腰椎管狭窄症31例诊断与治疗

目的　探讨腰椎管狭窄症的诊断与治疗。方法　对 3 1例手术患者临床资料进行分析。结果　本组 3 1例均为继发性腰椎管狭窄 ,其中 2 9例为退行性变型。 2 3 % (7/ 3 1 )同时合并颈、胸椎管狭窄。 2 9% (9/ 3 1 )合并椎间盘突出。椎管造影优点多。治疗中存在误区。结论　椎管造影是不可取代的腰椎管狭窄症诊断方法。避免重手法推拿按摩或大重量牵引和反复椎管内封闭 ,合并颈、胸椎管狭窄者需分期手术。充分、彻底减压特别不能忽略侧椎管狭窄是提高疗效的关键     

Myelography in cancer patients: modified technique

Because of the frequency of multiple sites of involvement, a thorough evaluation of the entire spinal canal is essential for detection and treatment of spinal compression in cancer patients. For the examination of the entire spinal canal in cancer patients, a modified approach is described using water-soluble contrast medium (metrizamide), oil-based material (Pantopaque), and a "squeezing" technique for a complete myelographic block. Of 240 patients who underwent myelography for possible spinal compression, the squeezing technique was applied through a lumbar puncture to demonstrate a complete block in 39 patients; six of these had more than one block. Of the other 201 patients, the quality of the myelograms was satisfactory or excellent in 189 (94%).     

继发椎管狭窄与脊髓亚急性联合变性MRI异常信号的相关性

目的：研究脊髓亚急性联合变性(SCD)的 MRI 表现特点,探讨继发椎管相对狭窄与 SCD 的 MR 异常信号的相关性。方法收集56例 SCD 患者的临床及 MRI 影像资料,分析 SCD 病例中椎间盘膨出/突出、黄韧带增厚、后纵韧带增厚或两者以上协同作用下的椎管相对狭窄与脊髓内病灶的表现特点。结果56例 SCD 患者中,MRI 检查脊髓表现有病灶的45例,均表现为典型的SCD 影像表现。继发椎管相对狭窄并脊髓信号异常者37例,继发椎管相对狭窄脊髓未见异常信号者2例,无继发椎管相对狭窄脊髓信号异常者8例,无继发椎管相对狭窄脊髓也未见异常信号者9例。比较采用χ2检验统计继发椎管相对狭窄与脊髓异常信号有显著性差异(P <0.05)。37例 SCD 有继发椎管相对狭窄中15例行物理治疗后较对照组病程缩短。结论继发椎管相对狭窄致脊髓微循环障碍是导致 SCD 脊髓病变 MRI 表现更显著或更易于显现的重要因素。     

腰椎管狭窄症的CT分型

目的 探讨腰椎管狭窄症的ＣＴ分型。材料与方法 对７４５例腰椎管狭窄症的术前ＣＴ分型与手术结果进行对比分析。结果 ＣＴ分为３组,Ｉ型：中心椎管狭窄型;Ⅱ型：脊神经根管狭窄型;Ⅲ型：混合型（即Ｉ、Ⅱ型并存）。其中Ｉ型１０４例（１３．９６％）,Ⅱ型１５８例（２１．２１％）,Ⅲ型４８３例（６４．８３％）。ＣＴ分型与手术符合率为９２．２１％,不符多见于Ⅲ型。结论 ＣＴ分型对腰椎管狭窄的手术治疗具有指导意义,     

腰椎管狭窄104例与黄韧带的关系

目的　探讨形成腰椎管狭窄症的原因及与黄韧带的关系。方法　对我院 1990年以来手术的 10 4例腰椎管狭窄症进行分析。结果　腰椎管狭窄可由骨性椎管因素造成 ,也可由非骨性物退变增生导致的椎管内占位所造成。结论　腰椎黄韧带钙化、骨化及肥厚是引起腰椎管狭窄的常见原因 ,特别是骨性椎管已有狭窄或有椎间盘突出等病变存在时更会加重症状     

腰椎椎体后缘骨内软骨结节所致腰椎管狭窄症的影像诊断

目的　总结腰椎椎体后缘骨内软骨结节 (LPMN)所致腰椎管狭窄症临床、影像诊断 ,探讨有关的发病因素。方法　对经手术证实的 16例PLMN所致腰椎管狭窄症的临床表现、影像学特征、手术方式进行回顾性分析总结。结果　典型的影像改变为 :( 1)椎体后上缘类圆形骨质缺损 ,边缘较致密硬化 ;( 2 )缺损后方有一骨块突入椎管 (游离或部分与椎体相连 ) ;( 3)硬膜囊及神经根受压 ,可伴有椎间盘突出。结论　影像学检查能明确诊断腰椎椎体后缘骨内软骨结节 (LPMN)所致腰椎管狭窄症 ,并为制订治疗方案提供可靠依据。     

Percutaneous Treatment of Lumbar Compression Fracture with Canal Stenosis and Neurogenic Intermittent Claudication: Combining Kyphoplasty and Interspinous Spacer

Vertebral compression fractures (VCFs) can cause symptomatic spinal canal stenosis secondary to posterior wall retropulsion. This report describes four patients with VCF and lumbar stenosis secondary to posterior wall retropulsion who were treated with combined kyphoplasty and percutaneous interspinous spacer (IS) placement. Clinical and imaging follow-up ranged from 12–36 months. Outcomes were favorable. Combined kyphoplasty and percutaneous IS implant represents a minimally invasive, safe, and efficient option to treat VCF with symptomatic spinal stenosis.     

Spinal stenosis subsequent to juvenile lumbar osteochondrosis

This paper describes eight patients with spinal stenosis associated with marked osteochondrous changes in the vertebral bodies due to juvenile lumbar osteochondrosis (Scheuermann's disease). In no case was the midsagittal or interpedicular diameter of the spinal canal indicative of bony stenosis. On the other hand, in the myelograms the sagittal diameter of the dural sac was in all cases significantly narrowed, a diagnostic sign of central spinal stenosis. Therefore, myelography should always be contemplated when osteochondrous changes are present and spinal stenosis is suspected clinically regardless of whether the spinal canal diameters are normal in plain films.     

腰椎管狭窄再手术的临床分析

 目的 探讨腰椎管狭窄术后再手术的常见原因, 寻求再手术时术中和术后的应对措施。方法 回顾性分析我科收治的21例腰椎管狭窄症再手术患者的临床资料。全部患者均经过先期后路减压手术, 部分经过后路内固定, 由于症状不缓解或再次出现症状而采取后路再手术, 分析再手术的原因、术后疗效和相关的手术操作过程。结果 本组再手术的原因主要包括：减压不彻底、腰椎不稳、螺钉位置偏差、椎间盘突出术后复发、术式选择欠妥等, 再手术前JOA评分为11.28±2.67, 再手术后的患者均得到随访和定期复查, 随访时间12~36个月, 平均24.8个月, 随访终末JOA评分及改善率为（19.45±2.79）%和（45.34±7.87）%, 术后下肢感觉、肌力和功能障碍得到明显恢复。结论 严格掌握手术适应证, 有效的减压, 合理的内固定, 可以使再手术的患者获得较好的疗效。     

Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT

The aim of this study was to investigate the correlation of vertebral dimensions with somatometric parameters in patients without clinical symptoms and radiological signs of central lumbar spinal stenosis. One hundred patients presenting with low back pain or sciatica were studied with CT. In each of the L3, L4 and L5 vertebra three slices were taken with the following measurements: 1. Slice through the intervertebral disc: (a) spinal canal area; (b) interarticular diameter; (c) interligamentous diameter. 2. Slice below the vertebral arcus: (a) dural sac area; (b) vertebral body area. 3. Pediculolaminar level: (a) anteroposterior diameter and interpedicular diameter of the spinal canal; (b) spinal canal area; (c) width of the lateral recesses. The Jones-Thomson index was also estimated. The results of the present study showed that there is a statistically significant correlation of height, weight and age with various vertebral indices. The conventional, widely accepted, anteroposterior diameter of 11.5 mm of the lumbar spinal canal is independent of somatometric parameters, and it is the only constant measurement for the estimation of lumbar spinal stenosis with a single value. The present study suggests that there are variations of the dimensions of the lumbar spinal canal and correlations with height, weight and age of the patient. Received 9 July 1997; Revision received 11 February 1998; Accepted 11 March 1998     

老年重度腰椎管狭窄症围术期特点及其术后早期并发症

 目的 探讨老年重度腰椎管狭窄症围术期特点和术后早期并发症的处理方法。方法 回顾性分析我院骨科2008-02至2013-12共184例老年重度腰椎管狭窄症的病历资料,总结术前合并症、术中出血量、手术时间、住院时间,观察术后早期并发症的出现情况,总结处理方法。结果 患者平均(68.77±5.76)岁,平均住院时间(27.26±9.61)d,无围术期死亡病例,手术时间平均(3.09±1.09) h,术中出血量平均(618.60±366.50)ml,融合节段超过3个的106例(57.61％)。出现各种并发症合计119例(64.67％),按发生的比例依次排列为切口愈合不良、术后疼痛、全身状况不稳定、低血容量、脑脊液漏、神经根损伤和深静脉血栓形成,对所发生的并发症,均给予了积极有效的对应治疗,效果较好。结论 老年重度腰椎管狭窄症患者的手术有一定的风险,但并非不能手术,做好术前准备和术后应对预案,可以提高围术期安全性。     

Axial loading during MR imaging can influence treatment decision for symptomatic spinal stenosis

BACKGROUND AND PURPOSE: Previous studies have shown that axial loading can narrow the spinal canal. However, the clinical significance is unclear. The purpose of this study was to determine whether the narrowing of the spinal canal with axial loading during MR imaging could influence treatment decision for spinal stenosis. METHODS: Two hundred patients with clinical symptoms of spinal stenosis underwent routine MR imaging and then immediately underwent axially loaded MR imaging. We selected 20 of these patients because they had narrowing of the spinal canal shown on the axially loaded images. Three experienced neurosurgeons evaluated these 20 patients based on clinical information and routine MR images. The same neurosurgeons were then asked for second treatment decisions based on the same clinical information but with axially loaded MR images. RESULTS: Axial loading during MR imaging of the lumbar spine can influence neurosurgeons in their treatment decisions for symptomatic spinal stenosis. For this selected group of patients, all three neurosurgeons changed their treatment decision from conservative management to decompressive surgery for five patients when shown the axially loaded MR images. For two other patients, two neurosurgeons changed their treatment decisions, and for three additional patients, one neurosurgeon changed his treatment decision, all based on the axially loaded MR images. Treatment was not changed from surgical to medical management for any of the patients when shown the axially loaded images. CONCLUSION: In selected patients with spinal stenosis and apparent narrowing of the spinal canal shown by axially loaded MR imaging, the additional information gained from this technique can influence experienced neurosurgeons in their treatment decisions.     

腰椎体后缘软骨结节椎管狭窄的CT诊断

目的 :探讨腰椎后缘软骨结节 (LPMN)椎管狭窄的CT诊断价值。材料和方法 :回顾性分析 2 7例腰椎后缘软骨结节的临床及CT表现。结果 :LPMN的CT表现为 :( 1)椎体后上缘或下缘局限性骨缺损 ,缺损区周围骨质硬化 ;( 2 )缺损区后突入椎管内的骨块 ;( 3 )在矢状位上见骨块“翘起”征 ,缺损区呈“V”形或类三角形 ;( 4 )椎管狭窄 ,多伴有椎间盘突出。结论 :CT能明确诊断LPMN导致的椎管狭窄 ,并为手术治疗提供可靠依据。     

Gas in the spinal canal in association with the lumbosacral vacuum phenomenon: CT findings

Summary Twenty-two of 79 patients examined for lumbar spinal stenosis with CT showed the vacuum phenomenon. Three of these cases also had free gas in the spinal canal. The CT findings of vacuum phenomena and free gas in the spinal canal are discussed.     

Postoperative bony stenosis of the lumbar spinal canal: evaluation of 164 symptomatic patients with axial radiography.

Computed tomography (CT) and transverse axial tomography (TAT) were used to study the lumbar spines of 164 patients with persistent or recurrent low back pain and/or radiculopathy. Of those patients with previous spinal fusion and of those with previous disectomy, 43% and 28%, respectively, demonstrated bony stenosis of the lumbar spinal canal. Of the patients who underwent surgery for this narrowed canal, 91% showed clinical improvement.     

MRI of marked dural sac compression by surgicel in the immediately postoperative period after uncomplicated lumbar laminectomy

PURPOSE: Our purpose was to determine what represents normal findings on MR examinations of the lumbar spine in the immediately postoperative period following lumbar laminectomy with retained Surgicel. METHOD: MR examinations were performed immediately following lumbar laminectomy in 10 patients referred for symptoms of spinal stenosis. All had Surgicel retained against the dura and were doing well postoperatively without suggestion of adverse symptoms. Images were obtained within 4 days of surgery, most within 24 h. RESULTS: In 9 of 10 patients, severe dural tube compression was present, greater than that evident on preoperative studies. CONCLUSION: Marked spinal canal compression can be a normal finding in the immediately postlaminectomy period in patients with retained Surgicel. There is a lack of correlation between apparent mass effect on the thecal sac and adverse effect. The MR appearance in such instances is not significant in the absence of compressive clinical symptomatology.     

Ⅰ期后前路减压、植骨固定术治疗严重下颈椎椎管骨性狭窄

目的 探讨Ⅰ期后前路减压、植骨固定术治疗严重下颈椎椎管骨性狭窄的临床疗效。方法 2006年4月- 2009年3月采取Ⅰ期后路减压、前路减压植骨固定术治疗严重下颈椎椎管骨性狭窄患者29例,其中颈椎陈旧性骨折11例,颈椎后纵韧带钙化7例,颈椎间盘突出钙化11例。病程2个月～3.2年,平均1.4年。术前神经功能按Frankel分级：B级2例,C级19例,D级8例;日本骨科学会( JOA)术前平均评分为9.8分。结果 本组患者随访7～28个月,平均15.2个月。植骨块于术后5个月骨性融合,融合率为100％。所有患者Frankel分级平均提高1.2级,神经症状均有明显减轻。JOA脊髓功能术后平均评分为13.8分,平均提高4.0分,平均改善率为55.6％。结论 Ⅰ期后前路减压、植骨固定术是治疗严重颈椎管骨性狭窄的安全有效的方法,术中可进行电生理监护以提高手术的安全性。     

Lumbar facet joint injection: feasibility as an alternative method in high-risk patients

Objective

To evaluate the effectiveness of therapeutic facet joint steroid injections for symptoms caused by lumbar spinal stenosis in patients who are at risk of bleeding.

Methods

We analysed 134 patients who had previously undergone one-level bilateral facet joint steroid injections for lumbar radiculopathy caused by spinal stenosis from January 2011 to December 2012. All patients had a bleeding tendency due to several medical conditions. A retrospective chart review was conducted by one radiologist. Response was measured by using a five-point patient satisfaction scale. Evaluations of the relationship between possible outcome predictors were made using the chi-squared or Fisher’s exact test, as appropriate.

Results

Among the 42 enrolled patients (male/female?=?14/28; mean age, 58 years; range, 41–88 years), 25 patients (59.5 %) were classified to have received effective treatment; in 17 patients treatment was classified as ineffective. Eighteen (72 %) of the 25 patients with mild-to-moderate central canal stenosis had symptom relief, and 7 of the 17 (41.2 %) patients with severe central canal stenosis had symptom relief (P?<?0.05). Other outcome predictors were not statistically significant.

Conclusion

Therapeutic facet joint steroid injection is potentially effective for lumbar radiculopathy caused by spinal stenosis. This could be helpful in patients at risk of bleeding.

Key Points

? Epidural injection of steroids is a conventional treatment for lumbar radiculopathy. ? Facet joint steroid injections showed similar therapeutic effects in lumbar spinal stenosis. ? No serious complications, including bleeding, occurred with facet joint injections. ? Facet joint steroid injection offers an alternative therapy in patients with bleeding risk.     

腰椎管狭窄症的CT诊断(附102例报告)

本文报告102例腰椎管狭窄症的CT表现,提出了腰椎管狭窄各径线的测量标准,并比较它们的诊断价值,提出该病诊断标准,同时指出本病是一种较常见疾病。     

Imaging of spinal stenosis: neurogenic intermittent claudication and cervical spondylotic myelopathy

Spinal stenosis in either the cervical or lumbar spinal segments is one of the most common indications for spine imaging and intervention, particularly among the elderly. This article examines the pathophysiology and imaging of the corresponding clinical syndromes, cervical spondylotic myelopathy or neurogenic intermittent claudication. The specificity fault of spine imaging is readily evident in evaluation of spinal stenosis, as many patients with anatomic cervical or lumbar central canal narrowing are asymptomatic. Imaging also may be insensitive to dynamic lesions. Those imaging features that identify symptomatic patients, or predict response to interventions, are emphasized.