老年腰椎间盘突出并椎管狭窄的手术治疗

目的分析老年腰椎间盘突出并椎管狭窄的手术治疗手段与效果。方法取在2009-01—2010-01入院治疗的老年腰椎间盘突出并椎管狭窄接受手术患者57例,根据病情采用神经管扩大术,全、半椎板切除减压,髓核摘除,椎板开窗减压术。随访6～10个月观察预后疗效,并对患者进行生活质量评价。结果 57例患者中疗效优25例（43.86%）,良22例（38.60%）,稳定6例（10.53%）,差4例（7.01%）,总优良率92.99%。治疗后患者的生活质量得到明显提高。结论手术治疗老年腰椎间盘突出症并发椎管狭窄疾病有良好的疗效,但需根据不同的病情临床分析,且要保证脊柱的受压小、安全稳定。     

颈段椎管内肿瘤的显微外科治疗

1977年1月至1995年10月收治374例椎管内肿瘤病人，肿瘤位于颈段椎管内76例（20.3%），其中硬脊膜外肿瘤21例，硬脊膜内髓外34例，硬脊膜内，外同时生长11例，髓内肿瘤10例，肿瘤全切除55例（72.3%），次全切除13例（17.1%），活检加椎板减压手术6例，椎板减压2例，采用显微外科技术切除31例颈椎管内肿瘤，收到满意效果。     

经椎板间人路椎间孔镜技术治疗腰椎间盘突出症疗效分析

目的 探讨经椎板间人路椎间孔镜技术治疗腰椎间盘突出症的临床疗效.方法 采用经椎板间入路椎间孔镜TESSYS技术治疗54例腰椎间盘突出症患者(L4-5椎间盘突出13例、L5-S1椎间盘突出41例),分别于术前和术后1d、3个月、1年时采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价手术前后疼痛改善情况,复查腰椎MRI评价髓核摘除情况和有无复发.结果 54例患者手术成功率为96.30％(52/54),其中2例术中出现硬脊膜破裂,改为手术显微镜下椎板开窗、髓核摘除术.平均手术时间58.35 min,中位住院时间3d.出院时52例疼痛消失、2例疼痛减轻,其中5例患侧小腿外侧麻木感加重.与术前相比,术后1d、3个月和1年时VAS和ODI评分均减少(均P=0.000).术后复查腰椎MRI显示髓核摘除满意,神经根压迫解除,亦未见复发.无一例发生感染等手术相关并发症,1例L5-S1椎间盘突出患者因髓核脱出椎管内游离较远,术中对神经根牵拉较重,术后出现S1神经根分布区麻木,术后1个月缓解.结论 经椎板间入路椎间孔镜技术治疗腰椎间盘突出症临床疗效满意、安全性良好.     

经椎板间入路椎间孔镜技术治疗腰椎间盘突出症疗效分析

目的探讨经椎板间入路椎间孔镜技术治疗腰椎间盘突出症的临床疗效。方法采用经椎板间入路椎间孔镜TESSYS技术治疗54例腰椎间盘突出症患者(L4-5椎间盘突出13例、L5-S1椎间盘突出41例),分别于术前和术后1 d、3个月、1年时采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价手术前后疼痛改善情况,复查腰椎MRI评价髓核摘除情况和有无复发。结果 54例患者手术成功率为96.30%(52/54),其中2例术中出现硬脊膜破裂,改为手术显微镜下椎板开窗、髓核摘除术。平均手术时间58.35 min,中位住院时间3 d。出院时52例疼痛消失、2例疼痛减轻,其中5例患侧小腿外侧麻木感加重。与术前相比,术后1 d、3个月和1年时VAS和ODI评分均减少(均P=0.000)。术后复查腰椎MRI显示髓核摘除满意,神经根压迫解除,亦未见复发。无一例发生感染等手术相关并发症,1例L5-S1椎间盘突出患者因髓核脱出椎管内游离较远,术中对神经根牵拉较重,术后出现S1神经根分布区麻木,术后1个月缓解。结论经椎板间入路椎间孔镜技术治疗腰椎间盘突出症临床疗效满意、安全性良好。     

“Ⅵ型田氏脊柱骨刀”征购启事

“Ⅵ型田氏脊柱骨刀”乃由田慧中教授近年来新设计成功的,制造工艺精细优美的一套薄刃骨刀共10把。主要用于腰椎间盘手术的椎板间开窗;半椎板切除全椎管减压术;椎管、根管狭窄扩大术;自后路椎体间植骨或Cage手术的开窗暴露;强直性脊柱后凸的Ⅴ型截骨术;脊柱侧弯的顶椎切除术;小儿先天性半椎体切除术;角形脊柱后凸的全脊柱截骨术;胸腰段爆裂性骨折的前路椎体后缘切除植骨术或Kaneda手术;颈椎前路刨槽植骨术等,均可用这套器械顺利完成手术的全过程,节约了手术时间,避免了用咬骨钳切除椎板时,挤压     

腰椎间盘突出症的治疗进展

腰椎间盘突出的治疗方法大致分为保守治疗和手术治疗二类。保守治疗有卧床休息、牵引、理疗、全身及局部药物治疗。手术治疗有传统的后路全椎板或半椎板切除腰椎间盘摘除术、椎板间开窗腰椎间盘摘除术及前路腰椎间盘摘除术。有借助穿刺针、显微镜、腹腔镜及椎间盘镜进行的腰椎间盘摘除术。腰椎间盘摘除后或行椎间融合或行人工椎间盘置换。本文就以上问题进行综述     

骶管囊肿伴腰椎间盘突出症的手术治疗

目的 探讨骶管囊肿伴腰椎间盘突出症的手术治疗方法及疗效。方法 回顾性分析2015年1月~2017年1月手术治疗的7例骶管囊肿伴腰椎间盘 突出症的临床资料。采取小切口开窗潜行减压髓核摘除及大部分切除、肌肉填塞交通孔处理骶管囊肿。结果 术后随访10~30个月,平均15个月。术前 囊肿压迫所致神经根症状和突出椎间盘压迫所致运动感觉症状觉缓慢恢复,1例性功能障碍术后部分恢复,2例排尿困难术后恢复。结论 手术摘除突 出的髓核及同期修补骶管囊肿交通孔是有效治疗骶管囊肿伴腰椎间盘突出症的方法。     

半椎板入路显微手术切除椎管内髓外硬膜下肿瘤的效果分

目的 探讨半椎板入路显微手术切除椎管内髓外硬膜下肿瘤的方法及疗效。方法 回顾性分析2016年1月至2018年12月采用半椎板入路显微手术切除的38例椎管内髓外硬膜下肿瘤的临床资料。结果 肿瘤全切除35例,次全切除3例（肿瘤与周围神经组织粘连紧密）。术后病理示神经鞘瘤 29例、脊膜瘤6例、表皮样囊肿2例、副神经节瘤1例。术后随访6~36个月,平均19.3个月;MRI复查显示复发1例,未见椎体滑脱及脊柱畸形发生;术后6个月Frankel分级:改善34例,不变3例,恶化1例。结论 半椎板入路显微手术切除椎管内髓外硬膜下肿瘤,不但能够充分显露肿瘤,而且保留椎板后弓的完整性,脊柱稳定性良好。     

颈段椎管内肿瘤的显微外科治疗

1977年1月至1995年10月收治374例椎管内肿瘤病人.肿瘤位于颈段椎管内者76例(20.3%).其中硬脊膜外肿瘤21例.硬脊膜内髓外34例.硬脊膜内、外同时生长11例,髓内肿瘤10例.肿瘤全切除55例(72.3%).次全切除13例(17.1%).活检加椎板减压手术6例.椎板减压2例.采用显微外科技术切除31例颈段椎管内肿瘤.收到满意效果.     

比较4种方案治疗脊髓型颈椎病效果的系统性评价

背景：对于多节段脊髓型颈椎病,手术治疗方式的选择尚存争议。 目的：对脊髓型颈椎病的4种治疗方式进行系统评价。 方法：选取1980/2010-12有关比较多节段椎体次全切除+融合、前路颈椎间盘切除+融合、椎管扩大成形及椎板切除减压+融合文章的回顾性分析,系统评价脊髓型颈椎病治疗的最佳治疗方式,并对随访超过10年的病例进行独立评价。 结果与结论：共检索到1 718篇文章,筛选出591篇摘要,36篇有全文,均为回顾性队列研究。有4项研究比较了多节段椎体次全切除+融合和椎管扩大成形,1项研究比较了椎板切除减压+融合和椎管扩大成形,2项研究比较了前路颈椎间盘切除+融合和椎管扩大成形。3项病例研究随访时间在10年以上。所有治疗方法的神经功能改善率基本相同。与多节段椎体次全切除+融合相比,椎管扩大成形有较高的颈痛发生率。与椎管扩大成形相比,前路颈椎间盘切除+融合增加了邻近节段继发性病变的概率。多节段椎体次全切除+融合和椎板切除减压+融合有较高的与植骨、内固定、手术入路相关的并发症。与椎板切除减压+融合相比,多节段椎体次全切除+融合和椎板切除减压+融合后颈活动范围明显下降。     

椎板间入路治疗腰椎间盘突出症

目的 研究椎板间入路显微椎间盘切除术治疗腰椎间盘突出症的手术效果. 方法对36例病人行显微椎间盘切除术,术中对椎间盘碎片及纤维环缺损情况进行评估,分析术前资料和术后随访情况.结果 椎板间入路在28例(78%)病人中可充分暴露椎间隙,部分椎间孔扩大术在17例(47%)病人中使用.碎片-裂隙型及碎片-包含型病人手术效果最好,复发率低.结论 椎板间入路是治疗腰椎间盘突出症的一种安全、有效的手术技术,椎间盘突出类型及椎间盘切除术后纤维环的完整性对预测腰腿痛复发有价值.     

Discectomy strategies for lumbar disc herniation: results of the LAPDOG trial.

Since its introduction in the 1970s percutaneous treatment of lumbar disc herniation has been an attractive concept that has been the object of technical development and clinical application throughout the world. Little scientific evaluation of the efficacy and effectiveness of the procedure has been done. To estimate the success rates of automated percutaneous and conventional discectomy in comparable patients and to document the resource consumption of patients treated in these ways, a multicenter randomized clinical trial designed to compare both treatment efficacy and cost-effectiveness of automated percutaneous discectomy and conventional discectomy in adult patients with no prior lumbar spinal surgery, no coexistent lumbar spinal disease, unilateral single level lumbar radiculopathy with images confirming disc herniation at the appropriate level. In the course of the trial important technical advances allowing epidural extraction of free-fragment disc herniation was incorporated into the trial. It was not possible to enroll the required number of patients to complete the trial. Of 5735 screened patients, 95 were eligible and 36 were enrolled. Two elected watchful waiting and did not have any surgical procedure. Eight patients were lost to follow-up. Among the 27 evaluable patients, 41% of the percutaneous discectomy patients and 40% of the conventional discectomy patients were assessed as achieving "success" on the primary outcome measure. No clinical trial of any percutaneous discectomy technique provides definitive evidence supporting the efficacy or effectiveness of the procedure. Such evidence should be required by patients to whom such procedures are proposed and those who are asked to pay for them.     

Clinical and Radiological Findings of Nerve Root Herniation after Discectomy of Lumbar Disc Herniation

The authors report 2 cases of nerve root herniation after discectomy of a large lumbar disc herniation caused by an unrecognized dural tear. Patients complained of the abrupt onset of radiating pain after lumbar discectomy. Magnetic resonance imaging showed cerebrospinal fluid signal in the disc space and nerve root displacement into the disc space. Symptoms improved after the herniated nerve root was repositioned. Clinical symptoms and suggestive radiologic image findings are important for early diagnosis and treatment.     

经皮椎间盘摘出联合医用臭氧治疗腰椎间盘突出症

目的探讨经皮髓核摘除术(PLD)联合医用臭氧注射治疗腰椎间盘突出症的临床效果及可行性。方法临床与影像检查确诊为腰椎间盘突出25例,先行PLD,后行椎间盘内及椎旁注射臭氧。结果25例病人治疗后经一年随访,治愈21例,有效24例,无效1例,无一例并发症。结论PLD联合医用臭氧治疗腰椎间盘突出症,安全可靠,可改善治疗效果,减少不良反应,值得推广应用。     

Endoscopic Discectomy for the Cauda Equina Syndrome During Third Trimester of Pregnancy

Low back pain is common during pregnancy. However, the prevalence of symtomatic lumbar disc herniation is rare, and cauda equina syndrome due to disc herniation during pregnancy is even rarer. We report a rare case of lumbar disc herniation causing cauda equina syndrome during third trimester of pregnancy which successfully treated by endoscopic discectomy. This case shows that endoscopic discectomy can be the treatment option for the lumbar disc herniation during pregnancy.     

MRI predictors of revision surgery after primary lumbar discectomy

The prognostic significance of preoperative MRI findings in patients undergoing discectomy is incompletely understood. Identifying the radiological predictors of revision surgery on pre-operative MRI can guide management decisions and potentially prevent multiple surgeries. We included 181 patients who underwent primary lumbar discectomy between 2010 and 2014. All patients were contacted via a short telephone interview to determine if they had revision surgery within 5 years of their index surgery. Preoperative MRI of the lumbosacral spine was evaluated for various radiological factors including type of disc herniation, anatomical location of herniation, direction of herniation, degree of disc degeneration, end plate changes and presence of listhesis. Other potential confounders including age, gender, smoking status and index level of surgery were also recorded. Multivariate model of all radiological predictors and confounders were developed and a step-wise approach was used to remove insignificant variables in order to develop final significant multivariate model. P value of <0.05 was considered statistically significant. Patients with retrolisthesis were found to be 2.7 times more likely than the patients without listhesis to require revision surgery (p = 0.019). Patients with foraminal disc herniation were 3.45 times more likely than the patients with paramedian disc herniation to require revision surgery (p = 0.026). Other MRI predictors failed to achieve statistical significance. Based on the data presented patients with retrolisthesis and/or foraminal disc herniation should be counselled on the relatively higher risk of revision surgery when proceeding with discectomy, or alternative options should be considered.     

A long-segment string of bead- like schwannoma of cauda equina: a case report

Spinal schwannomas are one of the most common intradural extramedullary spinal tumors. However, a string of bead-like intradural extramedullary schwannoma is highly uncommon. In the paper we present a case of a long-segment string of bead-like intradural extramedullary schwannoma of cauda equina from L2 to S2.The patient had been suffering progressive low back pain and sciatica with progressive neurological deficits for three years. She was misdiagnosed as lumbar disc herniation at her first time of hospitalization after a simple lumbar computed tomography (CT) scanning and a discectomy. We found her tumor by magnetic resonance imaging (MRI) and totally removed it. We therefore emphasize differentiating this almost completely curable tumor from other lumbar diseases such as lumbar disc herniation. It is suggested that a reasonable and careful strategy of surgery for these tumors is important.     

椎板间入路经皮完全内镜手术治疗腰椎间盘突出症

目的评价经椎板间入路的完全内镜手术治疗腰椎间盘突出症的临床效果。方法回顾性分析60例应用经椎板间入路完全内镜手术治疗腰椎间盘突出症的病例资料。病人术前均符合单节段腰椎间盘突出症诊断。记录术前、术后3d、3个月和6个月腿痛VAS和腰椎JOA评分,手术时间、术中及术后并发症。结果60例病人均顺利完成手术,术中出血量少,无任何并发症。平均手术时间65min;平均住院时间4d,切口均一期愈合。术后随访：1例k;病人手术后2个月复发,其他59例病人腿痛VAS和腰椎JOA评分术后3d、3个月、6个月各个随访时间点与术前比较,均有显著性差异（P〈0.01）,术后3个月与6个月间比较无显著性差异（P〉0.05）。结论椎板间入路完全内镜手术治疗下腰椎椎间盘突出症具有微创、术后恢复快等特点,可获得良好临床疗效。     

经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症

目的 探讨经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症的方法及效果。方法 回顾性分析2013年3月至2016年1月经皮脊柱内镜下手术治疗的38例腰5-骶1腰椎间盘突出症的临床资料,采用经椎间孔入路26例,经椎板间入路12例。手术前后采用疼痛视觉模拟量表（VAS）评分、MacNab量表评分、KPS评分和日本骨科协会（JOA）评分评估疗效。随访时间大于6个月。结果 38例中,34例（89.5%）疗效优良。术后VAS评分[（1.0±1.5）分]较术前[（7.9±1.1）分]明显降低（P<0.05）。术后腰椎JOA评分[（21±5.7）分]较术前[（7.4±4.6）分]明显提高（P<0.05）。经椎间孔入路和经椎板间入路的手术疗效无明显差异。结论 经皮脊柱内镜下选择椎间孔入路或椎板间入路均可有效、安全并且微创地治疗腰5-骶1腰椎间盘突出症。     

锦州地区青少年椎间盘突出危险因素的logistic回归分析

背景：成人与青少年椎间盘突出的发病机制和危险因素差别很大,国内应用logistic回归分析青少年椎间盘突出危险因素的研究较少。 目的：多因素非条件Logistic回归分析锦州地区青少年椎间盘突出发病的危险因素。 方法：选择青少年椎间盘突出患者94例作为实验组,男56例,女38例;年龄9~18岁。居住地为锦州市。对照组患者选自同期因其他非椎间盘突出疾病入院的同年龄组同居住地患者共100例。采用多因素非条件Logistic回归分析对椎间盘突出发病的可能相关因素进行分析,以OR > 1为椎间盘突出发生的危险因素：OR < 1为椎间盘突出发生的保护因素。 结果与结论：194例患者均进入结果分析。多因素非条件Logistic回归分析显示：与对照组相比,椎间盘突出患者家族遗传OR =6.427,P=0.015;创伤因素OR=17.196,P=0.011;先天畸型 OR=31.429,P=0.002;运动过量OR=12.644,P=0.027。结果表明,家族遗传、创伤、先天畸型和运动过量是锦州地区青少年椎间盘突出发病的危险因素。以此为依据制定相应的预防方案十分必要。