Kunogi J, Hasue M
Department of Orthopedic Surgery, Japan Red Cross Medical Center, Tokyo.
Spine (Phila Pa 1976). 1991 Nov;16(11):1312-20. doi: 10.1097/00007632-199111000-00012.
The clinical, radiologic, and operative findings, and clinical results in 26 cases of foraminal nerve root involvement, each treated by variable operative procedures for an existing pathologic condition, were studied. These 26 cases consisted of 8 intraforaminal or extraforaminal lumbar disc herniations and 18 foraminal nerve root entrapments. The cases with an extreme lateral lumbar disc herniation underwent lateral fenestration or osteoplastic hemilaminectomy without concomitant spinal fusion, and showed excellent operative results. A sufficient selective decompression was achieved with a good clinical result in the cases of lumbar spondylosis without preoperative spinal instability, by lateral fenestration or osteoplastic hemilaminectomy. This result suggests that the selective decompression procedure is recommended for cases with reliable preoperative diagnoses. When an intraspinal lesion makes it difficult to diagnose coexisting foraminal nerve root involvement, decompression of the nerve root canal, approaching from medial to lateral, is recommended. The fusion operation should be performed in cases undergoing even a unilateral total facetectomy, regardless of the patient's old age. A correct preoperative diagnosis is crucial in order to obtain satisfactory operative results.
对26例椎间孔神经根受累病例的临床、影像学和手术发现以及临床结果进行了研究，这些病例均因现有病理状况接受了不同的手术治疗。这26例病例包括8例椎间孔内或椎间孔外腰椎间盘突出症和18例椎间孔神经根受压。极外侧腰椎间盘突出症病例接受了外侧开窗或骨成形半椎板切除术，未同时进行脊柱融合，手术效果良好。对于术前无脊柱不稳的腰椎退变性疾病病例，通过外侧开窗或骨成形半椎板切除术可实现充分的选择性减压，临床效果良好。这一结果表明，对于术前诊断可靠的病例，推荐采用选择性减压手术。当椎管内病变难以诊断并存的椎间孔神经根受累时，建议从内侧向外侧入路进行神经根根管减压。即使是单侧全关节突切除术的病例，无论患者年龄多大，均应进行融合手术。为获得满意的手术效果，正确的术前诊断至关重要。
