后间歇性跛行及神经根性症状均明显缓解;无术中及术后并发症。术后ODI、JOA、VAS评分改善率分别为48.7%、69.1%和62.0%。结论双通道椎间孔镜技术能安全、有效地治疗退变性腰椎管狭窄症,其手术创伤小,病人术后恢复快。该技术具有术野开阔、操作灵活的特点,是手术疗效、手术效率与微创的合理平衡。     

显微神经根减压术治疗腰椎管狭窄症

目的 探讨显微镜下微创小切口脊神经根减压术治疗腰椎管狭窄症的疗效.方法 回顾性分析110例腰椎管狭窄症病例资料,均行神经电生理监测与显微镜下神经减压治疗.在术前1 d、术后3个月、术后6个月及术后12个月进行疼痛视觉模拟评分(visual analogue score,VAS)与腰椎Oswestry功能障碍指数(Osw...     

单枚cage单侧椎弓根螺钉置入内固定治疗退行性腰椎不稳51例

背景：既往多采用双侧显露,双侧椎弓根钉置入固定治疗退行性腰椎不稳,手术风险较大,出血较多,手术时间长,费用高。 目的：探讨后路单枚cage单侧椎弓根钉置入内固定治疗退行性腰椎不稳的临床效果。 方法：采用后路椎弓根钉及椎间融合器治疗需行内固定融合的退行性腰椎不稳患者51例,男32例,女19例,年龄41~72岁;单节段47例,双节段4例。手术方法均采用单侧显露症状侧椎板及关节突,单侧置入椎弓根钉,经椎间孔入路手术切除椎间盘及软骨终板,植骨后放入单枚cage。根据日本JOA评分法评估术后疗效。 结果与结论：术中出血90~430 mL;手术时间单节段为100(85~120) min, 双节段为150(120~170) min;术后第二三天即可离床活动。术后有2例患者腰腿痛无好转,复查CT 和MRI 均未见异常,其中1 例经3 个月对症处理后腰腿痛减轻,另1 例无变化。按日本JOA 评分法评定标准,术前JOA 评分11(7~13 )分,术后1 年JOA 评分25(18~27 )分。94%患者的JOA改善率>50%。51 例患者中融合44 例,可能融合7例,融合时间为5.4(4.3~7.1) 个月。本组未发现椎弓根螺钉松动、拔出、断钉及cage 移位。说明单侧椎弓根钉及cage内固定手术方法简单,出血少,手术时间短,对脊柱结构破坏少,是治疗退行性腰椎不稳可供选择的较好方法。     

脊柱非融合U型棘突间钛合金材料植入治疗早期腰椎间盘突出伴

背景：脊柱非融合技术是目前对于早期脊柱疾病进行干预的新技术,可以在保护脊柱运动功能的同时达到治疗患者病情的效果。U型棘突间钛合金材料植入物属于后路棘突间非融合新技术范畴,此方面的研究将是非融合技术的一个热点。 目的：观察腰椎后路动态腰椎管狭窄运动保留的非融合U型棘突间钛合金材料植入物的临床力学性能。 设计、时间及地点：对比观察,病例来自2006-06/2007-12上海长海医院骨科。 对象：选择退变性椎间盘突出伴有动态椎管狭窄的患者28例,男23例,女5例,年龄41~58岁。 方法：根据患者自愿的方式随机分为2组,单纯椎间盘摘除减压组(n=20)：单纯椎间盘摘除减压术摘除责任节段椎间盘;材料植入物组(n=8)：先摘除责任节段椎间盘后去除棘突间韧带,将2个翼状突起夹在头尾端棘突上,然后在棘突间植入U型棘突间钛合金材料植入物。 主要观察指标：术后及随访测量责任节段的椎间隙高度保护度、椎管面积以及患者的腰椎JOA评分。 结果：28例退变性椎间盘突出伴有动态椎管狭窄患者均进入结果分析。材料植入物组植入U型钛合金材料后椎间隙高度保护度和平均椎管面积较单纯椎间盘摘除减压组明显增加(P < 0.05)。患者腰椎手术前后的JOA评分均有明显改善,但是采用非融合技术材料植入物组的改善程度明显优于常规单纯椎间盘摘除减压组(P < 0.05)。 结论：脊柱非融合U型棘突间钛合金材料植入物对于早期椎间盘突出伴有动态腰椎管狭窄患者的腰椎力学性能有很好的保护作用。     

Coflex棘突间动力重建系统治疗腰椎退变性疾病18例

背景：近年来脊柱非融合技术一直是脊柱外科研究与争论的热点。Coflex棘突间动力重建系统作为腰椎后路非融合器材,国外虽已应用较长时间,但国内尚处于试用阶段。 目的：探讨Coflex棘突间动力重建系统治疗腰椎退变性疾病的适应证,并对其早期临床疗效进行评价。 方法：2008-10/2010-06使用Coflex棘突间动力重建系统治疗腰椎退变性疾病31例,对其中随访超过1年的18例患者临床资料进行分析总结。治疗方式均为后路髓核摘除,椎管减压、Coflex棘突间动力重建系统置入;1例患者术中置入2枚Coflex。治疗前及各次随访时均对患者进行日本骨科学会下腰痛功能量表、中文版Oswestry功能障碍指数量表及目测类比评分法评估,并测量治疗前后、各次随访时腰椎前屈后伸位置入节段及其上下节段活动范围、Colfex上下极板夹角及置入节段椎间隙高度。 结果与结论：患者均获随访,随访时间12~20个月。末次随访时患者日本骨科学会下腰痛功能量表评分、中文版Oswestry功能障碍指数量表评分及目测类比评分均获显著改善;治疗前后置入节段椎间高度及其上下节段椎间活动度差异均无显著性意义(P > 0.05),末次随访时Coflex上下极板夹角在过伸位较中立位显著增大(P < 0.05)。提示Coflex棘突间动力重建系统对腰椎间盘突出症、椎管狭窄及腰椎不稳等腰椎退变性疾病安全有效,在腰椎后伸时能够有效分担载荷,同时对腰椎生理活动影响较小,有利于维护腰椎功能,早期临床疗效肯定。     

Clinical Experience of the Dynamic Stabilization System for the Degenerative Spine Disease

Objective

The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases.

Methods

The study population included 20 consecutive patients (13 females, 7 males) with a mean age of 61±6.98 years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). The following radiologic parameters were measured in all patients : global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion (ROM) was then calculated.

Results

The mean follow-up period was 27.25±5.16 months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). The VAS decreased from 8.55±1.21 to 2.20±1.70 (p<0.001), and the patients'' mean score on the Korean version of the ODI improved from 79.58%±15.93% to 22.17%±17.24% (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure.

Conclusion

The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.     

单侧椎弓根螺钉置入并椎间融合对邻近椎间盘节段退变的影响

背景：坚强内固定和良好融合存在严重缺陷和不足。目前还未见临床应用单侧椎弓根螺钉固定结合椎间cage植骨融合治疗腰椎退变性疾病对邻近节段退变影响的相关报道。 目的：回顾分析单侧椎弓根螺钉固定结合椎间cage植骨融合治疗部分腰椎退变性疾病后对固定融合邻近上下节段退变的影响。 方法：2006-03/2009-12对收治的部分腰椎管狭窄症、腰椎失稳及腰椎间盘脱出症患者22例,进行了单侧椎弓根螺钉固定加椎间cage植骨融合,术中不显露对侧。在固定融合后3,6,12,20个月及取出内固定钉棒后3,6个月,随访X射线片及MRI。针对X射线片运用角平分线法测量固定融合邻近上位椎间隙高度变化,MRI测量椎间盘髓核退变情况。 结果与结论：所有病例获得随访,患者椎管狭窄症状及神经根性症状消失,并且在随访期间内没有新的临床症状出现。固定融合前、固定融合后3,6,12,20个月邻近节段上位椎间隙高度分别为(7.420±0.035 4),(7.426 6±0.036 9),(7.453 3±0.036 9),(7.516 6±0.036 9),(7.430 8±0.036 9) mm,结果表明,腰椎单侧固定融合后邻近节段椎间隙高度无明显变化(P > 0.05)。MRI测量结果显示,固定融合邻近上位椎间盘髓核信号在T2加权像无明显退变。提示单侧椎弓根螺钉固定结合椎间融合治疗部分腰椎退变性疾病能有效预防固定融合邻近上下节段退变。     

Wallis interspinous implantation to treat degenerative spinal disease: description of the method and case series

The Wallis interspinous implant is most commonly used in the treatment of intervertebral disc herniation and for tears in the outer layer of the disc. The dynamic vertebral fixation concept was first initiated in 1984 with the goal of imitating the physiologic spinal kinetic. A total of 15 years later, a second generation of implant has been developed, termed the 'Wallis interspinous Implant', which aims to preserve the mobility of the operated spinal segment. To underline our own experience, a retrospective review of 15 patients that were treated with 'Wallis implantation' at our institution between January 2006 and March 2008. Our main inclusion criterion for Wallis implantation was low back pain because of degenerative lumbar spinal stenosis associated with segmental instability along with Modic changes 0-1 and with UCLA arthritic grade II in the adjacent two segments cephalad to implantation. The outcome was analyzed according to clinical and radiological parameters. One (n = 9), two (n = 4) and three levels (n = 2) were operated on using Wallis implantation, ranging from L2-L3 to L5-S1. We used implants of 8-14 mm in size. There was a reduction in low back pain (73 vs 43%) and gait disturbances (73 vs 14%) at the 3-month follow-up compared with preoperative values. In line with these results, the modified Japan Orthopedic Association Score (mJAOS) was increased from 12 preoperatively to 18 at 3 months and 20 at 12 months postoperatively. A reduction in low back pain could only be demonstrated for implants that were 10 mm in size or greater at 3 months and 12-15 months postoperatively. An improvement was seen in Modic grades after the operations as compared with those observed at preoperative MRI. The outcome in our patients was rated as good or excellent according to Odom's criteria in all cases, independent of the levels that were used. Wallis implantation is therefore a safe procedure with a good to excellent outcome in the short- and mid-term follow-up and can lead to disc rehydration, as confirmed by postoperative MRI. Principal postoperative (clinical) success is based on the correct implant size.     

经皮脊柱内镜完全可视化椎间孔成形术治疗腰椎间盘突出症的短期疗效

目的探讨经皮脊柱内镜完全可视化椎间孔成形技术治疗腰椎间盘突出症的短期疗效。方法回顾性分析2016年6月至2018年12月复旦大学附属闵行医院神经外科(18例)和复旦大学附属中山医院神经外科(14例)采用经皮脊柱内镜完全可视化椎间孔成形技术治疗的32例腰椎间盘突出症患者的临床资料。术后复查腰椎MRI,并行疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)腰椎评分及Oswestry功能障碍指数(ODI)评估疗效。对所有患者行门诊随访,随访内容包括VAS、JOA评分、ODI评估及改良MacNab疗效评估。结果32例患者均顺利完成手术,术后均未出现感染、椎管内血肿及神经功能障碍。术后复查腰椎MRI显示突出的髓核摘除基本满意。与术前比较,32例患者术后2 d的VAS评分[分别为(2.21±1.18)分、(6.25±1.46)分]和ODI[(30.28±7.42)%、(68.63±11.04)%]均下降(均P<0.001),JOA评分升高[分别为(16.66±1.58)分、(12.43±1.85)分,P<0.001]。32例患者的随访时间为(15±5)个月(10~20个月)。随着随访时间的推移,32例患者的疼痛VAS评分呈下降趋势、JOA评分呈上升趋势、ODI呈下降趋势(F值分别为187.43、72.54、564.38,均P<0.001)。术后12个月随访时,32例患者的改良MacNab疗效评定结果为,优20例、良9例、可2例、差1例;优良率为90.6%(29/32)。结论经皮脊柱内镜完全可视化椎间孔成形技术治疗腰椎间盘突出症可改善疼痛和神经功能,帮助患者恢复生活和工作,短期疗效较好,远期效果需进一步随访观察。     

NFlex Dynamic Stabilization System : Two-Year Clinical Outcomes of Multi-Center Study

ObjectivePedicle-based dynamic stabilization systems, in which semi-rigid rods or cords are used to restrict or control spinal segmental motion, aim to reduce or eliminate the drawbacks associated with rigid fusion. In this study, we analyzed the two-year clinical outcomes of patients treated with the NFlex (Synthes Spine, Inc.), a pedicle-based dynamic stabilization system.MethodsFive sites participated in a retrospective study of 72 consecutive patients who underwent NFlex stabilization. Of these 72 patients, 65 were available for 2-year follow-up. Patients were included based on the presence of degenerative disc disease (29 patients), degenerative spondylolisthesis (16 patients), lumbar stenosis (9 patients), adjacent segment degeneration (6 patients), and degenerative lumbar scoliosis (5 patients). The clinical outcome measures at each assessment were Visual Analogue Scale (VAS) to measure back pain, and Oswestry Disability Index (ODI) to measure functional status. Radiographic assessments included evidence of instrumentation failure or screw loosening.ResultsSixty-five patients (26 men and 39 women) with a mean age of 54.5 years were included. Mean follow-up was 25.6 months. The mean VAS score improved from 8.1 preoperatively to 3.8 postoperatively, representing a 53% improvement, and the ODI score from 44.5 to 21.8, representing a 51% improvement. Improvements in pain and disability scores were statistically significant. Three implant-related complications were observed.ConclusionPosterior pedicle-based dynamic stabilization using the NFlex system seems effective in improving pain and functional scores, with sustained clinical improvement after two years. With appropriate patient selection, it may be considered an effective alternative to rigid fusion.     

Survival Rates and Risk Factors for Cephalad and L5-S1 Adjacent Segment Degeneration after L5 Floating Lumbar Fusion : A Minimum 2-Year Follow-Up

Objective

Although the L5-S1 has distinct structural features in comparison with other lumbar spine segments, not much is known about adjacent segment degeneration (ASD) at the L5-S1 segment. The aim of study was to compare the incidence and character of ASD of the cephalad and L5-S1 segments after L5 floating lumbar fusion.

Methods

From 2005 to 2010, 115 patients who underwent L5 floating lumber fusion were investigated. The mean follow-up period was 46.1 months. The incidence of radiological and clinical ASD of the cephalad and the L5-S1 segments was compared using survival analysis. Risk factors affecting ASD were analyzed using a log rank test and the Cox proportional hazard model.

Results

Radiological ASD of the L5-S1 segment had a statistically significant higher survival rate than that of the cephalad segment (p=0.001). However, clinical ASD of the L5-S1 segment was significantly lower survival rates than that of the cephalad segment (p=0.038). Risk factor analysis showed that disc degeneration of the cephalad segment and preoperative spinal stenosis of the L5-S1 segment were risk factors.

Conclusion

In L5 floating fusion, radiological ASD was more common in the cephalad segment and clinical ASD was more common in the L5-S1 segment. At the L5-S1 segment, the degree of spinal stenosis appears to be the most influential risk factor in ASD incidences, unlike the cephalad segment.     

The Role of Computed Tomography in the Presurgical Diagnosis of Foraminal Entrapment of Lumbosacral Junction

Objective

On the basis of preoperative computed tomography (CT) scans, we studied the change of the size of anterior primary division (APD) of the L5 spinal root in the presence of foraminal/extraforaminal entrapment of the L5 spinal root.

Methods

Two independent radiologists retrospectively reviewed the preoperative CT scans of 27 patients treated surgically and compared the sizes of the APDs on bilateral L5 spinal roots. If one side APD size was larger than the other side APD size, it was described as left or right "dominancy" and regarded this as "consensus (C)" in case that there was a consensus between the larger APD and the location of sciatica, and regarded as "non-consensus (NC)" in case that there was not a consensus. Oswestry Disability Index (ODI) scores were used for preoperative and postoperative evaluation.

Results

On CT scans, twenty-one (77%) of 27 patients were the consensus group (APD swelling) and 6 (22%) were a non-consensus group (APD no swelling). In 9 patients with acute foraminal disc herniations, asymmetric enlargement of the APD on L5 spinal root was detected in all cases (100%) and detected in 11 (64%) of 17 patients with stenosis. Preoperative ODI score was 75-93 (mean 83) and postoperative ODI scores were improved to 13-36 (mean 21). The mean follow-up period was 6 months (range, 3-11 months).

Conclusion

An asymmetric enlargement of the APD on L5 spinal root on CT scans is meaningfully associated with a foraminal or extraforaminal entrapment of the L5 spinal root on the lumbosacral junction.