Krishna Manoj, Pollock Raymond D, Bhatia Chandra
Spinal Unit, University Hospital of North Tees, Hardwick Road, Stockton on Tees, TS19 8PE, United Kingdom.
Spine J. 2008 Mar-Apr;8(2):374-9. doi: 10.1016/j.spinee.2006.09.004. Epub 2006 Dec 22.
Neurological symptoms are a well-recognized complication after posterior lumbar interbody fusion (PLIF) surgery. Concerns about this potential problem may deter surgeons from performing the procedure.
To determine the incidence, etiology, prevention, and management of neuralgia after PLIF surgery.
STUDY DESIGN/SETTING: This study is a retrospective review of patients who underwent PLIF surgery at a university hospital in the north east of England.
Two hundred sixty patients who met the inclusion criteria of degenerative disc disease, spondylolisthesis, disc herniation, and postlaminectomy/postdiscectomy syndrome underwent PLIF surgery.
The outcome measure of neuralgia was assessed postoperatively by a subjective description of leg pain. Patients were considered to have post PLIF neuralgia if they complained of severe radiculopathy, which was not present before surgery.
During the study period April 1996 to April 2002, all patients who met the inclusion criteria underwent the PLIF procedure. Outcome was assessed postoperatively. In all but the first 20 cases, interbody cages were used. A subtotal superior facetectomy was performed on the first 103 patients. The subsequent 123 patients had a total removal of the superior facet. Autogenous bone and pedicle screws and plates were used in all cases.
The study group comprised 226 patients (121 women, 105 men; mean age at surgery, 44.1 years; age range, 12-81 years). Duration of symptoms ranged from 5 to 480 months (mean, 90.6 months; median, 60.0). Overall, there were 16 cases of neuralgia in 226 patients (7.1%). In the subtotal facetectomy group, 10 of the 103 patients (9.7%) had neuralgic symptoms. In the total facetectomy group, 6 of the 123 patients (4.9%) had neuralgic symptoms. The difference in incidence was not statistically significant (p=.158).
This study describes our experiences of post-PLIF neuralgia. It outlines strategies for prevention and management of the problem.
神经症状是腰椎后路椎间融合术（PLIF）术后一种公认的并发症。对这一潜在问题的担忧可能会使外科医生不愿实施该手术。
确定PLIF术后神经痛的发生率、病因、预防措施及处理方法。
研究设计/地点：本研究是对在英格兰东北部一家大学医院接受PLIF手术的患者进行的回顾性研究。
260例符合退行性椎间盘疾病、椎体滑脱、椎间盘突出及椎板切除/椎间盘切除术后综合征纳入标准的患者接受了PLIF手术。
术后通过对腿部疼痛的主观描述来评估神经痛这一观察指标。如果患者主诉有术前不存在的严重神经根病，则被认为患有PLIF术后神经痛。
在1996年4月至2002年4月的研究期间，所有符合纳入标准的患者均接受了PLIF手术。术后对结果进行评估。除前20例病例外，其余均使用椎间融合器。前103例患者行部分上关节突切除术。随后的123例患者行上关节突全切除术。所有病例均使用自体骨及椎弓根螺钉和钢板。
研究组包括226例患者（121例女性，105例男性；手术时平均年龄44.1岁；年龄范围12 - 81岁）。症状持续时间为5至480个月（平均90.6个月；中位数60.0个月）。总体而言，226例患者中有16例出现神经痛（7.1%）。在部分关节突切除组中，103例患者中有10例（9.7%）出现神经痛症状。在全关节突切除组中，123例患者中有6例（4.9%）出现神经痛症状。发生率差异无统计学意义（p = 0.158）。
本研究描述了我们在PLIF术后神经痛方面的经验。概述了该问题的预防和处理策略。
