腰椎黄韧带骨化伴腰椎管狭窄的治疗

目的:探讨腰椎黄韧带骨化伴腰椎管狭窄影像学特点和手术治疗效果。方法 :2013年1月至2016年1月治疗腰椎黄韧带骨化伴腰椎管狭窄患者9例,男5例,女4例;年龄51~63岁,平均57岁。患者均表现为间歇性跛行和下肢放射痛,CT和MRI检查提示病变部位:L4,5和L5S1双节段2例,L4,5单节段5例,L5S1单节段2例。4例单纯行椎板切除椎管减压术,5例行椎板和椎间盘切除、椎间融合及椎弓根螺钉内固定术。采用JOA评分(包括主观症状、日常活动受限度、临床体征和膀胱功能)对治疗前后的临床疗效进行评定。结果:患者术后无感染或神经损伤等并发症,9例患者均获得随访,时间12~60个月,平均24个月。末次随访腰背疼痛和下肢放射痛等明显改善,行走距离均接近正常,JOA评分较术前明显改善。结论:腰椎黄韧带骨化CT检查有特征性影像学表现,影像学表现决定具体手术方法,手术目的以最小创伤获得椎管有效减压并重建下腰椎稳定性。

Treatment of ossification of ligamentum flavum complicated with lumbar spinal stenosis

Objective: To investigate the imaging characteristic and operation outcome of ossification of ligamentum flavum with lumbar spinal stenosis.Methods: From January 2013 to January 2016,9 patients with ossification of ligamentum flavum with lumbar spinal stenosis were treated,included 5 males and 4 females,aged from 51 to 63 years old with an average of 57 years old. All patients complained intermittent claudication and radiating pain at lower limb. The pathologic change regions examined by CT or MRI were as follows:2 cases in L_4,5 and L₅S₁,5 in L_4,5,and 2 in L₅S₁. Four patients underwent simple laminectomy and 5 patients underwent laminectomy and discectomy,interbody fusion and internal fixation with pedicle screw. Clinical effects were evaluated according to JOA score,which items included subjective symptom,daily activity limitation,clinical sign and bladder function.Results: No complications such as infection or nerve injury were found after operation. The follow-up period was from 12 to 60 months with an average of 24 months. The low back pain and radiating pain at lower limb improved significantly and walking distance approached normal at final follow-up;and JOA scores improved obviously.Conclusion: Ossification of ligamentum flavum has the special characteristic on CT scan,which decide the selection of operation method. The operative aim is effectively spinal decompression and rebuilding lower lumbar stability by minimally invasive surgery.