Herno A, Partanen K, Talaslahti T, Kaukanen E, Turunen V, Suomalainen O, Airaksinen O
Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Finland.
Spine (Phila Pa 1976). 1999 Aug 1;24(15):1533-7. doi: 10.1097/00007632-199908010-00006.
A cross-sectional retrospective study to observe the correlation between postoperation findings shown on magnetic resonance imaging and clinical observations of 56 patients 10 years after laminectomy for lumbar spinal stenosis.
To evaluate the relation between postoperation findings on magnetic resonance imaging and surgical outcome in patients surgically treated for lumbar spinal stenosis.
Surgical management of lumbar spinal stenosis is based on the compression seen in radiologic imaging of neurovascular structures in the vertebral canal, but the success of surgical decompression and its correlation with clinical observations very seldom have been monitored by postoperation radiologic imaging.
In this study, 56 patients surgically treated for lumbar spinal stenosis were re-examined clinically by use of the Oswestry disability questionnaire. Their walking capacity was evaluated by the treadmill test. Severity of pain before and after the treadmill test was investigated using a visual analog scale. Patients' perception of improvement measured as the change in their condition during the preceding 5 years was elicited by a questionnaire. On the basis of the stenotic findings on magnetic resonance imaging, the patients were classified into no stenosis (NoSten, n = 15) and stenosis (Sten, n = 41) groups, and a summative degenerative scale also was constructed with the findings categorized as follows: disc degeneration, disc herniation, facet joint arthrosis, and degenerative spondylolisthesis.
Whereas the patients' perception of improvement correlated very strongly with the Oswestry score and walking capacity, there was no statistical difference between the NoSten and Sten groups in the Oswestry score, walking capacity, perception of improvement, or severity of pain. The effect of the summative degenerative scale on the patients' walking capacity was 13 times greater than the effect of the minimum area of the dural sac.
Patients' perception of improvement had a much stronger correlation with long-term surgical outcome than structural findings seen on postoperation magnetic resonance imaging. Moreover, degenerative findings had a greater effect on patients' walking capacity than stenotic findings.
一项横断面回顾性研究，旨在观察腰椎管狭窄症椎板切除术后10年56例患者的磁共振成像术后表现与临床观察结果之间的相关性。
评估接受腰椎管狭窄症手术治疗患者的磁共振成像术后表现与手术结果之间的关系。
腰椎管狭窄症的手术治疗基于椎管内神经血管结构在影像学检查中所见的压迫情况，但手术减压的成功率及其与临床观察结果的相关性很少通过术后影像学检查进行监测。
在本研究中，对56例接受腰椎管狭窄症手术治疗的患者使用奥斯威斯功能障碍问卷进行临床复查。通过跑步机测试评估他们的行走能力。使用视觉模拟量表调查跑步机测试前后的疼痛严重程度。通过问卷询问患者对改善情况的感知，以其在前5年病情的变化来衡量。根据磁共振成像上的狭窄表现，将患者分为无狭窄组（NoSten，n = 15）和狭窄组（Sten，n = 41），并构建了一个综合退变量表，其结果分类如下：椎间盘退变、椎间盘突出、小关节骨关节炎和退行性椎体滑脱。
尽管患者对改善情况的感知与奥斯威斯评分和行走能力密切相关，但NoSten组和Sten组在奥斯威斯评分、行走能力、改善感知或疼痛严重程度方面无统计学差异。综合退变量表对患者行走能力的影响比硬脊膜囊最小面积的影响大13倍。
患者对改善情况的感知与长期手术结果的相关性比术后磁共振成像所见的结构表现更强。此外，退变表现对患者行走能力的影响比狭窄表现更大。
