腰椎椎体后缘离断合并椎间盘突出症

目的 分析腰椎椎体后缘离断合并椎间盘突出症的发病机理，探讨手术治疗方法。方法 回顾总结10例腰椎后缘离断合并椎间盘突出症患的临床表现、影像学资料及手术方法选择。结果 10例患中，6例表现为单侧腰腿痛，4例为双侧；4例合并间歇性跛行，其中2例伴有马尾神经受压。CT检查显示全部病例腰椎椎体后缘形成突向椎管内的骨块，其相应的椎体后角骨缺损区为椎间盘髓核组织，其中7例椎间盘突出物超过椎体后缘骨。10例均行手术切除突出的椎间盘组织，其中6例同时行离断骨块切除。全部病例经3～36个月随访取得满意效果。结论 本病发病机理主要还是由于青少年时期椎体后缘环状骨骺变异或损伤逐步引起椎间盘突出的继发改变，最终造成神经根和硬膜囊的压迫。椎体后缘骨块仅部分参与神经根压迫。椎管内神经根及硬膜囊的彻底减压才能达到满意效果。

Posterior Bony Separation and Intervertebral Disk Herniation of Lumbar Vertebrae

Objective To investigate the possible reason and operative methods of posterior bony seperation and lumbar intervertebral disk herniation. Methods A retrospective study was carried out on the clinical features, imaging studies and the operative methods of 10 patients with posterior bony seperation and lumbar intervertebral disk herniation. Results All patients had back pain of these, six cases had one leg pain, four cases had both leg pain, four cases had intermittent claudication while two cases had cauda equina syndrome. CT scans verified 10 avulsed or separated bodies at the posterior edges of lumbar vertebrae which protruded into the spinal canal. Corresponding the bony avulsion region, there was bony defect filled with disc material in the posterior part of the vertebrae. The intervertebrae disc herniation was higher than the separated body to the spinal canal in seven cases. Ten intervertebral discs and six separated bodies were excised in the operative procedures. The follow-up was 6 to 36 months. Completely recovery was observed in 8 patients, except in 2 patients who still felt slight back pain. Conclusion The possible reason for the disease is both the bony separation and intervertebral disc herniation which might be a secondary changes of the injury or variance of the epiphyseal ring of the verterbral body during the adolescent period. The intervertebral disk herniation as the main reason and the bony separation as a partial reason lead to the central or root stenosis. Satisfactory results in its treatment can only be achieved after nerve tissue complete decompress.