椎间盘源性腰痛诊断与手术治疗

目的探讨腰椎间盘源性疼痛的诊断方法及采用经椎间孔后路腰椎体间融合术的临床疗效。方法47例经保守治疗无效的椎间盘源性腰痛患者均行经椎间孔后路腰椎体间融合术（TLIF）。患者年龄平均43．7岁。L4-5 33例，L6S1 14例。术后3d下地活动，腰围固定3个月。结果所有患者随访11～49个月，平均23个月。vAS评分由术前平均84分，降至术后11分；ODI评分由术前平均56分，降至随访6个月时17．2分。椎间隙高度从术前平均9．3mm增加至术后13．7mm。结论椎间盘源性腰痛由于临床和影像学表现不典型，常被误诊或漏诊，可结合腰椎MRI及椎间盘造影进行诊断。经椎间孔后路腰椎体间融合术是治疗椎间盘源性腰痛的有效选择。

Study on diagnosis of discogenic low back pain and the therapeutic effect of transforaminal lumber interbody fusion

Objective To explore diagnostic method to discogenic low back pain and evaluate the effect of transforaminal lumber interbody fusion. Methods 47 patients who underwent a failed conservative trealment for at least 3 months received surgery. The surgically treated patients aged 44.7 years on average. The treated discs located: 33 in L4-5, 14 in L5S1; 47 cases (47 discs) received transforaminal lumber interbody fusion. the patients were allowed to leave bed with a brace 3 days postoperatively, and the brace was used for 3 months. Results All the cases were followed up for 23 months on average (11-49 months), at the end of follow-up, all the patients recovered normal social life and work without any symptoms.VAS decreased from 84 preoperatively to 11 postoperatively; ODI decreased from 56 preoperatively to averaged 17.2 at 6 months postoperatively. Disc height increased from 9.3mm preoperatively to 13.7 mm postoperatively. Conclusions Because of atypical symptoms , discogenic low back pain which is easily misdiagnosed should always be kept in mind when atypical back and leg pain are encountered. Discography provides good differential diagnosis .Surgical treatment (TLIF) provides satisfactory outcome.