经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症

目的总结经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症的体会。方法选取2017-02—2018-01间淇县人民医院收治的48例腰椎间盘突出症患者,均予以经皮椎间孔内窥镜下靶向穿刺椎间盘切除术。观察手术效果及随访情况。结果 48例患者均成功完成手术,手术时间为(51.85±6.20)min,术中出血量为(40.26±7.60)mL。未发生脑脊液漏、硬脑膜微小撕裂、神经受损等并发症。术后2个月及12个月随访时患者的VAS评分及ODI指数均较术前明显改善,差异均有统计学意义(P0.05)。依据Macnab标准,术后12个月时的治疗优良率为87.50%(42/48)。结论对腰椎间盘突出症患者在掌握手术适应证的基础上,应用经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗创伤小、安全性高、疗效肯定。     

经皮椎间孔镜靶向穿刺技术治疗腰椎椎间盘突出症的疗效分析

目的探讨靶向穿刺经皮椎间孔镜下腰椎椎间盘切除术治疗腰椎椎间盘突出症的安全性和有效性。方法 2011年5月～2012年2月58例单节段腰椎椎间盘突出症患者,局麻后影像学监视下行靶向穿刺,经皮椎间孔镜下行髓核摘除、直接减压手术。采用视觉模拟量表(visual analog scale,VAS)评分、Oswestry功能障碍指数(Oswestrydisability index,ODI)和MacNab标准评估手术疗效。结果患者术后平均随访18.5个月,术后各时间点腰腿痛VAS评分较术前均明显降低(P<0.01);术后12个月,ODI由术前平均72.4%降至平均19.7%(P<0.01),按MacNab标准评定疗效优良率93.1%。结论经皮椎间孔镜靶向穿刺技术治疗腰椎椎间盘突出症创伤小,并发症少,术后恢复快,近期疗效可靠,靶向穿刺是手术成功的首要前提和重要步骤。     

经椎间孔内窥镜手术治疗腰椎间盘突出症35例临床分析

目的探讨经椎间孔内窥镜技术椎间盘切除术治疗腰椎间盘突出症的手术技术和临床疗效。方法对35例腰椎间盘突出症患者应用经皮椎间孔镜下椎间盘切除术治疗,回顾性分析患者的临床资料。结果所有病例均顺利完成手术,手术时间60~135 min,平均85.6 min。术中出血10~50 mL。35例随访12~24个月,平均14.8个月,术前VAS评分为(8.1±2.9)分,术后12个月为(2.1±1.3)分,手术前后有显著差异性(P0.01)。术前ODI为(55.6±11.8)%,术后12个月为(18.4±7.1)%,手术前后有显著差异性(P0.01)。根据MacNab标准,优26例,良6例,中3例,优良率91.4%。两例术后6~12个月复发,均行后路内窥镜下椎间盘反修术后恢复。结论经皮内窥镜是治疗腰椎间盘突出症安全、有效的微创手段。     

椎间孔镜靶向技术治疗中青年腰椎间盘突出症

[目的]探讨靶向穿刺经皮椎间孔镜下腰椎间盘切除术治疗腰椎间盘突出症的安全性和有效性。[方法]2014年4月～2016年12月,采用靶向穿刺椎间孔镜治疗单节段青年腰椎间盘突出症患者131例,其中男90例,女41例,年龄18～44岁,平均(33.50±7.55)岁。采用VAS评分、ODI评分、JOA评分和改良MacNab标准评估手术疗效,MRI测量椎间隙高度变化。[结果]本组131例患者,均顺利完成手术,未发生血管、内脏损伤等并发症,虽发生4例硬膜损伤,但无不良后果。手术时间平均(112.84±26.26) min,术中出血量平均(31.87±26.33) ml。随访12～28个月,平均(17.41±6.20)个月。腿痛VAS评分由术前(5.89±1.06)减少至术后12个月(1.02±0.75)分;腰痛VAS评分由术前(3.17±1.51)减少至术后12个月(0.99±0.90)分;ODI评分由术前(55.15±10.86)减少至术后12个月(10.76±6.78)分,而JOA评分由术前(8.91±4.10)分增加至术后12个月(26.29±2.29)分,上述指标变化差异均有统计学意义(P0.05)。按照MacNab评价标准,术后1个月优良率98.47%,术后6个月优良率94.66%,术后12个月优良率91.60%。本组131例中,原间隙复发5例,复发率为3.82%。[结论]经皮椎间孔镜靶向技术治疗腰椎间盘突出症创伤小、并发症少、术后恢复快、近期疗效可靠,靶向穿刺是手术成功的首要前提和重要步骤。     

经皮腰椎间孔成形内窥镜下椎间盘切除术治疗腰椎间盘突出症的疗效观察

目的:观察经皮腰椎间孔成形、经椎间孔内窥镜下椎间盘切除术治疗非包含型腰椎间盘突出症的近期疗效.方法:2007年4月～2007年7月收治非包含型腰椎间盘突出症患者26例,其中L3/4 4例,L4/5 12例,L5/S1 10例.应用自制椎间孔成形器械行经皮腰椎间孔扩大成形、经椎间孔内窥镜下椎间盘切除术,分析治疗前及治疗后9个月时腰痛及腿痛视觉模拟评分(VAS)的变化情况,术后9个月时采用MacNab功能评分判断疗效.结果:手术均顺利完成,手术时间45～120min,平均75min;术中出血量20～50ml,平均35ml.2例患者术后1周出现下肢"日光烧灼综合征",均为L5/S1椎间盘突出,经过脉冲电刺激治疗1周后缓解;无其他手术并发症发生.随访9个月,腰痛VAS评分术前6.3±2.5分,术后1d 2.1±1.3分,术后3个月1.8±1.6分,术后9个月1.5±1.1分:腿痛VAS评分术前8.6±2.1分,术后1d 1.1±0.7分,术后3个月0.5±0.6分,术后9个月03±0.1分;术后腰痛和腿痛的VAS评分较术前均明显降低(P<0.01).按照MacNab评分标准,术后9个,月随访时优18例,良8例,优良率为100％.结论:经皮腰椎间孔成形、经椎间孔内窥镜下椎间盘切除术治疗非包含型腰椎间盘突出症患者创伤小、近期疗效好.     

经皮椎间孔镜TESSYS技术治疗单节段双侧腰椎间盘突出症

目的:探讨经椎间孔镜TESSYS (transforaminal endoscopic spine system)技术治疗单节段双侧腰椎间盘突出症患者的早期临床效果。方法:对2016年2月至2018年2月行经皮椎间孔镜TESSYS技术治疗的单节段双侧腰椎间盘突出症38例患者进行回顾性分析,男26例,女12例;年龄30～55(35.2±6.4)岁;L3,46例,L4,522例,L5S110例。使用德国Joimax GmbH公司椎间孔镜,局部麻醉,透视下双侧穿刺至病变节段的椎间孔外侧,应用4级扩张导管逐级完成椎间孔扩大成形,环锯逐级扩大椎间孔,双侧置入椎间孔镜,摘除突出髓核,直至神经根完全松解。术后对患者进行定期的门诊复查、电话随访,分别比较术前、术后1、3、6、12个月的双下肢疼痛的视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI),末次随访应用改良的MacNab标准进行疗效评定。结果:36例患者手术顺利且获得12个月以上的随访。术后1、3、6、12月的双下肢疼痛VAS评分和ODI评分较术前均有明显改善(P0.05),术后1、3个月与术后6、12个月双下肢疼痛的VAS评分和ODI评分差异均有统计学意义(P0.05),而术后1个月与3个月、术后6个月与12个月双下肢疼痛VAS评分和ODI评分差异无统计学意义(P0.05),末次随访根据改良MacNab评价标准,优14例,良16例,可4例,差2例。结论:运用经皮椎间孔镜TESSYS技术从双侧摘除突出髓核的同时能够充分对神经根进行减压,可以有效应用于单节段双侧腰椎间盘突出症的患者。     

经皮椎间孔镜下椎间盘切除治疗腰椎间盘突出症的效果

目的探讨经皮穿刺椎间孔镜(PTED)下椎间盘切除治疗腰椎间盘突出症的效果。方法采用PTED下椎间盘切除治疗48例腰椎间盘突出症患者。记录手术并发症情况;术前及术后1、3、6个月采用疼痛VAS评分评估患者腰、腿痛改善情况,采用ODI评估患者腰椎生理功能改善情况;术后1、3、6个月采用改良MacNab标准评估治疗效果。结果患者均获得6个月随访。术后1、3、6个月,腰、腿痛VAS评分及ODI均明显低于术前(P 0.05),且随着术后时间延长,腰、腿痛VAS评分及ODI呈明显降低趋势(P 0.05),改良MacNab标准优良率呈明显升高趋势(P 0.05)。术后4例出现术侧足拇趾麻木,2例穿刺部位皮下瘀血。未出现神经根或硬膜囊损伤、脑脊液漏、感染等严重并发症。结论 PTED下椎间盘切除治疗腰椎间盘突出症近期疗效显著。     

经皮内镜椎板间入路椎间盘切除术治疗L5～S1游离型腰椎间盘突出症

目的 探讨经皮内镜椎板间入路椎间盘切除术(PEID)治疗L5～S1游离型腰椎间盘突出症的临床疗效.方法 采用PEID治疗41例L5～S1游离型腰椎间盘突出症患者.记录疼痛VAS评分、JOA评分、ODI.术后12个月采用改良MacNab标准评价临床疗效.结果 手术时间55～98(76.50±20.16)min,住院时间2...     

经皮椎间孔内窥镜下手术治疗腰椎间盘突出症的近期疗效观察

目的:评价经皮椎间孔内窥镜下椎间盘切除术治疗腰椎间盘突出症的近期临床效果。方法:2009年9月～2010年3月应用经皮椎间孔内窥镜下椎间盘切除术治疗30例腰椎间盘突出症患者,男19例,女11例,年龄18～60岁,平均40.8岁;病程3个月～4年,平均9个月。术前患者均表现为腰痛伴单侧下肢放射性疼痛,均为单间隙突出,侧方型突出25例,旁中央型突出5例。均采用局部麻醉下手术。术前、术后不同时间对患者腰、腿痛进行VAS评分;采用Oswestry功能障碍指数(ODI)评估腰椎功能改善情况;术后6个月随访时采用Mac-Nab标准评价疗效。结果:30例患者均成功实施手术,手术时间55～135min,平均75min,术中出血5～30ml,平均12ml。术后第二天戴腰围下地行走。1例术后患侧膝反射减弱;1例术后腰痛缓解,出院后腿痛加重,均经保守治疗后恢复正常或症状缓解。随访6～12个月,平均9.2个月。腰痛、腿痛VAS由术前的平均6.5分、8.7分下降到术后6个月时的1.9分、1.5分,与术前比较均有显著性差异﹙P<0.01﹚。ODI由术前平均77.38%下降至术后6个月时的平均19.09%。根据MacNab标准,术后6个月时随访优10例(33.3%),良16例(53.3%),可3例(10%),差1例(3.3%),优良率86.6%。结论:经皮椎间孔内窥镜下椎间盘切除术治疗腰椎间盘突出症创伤小,并发症少,术后恢复快,近期疗效较满意。     

经皮椎间孔内窥镜下靶向穿刺椎间盘切除术后患者腰部功能及疼痛情况分析

[目的]探讨经皮椎间孔内窥镜下靶向穿刺椎间盘切除术后患者腰部功能及疼痛情况。[方法]选择本院2014年1月~2015年12月收治的94例腰椎间盘突出症患者,均给予经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗。术后采用疼痛视觉模拟评分(VAS)对患者腰痛、腿痛进行评价,采用Oswestry功能障碍指数(ODI)对腰部功能进行评价,采用Macnab标准评估临床总优良率,并且统计并发症(局部麻木感、脑脊液漏、硬脑膜微小撕裂、神经受损)的发生情况,并通过X线片、MRI观察术后腰椎间盘情况。[结果]手术用时42~116 min,平均74 min;术中出血量25~55 ml,平均40 ml。术后无局部麻木感、脑脊液漏、硬脑膜微小撕裂、神经受损等并发症出现。术后半年、末次随访,患者腰痛VAS、腿痛VAS、ODI评分均明显低于术前(P<0.05);术后半年总优良率88.30%,术后1年总优良率92.55%。术后半年椎体间隙较前变窄2例、成角>10°1例,术后1年椎体间隙变窄1例,所有患者在术后半年和末次随访均无椎间盘再次移位者。[结论]经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症,对患者创伤小、出血少、并发症少、有效恢复脊柱的稳定性、椎间盘恢复好,治疗效果满意,是一种治疗腰椎间盘突出症的有效的方法。     

Speculum lumbar extraforaminal microdiscectomy

BACKGROUND CONTEXT: Public interest, monetary pressures and improving diagnostic techniques have placed an increasing emphasis on minimalism in lumbar disc excision. Current techniques include microlumbar discectomy and minimally invasive spinal surgery. Both are good techniques but may be painful, require a hospital stay and/or are not widely used because of difficulty acquiring the necessary skills. The author therefore developed a less invasive microscopic technique that may be performed on a consistent outpatient basis with easily acquired skills. PURPOSE: The purpose of this study was to describe a variant of minimally invasive lumbar disc excision, while assessing the effects on a small group of patients. STUDY DESIGN: The treatment protocol was a prospective community hospital-based case study designed to evaluate a less invasive method of excising herniated lumbar discs residing in the canal, foraminal or far lateral space. PATIENT SAMPLE: This study is comprised of 50 patients with all anatomic forms of lumbar disc herniations, inside or outside the canal, at all levels except the lumbosacral joint. OUTCOME MEASURES: Clinical results were measured by return to work time, the criteria of MacNab and by Prolo et al.'s economic and functional criteria. METHODS: Selection criteria included adult patients with intractable low back and leg pain, plus an imaging study revealing a lumbar disc herniation consistent with the patient's clinical presentation. Mean patient age was 48 years. The male:female ratio was approximately 2:1. All patients failed at least 3 weeks of conservative therapy. Herniations occurred from the L2-3 space through L4-5, with 30 herniations being within and 20 outside the spinal canal. Both contained and extruded/sequestered herniations were treated. Excluded from the study were patients with herniations inside the spinal canal at the L5-S1 level. Surgical approach was by microscopic speculum transforaminal route for discs residing both within and outside the lumbar canal. RESULTS: The initial 50 consecutive patients had successful technical operations performed on an outpatient basis by this less invasive technique. By the criteria of MacNab (Table 3), 84% (42 of 50) had an excellent or good result, returning to work at a mean time of 3.5 weeks. Per Prolo et al.'s economic scale, 72% were disabled at levels I and II before surgery. Postoperatively, 92% had improved to levels IV and V. Similarly, on his functional scale, 94% functioned at levels I and II before surgery, whereas 88% achieved levels IV and V after surgery. Eighty percent required no pain medications 1 week after surgery. The only complication was an L3 minor nerve root injury as it exited the L3-4 foramen. CONCLUSION: The author has described a minimally invasive technique for excising herniated discs that is applicable to all types of lumbar herniations, except for those residing in the canal at L5-S1. Clinical outcomes are comparable to those of other forms of discectomy.     

Vascular complications of lumbar disc surgery

Summary Over a period of seven years nine patients with vascular complications after lumber discectomy received medical care at the Clinic of Vascular Surgery, University of Graz Medical School. We report five acute bleeding complications occurring during the operation and four late manifestations of vascular lesions.Five patients presented with acute life-threatening iatrogenic haemorrhages from pelvic vessels. Three patients made a complete recovery, one patient died from acute haemorrhagic shock, one further patient died from sepsis due to an associated complication — an injury to the ureter.Over a period of two to ten years after primary surgery we corrected late complications such as 1 case of posttraumatic aneurysm of the aortic bifurcation found to have eroded the body of the fifth lumbar vertebra, and three cases of arteriovenous fistula between the common iliac artery and the common iliac vein.The four cases described below are an attempt to document the vascular surgical procedures involved and to provide typical findings.The risk of injuring the pelvic vessels intra-operatively can be explained by the close anatomical relation between the retroperitoneal vessels and the vertebral column and furthermore not only by the fact that pre-existent deficiencies but also injury to the anterior longitudinal ligament give access to the retroperitoneal space.     

Micro- or macrodiscotomy for open lumbar disc surgery?

Summary Though many conservative and intradiscal therapies for lumbar dise herniation have been developed, open disc surgery is still necessary. To prevent postoperative epidural scar formation, which is responsible for postdiscotomy syndrome (failed back syndrome), a small approach is recommended. Microdiscotomy requires special instrumentation and training for the surgeon, otherwise problems occur such as exploration at the wrong level and dural tears. Surgeons should always use the procedure they are familiar with.     

腰椎滑脱术后失败病例后路再手术的疗效

目的:探讨个体化腰椎后入路手术治疗腰椎滑脱术后失败病例的疗效。方法:回顾分析2004年1月至2007年11月再手术治疗的12例腰椎滑脱术后失败病例的临床资料,单纯腰椎不稳2例,单纯腰椎管狭窄1例,腰椎不稳伴腰椎管狭窄4例,腰椎间盘突出1例,明显植骨未融合4例;内置物失败包括椎弓根内固定松动5例,椎弓根螺钉断裂3例(其中2例合并椎间融合器突入椎管),单纯椎间融合器突入椎管1例。再手术时采用双侧椎弓根螺钉系统内固定加双侧cage椎体间植骨融合术5例,双侧椎弓根螺钉系统内固定加单枚cage椎体间植骨融合术3例,单侧椎弓根螺钉系统内固定加单侧cage椎体间植骨融合术2例,单纯椎板间开窗减压术1例,另1例更换cage椎体间融合,而保留原有的椎弓根内固定系统。对所有患者进行定期随访,通过影像学检查与Oswestry功能障碍指数综合评价再手术的疗效。结果:所有患者均顺利完成手术,术中1例硬膜囊撕裂,术后发生脑脊液漏,经抬高床脚,术后5d脑脊液漏愈合,无脊髓神经损伤等严重并发症发生。随访1.5～4年,平均2.7年。椎间植骨均达骨性融合,椎间融合器无移位;未见椎弓根螺钉固定系统松动或断裂;腰椎滑脱无加重或复发。Oswestry功能障碍指数末次随访时为21.9%±3.0%,与术前81.8%±2.5%比较,差异有统计学意义(P0.05)。结论:腰椎滑脱术后失败因素复杂,应根据具体病因个体化选择手术方法,后路手术是治疗这类疾病的有效方法之一。     

微创与开放经椎间孔椎体间融合术治疗单节段腰椎病变的Meta分析

目的:对微创与开放经椎间孔椎体间融合术(TLIF)治疗单节段腰椎病变的临床疗效进行Meta分析。方法:计算机检索Pub Med、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网全文数据库、万方数据库等文献数据库,检索的主题词为"微创(minimally invasive、MIS或mini-open)、开放(open)及经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)",检索时间和语言未作限制。纳入关于微创与开放TLIF治疗单节段腰椎病变的对照研究文献。使用纽卡斯尔-渥太华量表(NOS)来进行文献质量评价与特征描述。利用Review Manager 5.1统计学软件进行数据分析。本研究选择的评价指标包括手术相关性指标(手术时间、术中出血量、术后引流量、术中放射时间、术后卧床时间、住院时间、住院总费用),术后腰痛/下肢痛视觉模拟评分法(VAS),术后Oswestry功能障碍指数(ODI),并发症,翻修手术例数和末次随访融合率。结果:经过筛选共纳入18篇文献,其中5篇前瞻性队列研究,12篇回顾性队列研究,仅1篇随机对照试验,共1437例,微创组691例,开放组746例。质量评价提示纳入文献均属高质量队列研究(NOS评分5~9分)。微创TLIF与开放TLIF比较,前者术中出血量、术后引流量、卧床时间、住院时间、住院总费用均明显少于后者(P0.01);术后3d及末次随访腰痛VAS评分改善优于后者(P0.00001);术中放射时间明显多于后者(P0.0001);在手术时间、并发症发生率、翻修手术率、末次随访融合率、术后下肢痛VAS评分及ODI方面,两者差异均无统计学意义(P0.05)。结论:与开放TLIF相比,微创手术创伤小,出血量少,恢复早,术后腰背痛程度较轻的优势,且术后下肢痛的改善及并发症发生率相当,但术中放射时间较长。     

Retroperitoneoscopic tension-free repair of lumbar hernia

Lumbar hernia is an infrequent pathology that is difficult to treat through open surgery. A 65-year-old man presented with a right-sided lumbar mass responsible for pain. This was a fatty mass of 10×15 cm, located in the lumbar fossa. A CT scan showed the hernia and the defect. Through a small incision in the flank, dissection was initiated with one finger; a 10-mm trocar was inserted into this incision and the retroperitoneal space inflated. Under direct vision, dissection of retroperitoneal fat was undertaken with the scope. A 5-mm trocar was inserted beyond the 11^th rib. Fat in the lumbar hernia was reintegrated into the retroperitoneal space, allowing the lumbar wall defect to be seen. A polypropylene mesh was applied and stapled onto the lumbar wall to widely cover the defect. Under trans-abdominoretroperitoneal laparoscopy, lateral peritoneum, colon, and ureter are detached to explore the lumbar wall and are reinserted at the end of the procedure. Under retroperitoneoscopy, even if the space is small, retroperitoneal fat is easily detached at a distance from the colon and ureter. The defect is covered with a polypropylene mesh. It is covered with an ePTFE mesh if the retroperitoneal space cannot be closed. Surgery and follow-up were uneventful with no recurrence in this case or in the published cases. Retroperitoneoscopy and trans-abdominoretroperitoneal laparoscopy are two easy approaches for a tension-free repair of lumbar hernia.     

微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的疗效比较

目的:比较Quadrant通道辅助下微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的临床效果.方法:2008年3月～2010年6月,选择经保守治疗无效的单一节段腰椎退变性疾病的患者80例,随机分为两组,每组40例,两组患者年龄、性别、体重、临床诊断与手术节段差异无统计学意义(P＞0.05),分别进行Quadrant通道辅助下微创经椎间孔减压腰椎融合内固定术与传统后路开放手术.随访24～36个月,平均29个月,比较两组患者的手术时间、术中出血量、术后引流量、住院时间、血清肌酸磷酸激酶、MRI-T2驰豫时间、VAS评分、Oswestry功能障碍指数(ODI)及融合率等.结果:两组手术时间(141.0±27.3min与139.5±33.7min)无统计学差异(P＞0.05).微创手术组的术中出血量、术后引流量分别为268.0±122.2ml和25.6±32.4ml,明显少于传统开放手术组的370.0±147.1ml和277.8±167.4ml (P＜0.05);术后住院时间为7.3±3.2d,短于传统开放手术组的9.5±2.7d(P＜0.05).每组患者术后1个月、24个月时的VAS评分与ODI与术前比较均有明显改善(P＜0.05),术后1个月时微创手术组腰、腿痛VAS评分优于传统开放手术组(P＜0.05),术后24个月时腰、腿痛VAS评分及术后1个月、24个月时ODI两组比较均无统计学差异(P＞0.05).肌酸磷酸激酶在术后1、3、5d时明显升高(P＜0.05),术后1d达到高峰,7d时基本恢复正常,并在术后1、3d时微创手术组明显低于传统开放手术组(P＜0.05).术后3个月时手术节段多裂肌的T2驰豫时间微创手术组明显低于传统开放手术组(P＜0.05).术后6个月及24个月随访时两组融合率无统计学差异(P＞0.05).结论:Quadrant通道辅助下微创经椎间孔减压腰椎融合内固定术与传统开放手术治疗单节段腰椎退变性疾病均可取得较好的近期疗效,但前者肌肉和软组织损伤小,有助于早期功能恢复.     

开窗法治疗多节段腰椎管狭窄症

目的探讨开窗法治疗多节段腰椎管狭窄症的疗效。方法根据临床定位和影像学检查确定减压节段及部位,先行椎板间开窗,切除同侧黄韧带,啃刮对侧椎板下黄韧带,从而扩大椎管。探查神经根,根据其受压情况,去除致压物,尽量保留骨质结构。结果治疗21例,17例得到随访,时间10～36个月。按Otanietal分级:优9例,良5例,可2例,差1例。结论应用开窗法治疗多节段腰椎管狭窄症可获得良好疗效。     

Complications in lumbar spine surgery: A retrospective analysis

Background:

Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate.

Materials and Methods:

From 2007 to 2011 the number and type of complications were recorded and both univariate, (considering the patients’ age) and a multivariate statistical analysis was conducted in order to establish a possible predisposing role. 133 were lumbar disc hernia treated with microdiscetomy, 88 were lumbar stenosis, treated in 36 cases with only decompression, 52 with decompression and instrumentation with a maximum of 2 levels. 26 patients showed a lumbar fracture treated with percutaneous or open screw fixation. 12 showed a scoliotic or kyphotic deformity treated with decompression, fusion and osteotomies with a maximum of 7.3 levels of fusion (range 5-14). 70 were spondylolisthesis treated with 1 or more level of fusion. In 34 cases a fusion till S1 was performed.

Results:

Of the 338 patients who underwent surgery, 55 showed one or more complications. Type of surgical treatment (P = 0.004), open surgical approach (open P = 0.001) and operative time (P = 0.001) increased the relative risk (RR) of complication occurrence of 2.3, 3.8 and 5.1 respectively. Major complications are more often seen in complex surgical treatment for severe deformities, in revision surgery and in anterior approaches with an occurrence of 58.3%. Age greater than 65 years, despite an increased RR of perioperative complications (1.5), does not represent a predisposing risk factor to complications (P = 0.006).

Conclusion:

Surgical decision-making and exclusion of patients is not justified only by due to age. A systematic preoperative evaluation should always be performed in order to stratify risks and to guide decision-making for obtaining the best possible clinical results at lower risk, even for elderly patients.