极外侧型腰椎间盘突出症的诊治体会

极外侧型腰椎间盘突出症是指腰椎间盘突出或脱出位于椎间孔或椎间孔外，临床发生率低。1996年8月至2003年5月，依据CT表现采取椎板间入路、椎板侧方入路等不同手术方式，治疗极外侧型腰椎间盘突出症13例，取得了满意疗效，现报告如下。     

极外侧型腰椎间盘突出症

极外侧型腰椎间盘突出症李明全，袁志，陈拱诒极外侧型腰椎间盘突出症国内报道甚少。此型腰椎间盘突出位于侧隐窝外侧、椎间孔、甚至椎间孔外。临床表现为典型的本间隙神经根受压症状￣［１］。手术中切除骨质范围较一般腰椎间盘突出为大，包括椎板、椎间孔和大部分关节突...     

椎间盘镜治疗椎间孔外突出型极外侧型腰椎间盘突出症

目的 探讨椎间盘镜治疗椎间孔外侧突出型极外侧型腰椎间盘突出症的临床价值.方法 回顾性分析应用椎间盘镜经椎旁肌小关节外侧入路治疗16例椎间孔外侧突出型极外侧型腰椎间盘突出症,完成神经根探查、减压和髓核摘除,疗效按Macnab标准评估.结果 平均手术时间41 min,平均术中出血量70 mL,全部患者经平均15个月随访,优...     

极外侧椎间盘突出症的诊断与治疗

极外侧型椎间盘突出症是指位于侧隐窝、椎间孔、椎间孔以外的,压迫对应神经根而引起的临床症状和体征.极外侧型腰椎间盘突出症临床较少,据文献报道发生率为1%～11.7%.     

极外侧型腰椎间盘突出症的临床研究

目的探讨极外侧型腰椎间盘突出症的临床表现、诊断、鉴别及治疗。方法通过CT或MRI将突出的腰椎间盘在椎管内所处的位置（矢状位、水平位、冠状位）予以定位,明确椎间盘突出部位。一旦确诊为极外侧型腰椎间盘突出症,即早期经横突间开放入路或后外侧椎间孔入路腰椎间盘镜监测下摘除突出的髓核。结果16例患者中15例行手术治疗,术后恢复取得了满意的疗效。结论CT或MRI为极外侧型腰椎间盘突出症的精确诊断提供了依据。早期诊断、早期手术是术后功能恢复的保证。     

极外侧型腰椎间盘突出症的诊断与治疗

极外侧型腰椎间盘突出症的诊断与治疗翁文杰陈亮朱丽华椎间孔与椎间孔外腰椎间盘突出症，亦称为极外侧型腰椎间盘突出症，是指椎间盘突出或脱出位于椎弓根内、外缘之间或椎弓根外缘以外，压迫相应的神经根而引起的一系列症状和体征。１９４４年Ｌｉｎｄｂｌｏｍ及１９５４...     

椎管内外联合入路治疗极外侧腰椎间盘突出症

目前绝大多数同行将椎间孔型和椎间孔外型椎间盘突出称极外侧型腰椎间盘突出,极外侧型腰椎间盘突出症发生率低,近五年来,我院手术9例均为向上移位的椎间孔内突出并出口区、椎间孔外突出者。手术方法：采用关节突外侧入路联合椎管内开窗髓核摘除术。     

极外侧型腰椎间盘突出症的手术治疗

目的探讨极外侧型腰椎间盘突出症的临床特点和手术方法。方法1996~2006年手术治疗极外侧型腰椎间盘突出症35例,手术分别采用经后正中入路椎板扩大开窗术,椎间孔切开和椎弓根螺钉内固定植骨融合术,或经肌间隙入路髓核摘除术。结果本组共32例获得随访,随访时间6个月~10年,平均4.7年。疗效按日本整形外科学会(JOA)下腰痛评分标准评价,优27例,良3例,可2例,优良率达84.4%。结论极外侧型椎间盘突出症与典型的腰椎间盘突出症不同,其多累及同序数腰神经根,并以下肢痛为主要症状,CT或MRI是诊断的主要依据。对极外侧型椎间盘突出的病例,采用不同的手术方法,其手术治疗效果良好。     

极外侧腰椎间盘突出症的临床分型和手术治疗(47例分析)

目的分析极外侧腰椎间盘突出症的临床特点和外科治疗方法。方法回顾性分析2007-09-2011-04收治的一组极外侧腰椎间盘突出症(47例)患者的临床特点、影像学分型和手术疗效。结果根据影像学表现将本组患者分为椎间孔内型(I型)、椎间孔内和椎间孔外型(II型)、椎间孔外型(III型)、同节段混合型(IV型)以及复杂型(V型),根据分型采用相应的外科手术入路治疗,经过平均2.6年随访,临床疗效优30例(64%)、良12例(26%)、可4例(8%)、差1例(2%)。结论极外侧腰椎间盘突出症发病率低,容易误诊和漏诊,常合并其他腰椎退变性疾病,开放式手术是安全和有效的治疗方法。     

应用METRx椎间盘镜治疗极外侧型腰椎间盘突出症

目的总结应用METRx椎间盘镜治疗极外侧型腰椎间盘突出症的临床疗效。方法1999年2月至2002年12月,采用METRx椎间盘镜行髓核摘除术,治疗极外侧型腰椎间盘突出症14例,均为单间隙突出,其中男性10例、女性4例,年龄41-55岁,平均49岁。突出间隙：L4,5 6例、L5-S1 8例。突出类型：椎间孔突出型6例,椎间孔外侧突出型8例。结果14例随访12—46个月,平均26．5个月。疗效：优10例、良3例、可1例。术后4例遗留感觉障碍,无神经根损伤、椎问盘炎、硬膜囊撕裂、椎间盘突出复发等并发症。结论应用METRx椎间盘镜治疗极外侧型腰椎间盘突出症,手术创伤小、神经根减压彻底和术后恢复快,适用于极外侧型腰椎间盘突出症的治疗,选择正确的手术入路和术中仔细的操作是手术成功的关键．     

Extreme lateral lumbar disk herniation. Apropos of a series of 25 cases

Twenty-five cases of extreme lateral disc herniation (ELDH) were identified amongst 680 operated lumbar discs (3.7%). Their anatomical, radiological and clinical features are presented. They were found at all levels between L3 and S1. At the L5-S1 level 12 ELDH occurred amongst 253 disc herniations (5%), at the L4-L5 level, 8 ELDH amongst 400 herniations (2%), and at the L3-L4 level, 5 ELDH amongst 21 herniations (24%). No clinical features were encountered which could allow to differentiate between an ELDH and a classical disc herniation of the above level. Twenty-three patients underwent lumbar myelogram. This was normal in 6. In 12 it showed a slight shortening and widening of the above situated nerve root sleeve. The same abnormality can be found with downward migration of a classical herniation of the above situated disc or with a lateral recess stenosis. Twenty-five patients underwent computed tomography (CT.). In 24, the ELDH could be unequivocally identified. Disc material occupied the intervertebral foramen or the extravertebral space just beyond it, replacing the normal fat. In order to identify an ELDH, CT has to be done whenever myelogram is normal or equivocal. If the patient is to be investigated by CT only, slices through the intervertebral foramen and the disc below the clinically suspicious level have to be included. Operation in all cases consisted in total or partial unilateral laminectomy with facetectomy.     

Computed tomographic discography in the evaluation of extreme lateral disc herniation

Thin section, high resolution computed tomographic (CT) scans of the lumbar spine produce images that can show herniated intervertebral discs without intravenous or intrathecal contrast enhancement. With this technique, the diagnosis of posterolateral and midline herniation has been greatly facilitated. This communication reports the use of CT discography in the preoperative evaluation of two patients who were shown at discography and proven at operation to have extreme lateral disc herniations.     

极外侧型腰椎间盘突出症诊治

目的对极外侧型腰椎间盘突出症的诊治进行分析,进一步提高对该病的认识。方法采用不同手术入路治疗12例极外侧型腰椎间盘突出症。结果3例出现延误诊断。12例均获得随访,优11例,良1例。结论极外侧型腰椎间盘突出症常累及同序数神经根,CT扫描是较好的检查手段;手术可选取不同的术式,单纯极外侧者以椎旁肌间隙为佳。缺乏系统认识是其延误诊断的主要原因。     

Facet tropism: a comparison between far lateral and posterolateral lumbar disc herniations

STUDY DESIGN: An assessment of the difference in the degree of facet tropism and disc degeneration between far lateral and posterolateral lumbar disc herniations. OBJECTIVE: To investigate the effect of the difference in the degree of the facet tropism and disc degeneration with respect to the development of far lateral lumbar disc herniation and posterolateral lumbar disc herniation, and to compare the effect between the two types of herniations. SUMMARY OF BACKGROUND DATA: The effect of facet tropism on the development of posterolateral lumbar disc herniation has been investigated previously, but there has been no study on far lateral lumbar disc herniation. METHODS: Thirty-eight lumbar disc herniations (far lateral, n = 19; posterolateral, n = 19) were included this study. The degree of facet tropism and disc degeneration was measured at the herniated disc level by using magnetic resonance imaging. The results were compared to show any differences between the two types of lumbar disc herniations. RESULTS: There were significant differences in the degree of facet tropism (24.74 vs. 14.26, P = 0.004) and disc degeneration (23.92 vs. 15.08, P = 0.005) between the far lateral and posterolateral lumbar disc herniations. There was no significant correlation between the degree of facet tropism and the degree of disc degeneration in far lateral lumbar disc herniation (r = -0.369, P = 0.120). CONCLUSION: This results suggest that the differences in the degree of facet tropism and disc degeneration might be considered a key factor in distinguishing the development of far lateral lumbar disc herniation from that of posterolateral lumbar disc herniation.     

Extreme lateral lumbar disc herniation

Extreme lateral lumbar disc herniation (ELLDH) occurring into and/or outside the intervertebral foramen was encountered in 95 cases amongst 1600 operations for herniated lumbar disc (6%): 43% occurred at L5-S1, 38% at L4-5, 18% at L3-4, and 1% at L2-3. The incidence amongst all herniations at one particular level was 6% at L5-S1, 4% at L4-5, and 18% at L3-4. The clinical presentation varied according to the level of extreme lateral disc herniation, but was not different from the presentation of a classical paramedian herniation occurring one level above. Forty-three patients were investigated with computed tomography (CT) only, 2 with myelography only, and 50 with both. CT always clearly demonstrated the pathology, but some cases are presented to illustrate the differential diagnosis. Myelography was normal in 13 cases; in 27 cases it showed a typical shortening and enlargement of the nerve root sheath which enters the affected intervertebral foramen. At operation, a total facetectomy was performed in 52 patients, a partial facetectomy in 34, and a lateral approach to the intervertebral foramen in 9. The lateral approaches, either paramuscular with retraction of the paraspinal muscles from the midline, or transmuscular by splitting of the paraspinal muscles, are described and illustrated in detail.     

极外侧型腰椎间盘突出症的诊断与治疗

目的 探讨极外侧型腰椎间盘突出症的诊断与治疗方法。方法回顾分析1999年1月～2004年1月收治16例极外侧型腰椎间盘突出症患者资料。其中椎间孔型8例，椎间孔外型2例，椎间孔内外混合型6例。L2.3 1例，L3,4 5例，L4,5例，L5、S1 2例。CT扫描显示在相应椎间孔内、椎间孔外、椎间孔内外有与椎间盘相同的CT值密度影像。手术采用椎板间入路10例，椎板侧方入路3例，椎板间和椎板侧方联合入路3例。结果术后16例均获随访6个月～5年，平均9个月。根据中华骨科学会脊柱组腰背痛手术评定标准：优8例，良5例，可3例。术后CT显示相应节段椎间盘突向椎间孔或椎间孔外的占位消失，同节段神经根压迫解除。结论CT是目前诊断腰椎间盘突出症的较好方法。手术入路应依突出椎间盘组织占位、病理类型及是否合并椎管内病变而定。     

Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression.

The clinical, radiologic, and operative findings, and clinical results in 26 cases of foraminal nerve root involvement, each treated by variable operative procedures for an existing pathologic condition, were studied. These 26 cases consisted of 8 intraforaminal or extraforaminal lumbar disc herniations and 18 foraminal nerve root entrapments. The cases with an extreme lateral lumbar disc herniation underwent lateral fenestration or osteoplastic hemilaminectomy without concomitant spinal fusion, and showed excellent operative results. A sufficient selective decompression was achieved with a good clinical result in the cases of lumbar spondylosis without preoperative spinal instability, by lateral fenestration or osteoplastic hemilaminectomy. This result suggests that the selective decompression procedure is recommended for cases with reliable preoperative diagnoses. When an intraspinal lesion makes it difficult to diagnose coexisting foraminal nerve root involvement, decompression of the nerve root canal, approaching from medial to lateral, is recommended. The fusion operation should be performed in cases undergoing even a unilateral total facetectomy, regardless of the patient's old age. A correct preoperative diagnosis is crucial in order to obtain satisfactory operative results.     

经椎问孔选择性神经根阻滞在复杂腰椎间盘突出症责任节段确定的应用

目的探讨经椎间孔选择性神经根阻滞技术应用于腰椎间盘突出症,以明确诊断及责任节段,为进一步手术治疗提供依据。方法42例复杂的腰椎间盘突出症患者进行47次选择性神经根阻滞,对可疑责任节段进行经椎间孔选择性神经根阻滞,根据患者症状改善情况明确腰腿痛的责任节段,并以此为依据进行手术治疗。结果93％（39／42）的患者结果为阳性,1例假阳性为隐匿性股骨颈骨折。神经根阻滞前下肢放射痛VAS评分为8．12＋1．43,选择性阻滞后下肢放射痛VAS评分改善为2．31±1．63。而后36例进行手术治疗。结论对于诊断复杂的腰椎间盘突出症,在常规诊断依据的基础上进行经椎问孔选择性神经根阻滞,能够明确诊断,为进一步手术治疗方案的确定提供了明确可靠的依据。     

Reoperation after treatment of a disk hernia. Comparison between radiology and surgical findings in 18 cases

Eighteen patients with recurrent sciatica after lumbar disc surgery were investigated by both, myelography and computed tomography (CT) before reoperation. The radiological diagnosis according to the original x-ray report was correlated with the surgical findings at reoperation. Myelography reports describe morphological changes but often contain no definite diagnosis. CT reports usually contain detailed tissue diagnosis, but correlation with surgical findings is generally poor. Review of the original x-ray films leads to the following conclusions: At present, myelography is always indicated, except in suspected extreme lateral disc herniation. CT should be reserved for particular clinical or myelographic problems.