经皮椎板间隙入路270°椎管减压治疗腰椎管狭窄症

[目的]探讨经皮椎板间隙入路的椎管减压技术治疗伴有双侧侧隐窝狭窄的腰椎管狭窄症临床疗效。[方法]本组单节段双侧侧隐窝腰椎管狭窄症患者20例,采取单侧经皮椎板间隙入路,通过改变内镜的倾斜角度并利用角度椎板钳和镜下磨钻行双侧侧隐窝和中央椎管270°减压,随访时间超过24个月,分析术后疗效参数如VAS评分、ODI评分、Macnab分级评分、单次连续行走距离和手术并发症。[结果]术后影像学证实所有患者进行了有效的中央椎管和双侧侧隐窝的减压。术后ODI评分和VAS评分较术前显著降低,差异有统计学意义;Macnab评分,80%的患者取得了满意或良好的疗效;单次连续行走距离较术前明显增加。[结论]单侧经皮椎板间隙入路双侧侧隐窝和中央椎管270°减压术,具有良好的中央椎管和双侧侧隐窝手术视野显示,可有效减压,是微创治疗退变性椎管狭窄症特别是合并双侧侧隐窝狭窄的有效安全的手术方式。     

可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症

目的 探讨可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症的疗效.方法 2007年6月至2009年6月采用可动式椎间盘镜下单侧开窗双侧减压治疗退行性腰椎管狭窄症32例,男14例,女18例;年龄56～74岁,平均65岁.均为双侧椎管狭窄合并椎问盘突出,有间歇性跛行和坐骨神经痛等症状,双下肢症状以一侧为重.在症状严重侧行棘突旁2 cm纵切口,在可动式椎间盘镜下行单侧椎板间隙开窗,神经根通道减压、突出髓核摘除;在棘突和椎板腹侧分别向上、下方用棉片压低保护硬膜囊,潜行咬除棘突基底部,在棘突基底、椎板腹侧与硬膜囊背侧之间形成工作空间,经此空间潜行咬除对侧椎板下缘和增厚的黄韧带,直至显露松解对侧神经根起始部.结果 术中无神经损伤发生,无中途转开放手术病例.发生硬膜囊撕裂2例,用棉片将其压低后完成手术.手术时间5～100min,平均70min;术中出血量50～350ml,平均150ml.术后CT示减压充分,中央椎管和对侧椎管扩大,对侧椎板、关节突和椎旁肌等结构保留完好.全部病例随访6～24个月,平均12个月.根据Macnab标准,优21例,良11例.结论 可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症操作简便,能保留对侧结构,达到双侧减压目的 ,早期随访结果优良.对双侧严重骨性狭窄者应慎用.     

显微内窥镜下手术治疗腰椎侧隐窝狭窄症

目的：评价显微内窥镜下神经根减压术治疗腰椎侧隐窝狭窄症的应用价值。方法：应用经椎板间隙入路显微内窥镜下神经根减压术治疗腰椎侧隐窝狭窄症43患者，随访观察疗效。结果：平均随访13.2个月，手术优良率93%，结论：应用椎板间隙入路显微内窥镜下手术治疗腰椎侧隐窝狭窄症可以达到较理想的临床疗效。     

椎板间隙入路椎间盘镜治疗腰椎管狭窄症

目的：探讨在椎板间隙入路椎间盘镜下有限化手术治疗退行性腰椎管狭窄症。方法：选取退行性腰椎管狭窄症病例，在椎板间隙入路椎间盘镜下行椎管有限减压。咬除病变间隙上位椎板下缘、肥厚的黄韧带和下位椎板上缘，摘除突出椎间盘髓核，松解神经根粘连，侧隐窝减压，必要时切除部分关节突。结果：应用椎板间隙入路椎间盘镜治疗迟行性腰椎管狭窄症，行椎管有限减压87例，减压彻底。82例得到随访，优良串92．7％，手术效果满意。结论：单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是椎板间隙入路椎间盘镜下椎管有限减压的适应证。满意的手术效果取决于：病人选择适当，术中操作精细，减压彻底。     

经椎板间入路椎管扩大减压Wallis系统动态固定治疗单节段腰椎管狭窄症的疗效

<正>经椎板间隙入路潜行减压治疗腰椎管狭窄症是常用术式之一,该术式能够在保留后柱骨性结构的前提下完成有效的神经减压。潜行减压扩大椎管,有效处理神经根管和侧隐窝,重视小关节的完整性,可达到椎管有效减压的目的。但是中远期常无法维持减压节段后方椎板及及棘突     

联合椎板间入路与后外侧入路内镜下减压治疗退变性腰椎管狭窄症的临床研究

目的分析联合椎板间与后外侧入路内窥镜下减压治疗退变性腰椎管狭窄症的临床疗效。方法退变性腰椎管狭窄症病人41例,行联合椎板间与后外侧入路内窥镜下减压治疗,通过手术前后椎管矢状径、盘黄间隙、椎管面积、椎间孔前后径,手术前后NRS评分、ODI指数及JOA评分评价疗效。结果手术时间82～114分钟,平均(91. 31±10. 64)分钟。术中出血130～210 ml,平均(174. 38±31. 18) ml。1例病人出现下肢放射性麻木,2例病人出现脑脊液漏。随访时间12～15周,平均随访(13. 37±2. 38)周。手术前后NRS评分、ODI指数、JOA评分比较差异有统计学意义(P 0. 05)。术后椎管矢状径、盘黄间隙、椎管面积、椎间孔前后径术后分别扩大24. 05%、53. 99%、45. 35%和21. 34%,与术前比较差异有统计学意义(P 0. 05)。结论联合椎板间及后外侧入路对退变性腰椎管狭窄症病人可在不影响腰椎稳定性的情况下,扩大腰椎管的有效空间,改善临床症状。     

微创单侧固定与开放双侧固定治疗单间隙腰椎管狭窄症的疗效比效

目的比较微创单侧入路双侧减压固定与开放双侧减压固定治疗单间隙腰椎管狭窄症的疗效。方法将33例单间隙腰椎管狭窄症患者随机分为两组:微创单侧组采用通道下单侧椎间孔双侧减压单侧固定治疗(16例),开放双侧组采用双侧椎间孔双侧减压双侧固定治疗(17例)。比较两组手术时间、出血量、住院时间以及术后椎间高度指数、ODI评分、VAS评分。结果微创单侧组的手术时间、出血量、住院时间均少于开放双侧组,差异均有统计学意义(P0.05)。两组患者均获得随访,时间12~52个月。术后ODI及VAS评分两组均较术前明显改善(P0.001),两组之间比较差异无统计学意义(P0.05)。两组术后1年椎间高度指数与术后比较差异均无统计学意义(P0.05)。结论对于单间隙腰椎管狭窄症,微创单侧入路双侧减压单侧固定具有与开放双侧减压固定相似的临床及影像学疗效;微创单侧固定创伤小,手术及住院时间短。     

单侧入路双侧减压治疗高龄腰椎管狭窄症的疗效观察

目的:观察与分析高龄腰椎管狭窄患者行单侧入路双侧椎管减压术的临床疗效.方法:回顾性分析2017年3月～2019年9月收治的因腰椎管狭窄症采用有限性椎管减压手术的35例75岁以上的高龄患者,依据手术方式分为传统后正中入路双侧椎板开窗椎管减压术组(A组,n=17,男7例,女10例,平均年龄80.1±3.8岁)及单侧入路双侧...     

显微内窥镜下治疗腰椎椎管狭窄症的初步探讨

[目的]探讨显微内窥镜下单侧入路保留椎间关节的椎管内硬膜及双侧神经根减压术治疗腰椎椎管狭窄症的临床应用效果。[方法]对29例腰椎椎管狭窄症病人使用METRxTMsystem行单侧入路保留椎间关节的椎管内硬膜及双侧神经根减压术。对手术时间、出血量、术后消炎镇痛药使用的次数、并发症及影像学术后的改变进行了探讨。疗效评定采用日本骨科学会腰椎疾病29分评分法(JOA评分)。[结果]24例患者获得随访7~24个月,平均15.3个月。术前JOA评分(14.5±3.7)分,随访时JOA评分(22.4±2.3)。改善率平均54.7%。本组手术时间平均94.2分,平均出血量56.4 m。l术后消炎镇痛药使用的次数平均0.37次。并发症包括定位错误1例次,硬脊膜撕裂2例次。术中镜下显示双侧神经根和硬膜得以充分减压;术后CT、3D-CT示进入侧、对侧的椎间关节得以保留。[结论]显微内窥镜下单侧入路保留椎间关节的椎管内硬膜及双侧神经根减压术使病理压迫组织切除减小到最小,是治疗腰椎管狭窄症安全有效的理想的减压方法。     

后路椎间盘镜显微治疗腰椎椎管狭窄症

目的 报道显微后路椎间盘镜治疗退行性腰椎椎管狭窄症的临床效果。方法 选取退行性腰椎管狭窄症病例，椎板间隙入路椎间盘镜下行椎管减压，单侧单节段开窗减压23例，双侧单节段开窗减压12例，单侧双节段开窗减压9例，单侧双节段半椎板切除减压4例。结果 除1例术中硬膜破裂改常规手术外，其余病例均在手术显微镜下完成腰椎管减压术。所有病例获得5～18个月随访，平均8．3个月，优良率92％。结论 显微后路椎间盘镜治疗退行性腰椎管狭窄症具有手术创伤小、神经根减压彻底、术后恢复快的特点；单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是其适应证。     

显微内窥镜下单侧入路双侧减压治疗腰椎椎管狭窄症

目的 探讨显微内窥镜下利用单侧入路双侧减压技术治疗腰椎椎管狭窄症的手术适应证及临床疗效.方法 2005年2月至2007年6月,采用显微内窥镜下单侧入路双侧减压技术治疗腰椎椎管狭窄症患者53例,男36例,女17例;年龄52～75岁,平均57岁.全部病例均有腰痛、单侧或双侧下肢疼痛、麻木及神经性间歇性跛行病史,其中有双下肢症状者均自觉一侧下肢症状较重.所有患者术前均行腰椎X线摄片、CT、MR等影像学检查确诊为单节段腰椎椎管狭窄症,并结合临床表现排除退变性腰椎失稳、多节段腰椎椎管狭窄.术后患者获得平均16个月(8～26个月)的随访,采用视觉模拟评分法(visual analogue scale,VAS)及腰椎功能障碍指数(Oswestry disability index,ODI)评定患者手术后的疗效.结果 术后无硬脊膜撕裂、神经根损伤等严重并发症发生.VAS及ODI评定结果显示患者手术前后的VAS及ODI分值改变有统计学意义(P<0.01).术后CT显示椎管得到有效扩大,解剖结构破坏较少.结论 显微内窥镜下单侧入路双侧减压技术减压效果良好,复发率低,适用于早期症状较轻的单节段腰椎椎管狭窄症患者.     

DELTA内镜下单侧入路双侧减压治疗腰椎椎管狭窄症的疗效分析

目的 探讨DELTA内镜下单侧入路双侧减压治疗单节段腰椎管狭窄症的临床疗效.方法 选取广东省中医院骨科自2018年1月～2019年6月手术治疗的60例单节段腰椎管狭窄症患者,根据手术方式不同分为DELTA组和MIS-TLIF组,DELTA组采用DELTA内镜下单侧椎板间入路双侧减压术治疗,MIS-TLIF组采用微创管道...     

微创单侧入路双侧减压治疗腰椎椎管狭窄症早期疗效观察

目的评估微创单侧入路双侧减压经椎间孔椎体间融合术治疗腰椎椎管狭窄症的短期疗效？方法2010年6—10月,38例腰椎椎管狭窄症患者接受开放或微创手术治疗,微创组17例,开放组21例。记录手术时间、术中出血量和引流量、术后住院时间、并发症情况以及手术前后的腰痛视觉模拟量表（visualanalogscale,VAS）评分及日本骨科学会（Japanese Orthopaedic Association,JOA）评分。结果平均随访7．6个月。微创组平均出血量较少,手术时间较长,而术后住院时间较短。2组患者术后腰痛及功能均有显著改善,微创组末次随访时腰痛VAS评分低于开放组,微创组术后、随访时JOA评分及JOA改善率均明显高于开放组。微创组患者并发症发生率略高于开放组但差异无统计学意义（P〉0．05）。结论微创单侧入路双侧减压结合微创经椎间孔椎体间融合术治疗腰椎椎管狭窄症短期疗效满意,其长期疗效有待进一步随访明确。     

显微外科手术单侧入路双侧减压治疗腰椎管狭窄症

目的 对脊柱显微手术下单侧入路行双侧减压治疗腰椎管狭窄症的方法和疗效进行评估.方法 从2007年6月至2010年6月,在手术显微镜辅助下行单侧入路双侧减压治疗腰椎管狭窄症60例,以症状最重侧为入路侧,按常规手术方法显露椎板间隙,Caspar拉钩维持并显露术区,脊柱专用手术显微镜下同侧椎管减压,倾斜手术显微镜和手术床,使医生的视角能看清对侧椎管并减压.采用目测类比评分法(visual analogue scale,VAS)评估治疗前后疼痛状况.结果 60例中57例的神经症状完全缓解;3例好转.手术后VAS评分从术前的9.08±0.76降为术后的2.33±1.43,术后随访6～24个月,平均(12.0±4.7)个月,所有病例的症状无加重或复发.结论 脊柱外科专用显微镜下单侧入路双侧减压治疗腰椎管狭窄是一种有效的治疗方法.并且具有创伤小、痛苦少、恢复快、疗效佳、术后对脊柱的稳定性影响很小的优点.

Abstract：

Objective To evaluate the characteristics and efficacy of microscope-assisted bilateral decompression via unilateral approach for the treatment of lumbar stenosis. Methods From June 2007 to June 2010, Sixty case lumbar stenosis with bilateral decompression were treated via unilateral approach under microscopy. Patients were followed up from 6 to 24 months, average (12 ± 4.7) months. Results The pain level of each patient was assessed both before and after the opeartion, using a visual analogue scale (VAS). Intermittent claudication was completely relieved in 57 out of 60 cases, moderately relieved in 3 cases. VAS score decreased from pre-operational 9.08 ± 0.76 to post-operational 2.33 ± 1.43, and there was significantly difference between them. There was no recurrent case during the whole follow-up. Conclusion Bilateral decompression via unilateral approach under microscope is proved to be an effective and safe procedure for the treatment of lumbar stenosis, and have the advantages of minimal invasion, less pain, quick recovery, better effect, little influence on the spinal stability.     

微创经椎间孔腰椎体间融合术治疗腰椎管狭窄合并腰椎不稳症

目的 探讨微创经椎间孔腰椎间融合术(MIS-TLIF)治疗腰椎管狭窄合并腰椎不稳的临床疗效.方法 对2010年3月至2011年1月42例微创通道下行单侧入路双侧减压加MIS-TLIF手术治疗的腰椎管狭窄合并腰椎不稳患者进行回顾性分析;其中男性18例,女性24例,年龄48～79岁,平均61.7岁.病变节段为L3～4 4例,L4～5 26例,L5～S1 12例;其中间歇性跛行伴单侧下肢症状24例,伴双侧下肢症状18例.记录手术时间、术中出血量、术后住院时间、手术并发症的情况.患者术前、术后采用视觉模拟评分(VAS)分别对腰痛及下肢痛进行评分;采用Oswestry功能障碍指数(ODI)评估腰椎功能情况及Bridwell方法评价腰椎融合情况;术后末次随访时采用MacNab标准评价疗效.结果 手术时间120～170 min,平均150.4 min;术中出血50～400 ml,平均147.1 ml,无输血病例;术后住院天数5～18d,平均8.8d;术中l例出现硬膜囊撕裂,l例骨质疏松患者行椎间融合时融合器打入上位椎体中,术后3例发生切口愈合不良.随访6 ～14个月,平均11个月.术前腰痛VAS评分为7.3±1.0,术后3个月及末次随访时分别为2.9±0.8和2.0±0.8,与术前比较有显著改善(t =25.319和29.334,P＜0.01);术前下肢痛VAS评分为7.9±0.7,术后3个月及末次随访时分别为2.0±0.5和1.0±0.7,与术前比较差异有显著改善(t=49.584和41.885,P＜0.01);OD1评分术前为75％±6％,术后3个月随访时为16％±6％,末次随访时为l2％±5％,与术前比较差异有统计学意义(t=43.675和56.323,P＜0.01).末次随访时,根据Bridwell椎间融合评价标准,Ⅰ级和Ⅱ级为40例(95.3％),无螺钉断裂及松动发生;采用MacNab标准评价临床效果,其中优16例,良22例,可4例.结论 MIS-TLIF手术是治疗单节段腰椎管狭窄合并腰椎不稳的一种理想手术方法,但要根据术者的临床经验、手术技巧和医院的具体条件谨慎开展.     

Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis

Purpose

Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although many technical reports have demonstrated acceptable overall surgical outcomes for this approach, no studies have attempted to clarify the clinical outcomes thereof in regard to anatomical variance of the spinal canal. This study was conducted to analyze the clinical outcomes of microsurgical bilateral decompression via a unilateral approach according to spinal canal morphology in degenerative lumbar spinal stenosis.

Methods

Between January 2008 and December 2009, 144 patients with single-level spinal lumbar stenosis underwent microsurgical bilateral decompression via a unilateral approach by a single surgeon. Patients were categorized into three groups according to spinal canal shape: round (n = 42), oval (n = 36), and trefoil (n = 66), and clinical parameters were assessed both before and after surgery with 2–3 years of follow-up.

Results

Mean visual analog scale (VAS) and Oswestry disability index (ODI) decreased after surgery, respectively, from 8.1 and 59.8 % to 2.1 and 19.1 % in the round shaped spinal canal group, from 7.2 and 47.1 % to 2.2 and 15.1 % in the oval shaped spinal canal group, and from 6.8 and 53.6 % to 3.6 and 33.3 % in the trefoil shaped spinal canal group. In all groups, VAS and ODI scores significantly improved postoperatively (p < 0.01), although less improved VAS and ODI scores were observed in the trefoil shaped spinal canal group (p < 0.01). The overall patient satisfaction rate was 66.7 %; however, statistically significant lower satisfaction rates were reported in the trefoil shaped spinal canal group (p < 0.01).

Conclusions

Microsurgical bilateral decompression via a unilateral approach may be a good modality for treating round or oval shape spinal canal stenosis, but is not recommended for trefoil-shaped-stenosis. The current authors recommend performing the bilateral decompression technique in cases of trefoil-shaped-spinal canal stenosis.     

Bilateral decompression via unilateral fenestration using mobile microendoscopic discectomy technique for lumbar spinal stenosis

Objective: To evaluate the feasibility and clinical efficacy of bilateral decompression via unilateral fenestration (BDUF) with mobile microendoscopic discectomy (MMED) for lumbar spinal stenosis. Methods: From June 2007 to June 2009, 32 patients were treated by the technique of BDUF with MMED for lumbar spinal stenosis in our hospital. All patients complained of bilateral sciatic neuralgia and intermittent claudication that was dominant in one limb. CT scan and MRI revealed disc herniation and bilateral stenosis of the spinal canal. Patients with bilateral severe osseous stenosis and multilevel stenosis were excluded. Results: The procedure was technically successful in all patients, bilateral decompression and spinal canal enlargement being achieved by unilateral fenestration. The mean operative time was 70 min (range, 50–100 min), with a mean blood loss of 150 ml (range, 50–350 ml). No significant complication was noted; dural tears were encountered in only two patients without obvious side effects. The patients were followed up for 3 to 24 months (mean, 12 months) and the clinical results were excellent in 21 cases and good in 11 cases according to the MacNab scale. Conclusion: The procedure of BDUF can be performed in conjunction with the MMED technique for lumbar spinal stenosis with good clinical results; however, severe bilateral osseous stenosis may be not suitable for this technique.     

Minimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes

Standard open posterior decompression is well established and familiar to virtually all spine surgeons. However, this traditional surgical treatment of lumbar spinal stenosis (LSS) is often associated with significant postoperative pain, disability, and dysfunction. This article reviews the use of a minimally invasive microendoscopic approach for bilateral decompression of lumbar stenosis by way of a unilateral approach. This technique has been shown to provide symptomatic relief equivalent to that of open discectomy, with significant reductions in operative blood loss, postoperative pain, hospital stay, and narcotic usage. Furthermore, the article explains the rationale, indications, and surgical techniques for minimally-invasive LSS surgery and presents the authors' 4-year outcomes data.     

X—tube肌间隙入路腰椎减压内固定加椎间植骨融合治疗腰椎管狭窄的临床应用

目的探讨X-tube下肌间隙入路腰椎减压内固定加椎间植骨融合治疗腰椎管狭窄的可行性及疗效。方法2010年3月～2011年10月在X-tube下经肌间隙入路行腰椎减压内固定加椎间植骨融合治疗椎管狭窄32例。术前、术后1月及末次随访时采用ODI及VAS评估患者疗效,并在x线片上观察患者椎间隙高度及植骨融合情况。结果本组手术平均时间60（55～70）min;手术切口平均长度3．5（3～5）cm;术中出血量平30（20～50）ml;平均住院时间6．5（6—7）d。术中无硬脊膜损伤发生。32例患者均获得随访,平均21．6（12～31）个月。手术切口均I期愈合,无术后感染发生。术前、术后1个月及末次随访ODI评分分别为38．96±1．68、16．28±3．12和3．60±1．40,VAS评分分别为7．16±0．78、2．56±0．76和1．04±0．70,三者比较均有统计学差异（P〈0．01）。术后1月和末次随访时椎间隙高度分别为（13．48±0．56）mm和（12．41±0．87）mm,较术前（8．86±0．79）mm均有统计学差异（P〈0．01）。结论X—tube下经肌间隙入路是一种安全有效的微创手术入路,经该入路行腰椎减压内固定加植骨融合术治疗腰椎管狭窄可取得满意的临床疗效。     

管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术治疗单节段腰椎退行性疾病

目的 探讨管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗单节段腰椎退行性疾病的临床疗效.方法 2013年11月—2016年2月,同济大学附属同济医院采用管状通道下单侧入路双侧减压MIS-TLIF治疗28例单节段腰椎退行性疾病患者.记录手术时间、术中出血量、术后引流量;测量手术前后及末次...