不同类型退变性腰椎管狭窄症的手术治疗

目的 通过对不同类型退变性腰椎管狭窄症手术方法的选择，提高手术治疗的疗效。方法回顾性分析2001年9月～2004年1月收治退变性腰椎管狭窄症患者96例，其中男85例，女11例。年龄39～71岁，平均54岁。病程3个月～7年。根据患者临床症状、体征及脊髓造影检查，分为5组，A组：1个节段椎间管狭窄，39例，行椎板间开窗椎间管（侧隐窝、神经根管）潜行扩大术；B组：1个节段中央椎管狭窄，21例，行椎板间开窗椎间盘摘除，椎间管潜行扩大术；C组：1个节段退行性脊柱滑脱，18例，行两侧椎板间开窗减压潜行扩大椎管后椎弓根钉系统内固定（AF、RF等）并横突间、小关节间植骨；D组：2个以上节段混合型椎管狭窄，ll例，行病变节段两侧开窗潜行扩大椎管，切除黄韧带，摘除椎间盘，松解神经根；E组：退行性脊柱侧突，7例，综合以上减压措施行椎弓根钉棒系统矫形内固定后外侧植骨。随访并评价其疗效。结果96例患者获随访6～36个月，平均12．2个月，未出现手术并发症。JOA评分优85例、良9例、中1例、差1例；X线片复查无椎弓根钉误置、断钉、拔出等。结论退变性腰椎管狭窄症的治疗采取有限化手术、有效化减压原则可减少并发症，提高疗效。脊髓造影对退变性腰椎管狭窄症的手术方式选择有重要价值。     

退变性腰椎管狭窄症的诊断与手术治疗

目的　探讨退变性腰椎管狭窄症的诊断与手术治疗方式。方法　 1995～ 2 0 0 2年对 6 2例诊断为退变性腰椎管狭窄症的患者 ,仔细分型 ,采用 3种方法 ,a)开窗潜行扩大椎板减压术 ;b)扩大的半椎板切除减压术 ;c)全椎板切除加椎间融合术。结果　随访 1～ 6a ,按Nakal分级评定优 4 3例 ,良 16例 ,可 3例 ,优良率 96 .5 %。结论　退变性腰椎管狭窄症的手术治疗主要以充分彻底的减压、解除神经根的致压因素为主 ,但要兼顾减压的彻底性与腰椎的稳定性。单节段病变选择开窗潜行减压术或扩大半椎板切除减压术 ,多节段病变选择全椎板减压术同时行椎间融合术以保证腰椎稳定。     

多节段开窗减压椎管潜行扩大治疗腰椎管狭窄症

目的：探讨腰椎管狭窄症的治疗方法。方法根据腰椎管狭窄症呈节段性特点,对病变节段行手术治疗,应用多节段开窗减压椎管潜行扩大术治疗腰椎管狭窄症１１２例,结果平均随访３８．６个月。疗效７３例,良３３例,可５例,差１例,优良率９４．６％,结论多节段开窗减压椎管潜行扩大既治疗腰椎管狭窄症又保留了脊椎的稳定性。     

双侧开窗潜行扩大治疗老年人腰椎管狭窄症

目的：探讨老年人腰椎管狭窄症的手术适应证以及术中尽量保持骨性结构完整的重要性。方法：72例患者均行双侧开窗，潜行扩大椎管减压术治疗。结果：63例获1－7年随访，疗效评定：优52例（82．6％），良9例（14．3％），可2例（3．1％），优良率96．9％。结论：手术治疗能解除老年腰椎管狭窄症患者的病痛，提高生活质量。应用双侧开窗，潜行扩大术行椎管减压，既保持了骨性结构的完整性，又减少了合作 ，有利于患者早期下床活动，可以减少或避免手术并发症。     

选择性椎管减压术治疗退行性腰椎管狭窄症

采用选择性椎管减压治疗行性腰椎管狭窄症６８例，经术后平均２７个月的随访、优良率９４．１％。文中将退行性腰椎管狭窄症分为中央性腰椎管狭窄，侧隐窝狭窄，混合性狭窄。分别采用中央开窗、潜行扩大减压、一侧或双侧扩大开窗、侧隐窝扩大，蝶形扩大减压术。文中还对选择性腰椎管减压术的理论依据及减压范围进行了讨论。     

选择性开窗潜行扩大椎管治疗腰椎管狭窄症

目的 探讨退行性腰椎管狭窄症治疗的手术方式,讨论本病的病理特点和采用选择性开窗潜行式内板切除扩大椎管这一术式的可行性。方法 对106例退行性腰椎管狭窄症患者,根据其术前CT等的定位、定性、定量及术中的具体所见,针对性地选择一侧或双侧,单个或多个开窗,行潜行式内板切除扩大椎管治疗,并观察其后期疗效。结果 经治疗的106例患者,疗效达优69例,占65．09％;良32例,占30．19％;可5例,占4．72％;差0例。结论 通过不同的开窗方式和多个开窗、有限的椎板及关节突切除、剥离和摘除退变增厚的黄韧带和椎间盘、潜行扩大椎管,能达到充分减压及尽量保留腰椎后部结构的双重目的,保证腰椎的稳定性,避免医源性椎管狭窄及脊椎滑移的发生。     

退变性腰椎管狭窄症的手术治疗(附120例临床报告)

退变性腰椎管狭窄症传统的的临床手术治疗方式是全椎板切除椎管减压术。因为全椎板切除破坏了脊柱后柱结构,存在术后腰椎不稳定和硬膜外瘢痕形成等缺点,影响术后效果。脊柱内固定器械的临床应用能减少椎板切除术后腰椎不稳的发生,提高了融合率,但也存在神经损伤,内固定松动,脱落和移位等内固定并发症,同时内固定又增加患者的经济负担,故应严格掌握内固定应用的指征。自1996年12月～2 0 0 1年12月本研究对135例退变性腰椎管狭窄症患者根据病变特点,采用三种术式,即保留腰椎棘突韧带复合体的腰椎管扩大术,经椎板间隙开窗神经根管潜行扩大术及…     

交叉开窗潜行式椎管扩大治疗腰椎管狭窄症

腰椎管狭窄症是骨科常见病、多发病，严重地影响了患者的劳动、工作甚至生活，手术治疗是最终选择，方法较多，效果亦不尽然。近十几年来我们采用交叉开窗潜行式椎管扩大术治疗腰椎管狭窄症，取得满意效果，现报告如下。     

有限性椎板切除术治疗退行性腰椎管狭窄症

采用有限性椎板切除术治疗退行性腰椎管狭窄症６８例，经术后平均２７个月的随访，优良率９４．１％。文中将退行性腰椎管狭窄症分为中央性腰椎管狭窄，侧隐窝狭窄，混合性狭窄。分别采用中央开窗、潜行扩大减压，一侧或双侧扩大开窗、侧隐窝扩大，蝶形扩大减压术。作者还对有限性椎板切除术的理论依据及减压范围进行了讨论。     

多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症的CT椎管测量分析

目的探讨多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症的临床疗效。方法选取2013-03-2015-09甘肃省中医院脊柱骨三科所收治的退变性腰椎管狭窄症患者100例,所有患者均采用多节段椎板开窗潜行扩大术治疗,手术前后运用Digimizer图像分析测量软件对100例患者的CT扫描片进行椎管矢径、椎板间距、上关节突内缘间距、椎管截面积测量,同时对患者手术前后进行JOA评分(日本骨科学会下腰痛评分法)。结果术后L_(3-4)、L_(4-5)、L_5-S_1各平面的椎管矢径较术前平均增加4.823 mm、5.585 mm、5.517 mm;术后L_(3-4)、L_(4-5)、L_5-S_1各平面的椎板间距较术前平均增加7.134mm、5.998 mm、5.143 mm;术后L_(3-4)、L_(4-5)、L_5-S_1各平面的上关节突内缘间距较术前平均增加7.231mm、7.046 mm、6.052 mm;术后L_(3-4)、L_(4-5)、L_5-S_1各平面的椎管截面积较术前平均增加183.818 mm~2、202.435 mm~2、177.953 mm~2,且P0.05,具有统计学意义。手术前后JOA评分,由术前的(8.63±1.83)分升高到术后的(26.33±1.53)分(P0.05)具有统计学意义;JOA评分改善率为86.90%。结论多节段椎板开窗潜行扩大术减压充分,能明显扩大病变节段的椎管矢径、椎板间距、上关节突内缘间距及椎管截面积,解除了患者的临床症状,疗效可靠。     

选择性神经根封闭术在腰椎退变性疾病中的应用

目的探讨选择性神经根封闭术在腰椎退变性疾病中的定位诊断作用。方法 2008年1月～2010年12月共收治多节段腰椎退变患者58例。多节段腰椎椎管狭窄症患者共32例,其中男20例,女12例;年龄55～75岁,平均64岁;病程1～11年。多节段腰椎椎间盘突出患者26例,其中男15例,女11例;年龄38～63岁,平均45岁;病程1～8年。以上患者均有下肢疼痛不适症状。所有患者均采用选择性神经根封闭术明确责任节段。结果 32例多节段腰椎椎管狭窄症患者中25例行>2个节段的减压术;26例多节段腰椎椎间盘突出患者,12例行单节段髓核切除,另14例行双节段髓核切除。责任间隙准确,患者疗效良好。结论在腰椎退变性疾病的定位诊断中,选择性神经根封闭是一种准确而有效的确认责任间隙的方法。     

Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders

Background Lumbar facet joint tissue has inflammatory cytokines. However, no reports have shown whether inflammatory cytokines in the facet joint leads to pain. This study was designed to characterize the correlation between inflammatory cytokines released from facet joint tissue and symptoms in degenerative lumbar spinal disorders. The purpose of this study was to seek involvement of inflammatory facet joint for radiculopathy in lumbar spinal canal stenosis with clinical and anatomical studies. Methods Lumbar facet joint cartilage and synovial tissues in 40 cases of posterior lumbar surgery were harvested to measure tumor necrotizing factor-α (TNFα), interleukin-1β (IL-1β), and interleukin-6 (IL-6) during operation. The visual analogue scale (VAS) and Roland-Morris disability questionnaire (RDQ) were used to examine the correlation between cytokine concentration and symptoms. Coloring agent was injected into facet joints of fresh cadavers to find leakage of pigment from the facet joint into the spinal canal. Results Inflammatory cytokines were detected in the joint tissues in the lumbar spinal canal stenosis (LSCS) and lumbar disc herniation (LDH) groups. A positive reaction rate of IL-1β was significantly higher in the LSCS group than in the LDH group. IL-1β-positive cases in the LSCS group showed higher VAS scores for leg pain and higher RDQ scores. Intraspinal canal tissues including lumbar nerve root were stained by injection of methylene blue into the facet joints. Conclusions IL-1β in facet joint cartilage in LSCS was associated with leg pain and a decline of quality of life. Inflammatory cytokines produced in degenerated facet joint may leak into the intraspinal space through the lateral part of the ventral facet joint capsule. These results suggest the involvement of inflammatory cytokines in degenerated lumbar facet joints regarding the genesis of pain production.     

选择性神经根封闭术在多节段腰椎管狭窄症诊治中的应用

目的探讨选择性神经根封闭术在多节段腰椎管狭窄症定位诊断及术式选择中的作用。方法自2008年7月至2010年4月收治多节段腰椎管狭窄症患者共53例,男20例,女33例;年龄57～85岁,平均68岁。所有患者均采用选择性神经根封闭术明确责任节段。根据责任节段行手术治疗,A组采用开窗减压、间盘摘除术;B组采用椎板减压、椎间植骨融合、椎弓根螺钉固定术。术前、术后均采用视觉模拟评分法(visual analogue scale,VAS)及日本骨科协会(Japanese orthopaedic association,JOA)评分进行疗效评估。结果选择性神经根封闭术明确单节段责任间隙40例,两节段11例,有2例在神经根封闭后症状缓解不到30%,未再行手术治疗。A组(18例)手术前、后及最后随访时JOA评分分别为(5.8±2.3)分、(12.3±1.6)分、(11.9±1.3)分,VAS评分分别为(7.6±1.6)分、(2.3±1.5)分、(1.8±1.1)分。B组(33例)进行单节段融合29例,两节段融合4例,手术前、后及最后随访时JOA评分分别为(5.5±2.1)分、(11.8±1.8)分、(11.6±1.5)分,VAS评分分别为(7.4±2.3)分、(2.5±1.2)分、(2.1±1.5)分。术后及最后随访时JOA、VAS评分与术前比较差异有统计学意义(P<0.001),A组与B组术前、术后JOA、VAS评分差异无统计学意义(P>0.05)。结论在腰椎管狭窄症的定位诊断中,选择性神经根封闭是明确责任节段准确而有效的方法,有助于减小手术范围,提高手术疗效。     

Hyperostotic lumbar spinal stenosis. A review of 12 surgically treated cases with roentgenographic survey of ossification of the yellow ligament at the lumbar spine

Although there is considerable literature concerning ossification of the posterior longitudinal ligament or the ligamentous flava (OPLL or OYL) in the cervical and thoracic spine, there are only a few references about OPLL or OYL in the lumbar spine. The authors have described lumbar spinal stenosis due to OPLL or OYL as hyperostotic lumbar spinal stenosis, and analyzed 12 surgically documented cases with this condition. The symptoms and signs of hyperostotic lumbar spinal stenosis are the same as those seen in degenerative lumbar spinal stenosis, but the degree of paraparesis is much more severe in hyperostotic lumbar spinal stenosis. Computed tomography scan imaging clearly demonstrates OPLL or OYL in the lumbar spine, although some lesions can be seen on the lateral view of a plain roentgenogram. The results of 12 surgical cases suggest that decompression laminectomy produces relief of symptoms. An analysis of 2,403 plain lumbar roentgenograms showed an incidence of 8.4% OYL in the lumbar spine, with frequent involvement of the upper and middle lumbar spine. A classification system of OYL in the lumbar spine has been developed. The entire spine should be examined before surgery on a patient with hyperostotic lumbar spinal stenosis because of a tendency to ossify spinal ligaments at other levels.     

Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenoses

Spinal stenosis may rarely involve both cervical and lumbar spines. An alternative surgical strategy used for the treatment of combined cervical and lumbar spinal stenosis is presented. Two cases with symptomatic combined stenosis of the cervical and lumbar spinal canal are described. Simultaneous surgery was performed in both cases. The combined stenosis of the cervical and lumbar spinal canal dictates careful neurologic and neuroradiologic examinations. Simultaneous surgery is an alternative approach for patients with symptomatic multilevel spinal stenoses, whose general conditions necessitate a one-session and short-lasting surgery.     

腰椎狭窄软性椎管的应力改变分析

目的 探讨腰椎软性椎管改变与椎管狭窄的关系。方法 在本研究52例中分为椎管狭窄组和对照组，2003年1月至2007年12月，推管狭窄组从因腰椎管狭窄病行后路椎板减压术的患者中取黄韧带标本对照组黄韧带标本共为10例，取自青年腰椎骨折行后路椎板减压术患者，后纵韧带标本共4例取自腰椎爆裂骨折前路椎体减压术患者。分别观察两组标本切片镜下的表现并加以分析。结果 在腰椎管狭窄病组，黄韧带及后纵韧带镜下表现为纤维肥大，基质内可见脂肪及小囊肿；对照组则表现为纤维细胞排列规则、无纤维化表现。结论 腰椎管软性椎管的应力改变及退行性变，是导致腰椎管狭窄的一个因素。     

Percutaneous endoscopic lumbar discectomy and interbody fusion with B-Twin expandable spinal spacer

Background  

Posterior lumbar interbody fusion (PLIF) is biomechanically sound as it ablates the degenerated disc, restores the intervertebral height, relieves foraminal stenosis, and positions the bone graft along the weight-bearing axis. But this conventional procedure also results in significant traction on the dural sac and the cauda equina and is thereby a potential source of neurologic damage. Therefore, we performed a minimally invasive technique: percutaneous endoscopic discectomy and interbody fusion (PEDIF) with B-Twin expandable spinal spacer (B-twin ESS) to treat symptomatic lumbar degenerative disc disease and explored the clinical outcome.     

CT联合肌电图诊断椎间孔型腰椎管狭窄症的临床研究

目的探讨64排螺旋CT及肌电图联合应用诊断椎间孔型腰椎管狭窄症的临床价值。方法回顾性分析507例手术证实腰椎管狭窄症患者,其中29例术前普通CT、MRI扫描检查均未发现明确椎管狭窄情况,经肌电图联合64排螺旋CT薄层扫描初步定位,再进行手术探查性治疗。结果29例经手术证实均为特殊类型腰椎间孔狭窄,术后参照改良Macanab分级标准进行疗效评价,优19例,良7例,可3例,差0例,优良率89．7％。术前及术后疗效差异有明显统计学意义。结论64排螺旋CT薄层扫描联合肌电图能够更加准确定位腰椎管狭窄部位,从而提高手术的治疗效果。     

Management of cervical and lumbar stenosis]

Spinal stenosis is most common in elderly patients and is defined as narrowing of the spinal canal and (or) lateral nerve root canals. The underlying processes leading to spinal stenosis are degenerative changes in facet joints and intervertebral discs and buckling of the ligamentum flavum. Spinal stenosis can occur in both the cervical and the lumbar spine. Cervical stenosis mayleat to the development of radiculopathy and (or) myelopathy. The majority of patients respond to nonoperative management. Degenerative lumbar spinal stenosis presents with back and (or) leg paints of valuing severity and duration. Nonoperative treatment associated with lumbar spinal stenosis consists of restituting and avoiding those maneuvers that reproduce pain. Surgical treatment of cervical and lumbar stenosis includes decompressive lamine ctomy, often fusion and instrumentation.     

Validation study of a clinical diagnosis support tool for lumbar spinal stenosis

Background

A clinical diagnosis support tool for lumbar spinal stenosis was developed by the Japanese Society for Spine Surgery and Related Research. However, the use of this tool has not yet been validated.

Methods

Patients with symptoms in the lower extremities and who visited the Department of Orthopedics initially were recruited to the study. Orthopedic physicians who were not spine specialists completed the support tools. Spine specialists examined the patients, made a diagnosis, and completed the lumbar spine examination sheet made for the study. The support tool and lumbar spine examination sheet were sent to a central panel comprising four panelists who then decided on a final diagnosis.

Results

In total, 118 patients were evaluated, including 62 males and 56 females. Lumbar spinal stenosis was diagnosed in 58 and nonlumbar spinal stenosis in 60 patients. The mean score in the lumbar spinal stenosis group was 12.2 points (median 13 points). In the nonlumbar spinal stenosis group, the mean score was 7.5 points (median 7 points). Sensitivity was 0.948, and specificity was 0.40.

Conclusions

Patients with lumbar spinal stenosis with a very low score were diagnosed with mild lumbar spinal stenosis, whereas nonlumbar spinal stenosis patients with a very high score were diagnosed as suffering from spine disease and needing special treatment by spine surgeons. Our results validate the use of the support tool for the diagnosis of lumbar spinal stenosis. Although the specificity observed in the present study was lower than that reported at development, we conclude that this support tool is useful for screening patients with lumbar spinal stenosis.