Xia Yingpeng, Ishii Ken, Matsumoto Morio, Nakamura Masaya, Toyama Yoshiaki, Chiba Kazuhiro
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Spinal Disord Tech. 2008 May;21(3):153-8. doi: 10.1097/BSD.0b013e318074dded.
Retrospective study of patients who underwent laminectomy for unification.
To identify radiographic predictors of residual low back pain (LBP) after laminectomy for lumbar spinal canal stenosis (LCS).
Residual LBP is a common complication of laminectomy and no radiographic predictors of its occurrence have been identified previously.
Clinical results and radiographic findings in 49 patients (21 males and 28 females, minimum 5-year follow-up) who underwent single level laminectomy for LCS were retrospectively reviewed. Patients who had an improvement in LBP scores in the Japanese Orthopedic Association (JOA) scoring system during the follow-up periods were classified as the recovery group, whereas those without improvements were classified as the nonrecovery group. Patients' clinical data (sex, duration of symptoms, age at surgery, JOA scores) and radiographic parameters (including lumbar lordotic angle, lumbar range of motion (ROM) and the intervertebral rotational angle) were analyzed to detect the factors significantly related with the occurrence of residual LBP.
The average preoperative JOA score of 14.8+/-5.1 points improved to 21.6+/-5.5 points at the final follow-up providing an average recovery rate of 48.1+/-36.8%. Thirty-four and 15 patients were classified into the recovery and the nonrecovery groups, respectively. Binary logistic regression analysis revealed that significant predictors of residual LBP were preoperative lumbar lordosis angle and lumbar ROM. The mean preoperative lumbar lordosis and ROM in the nonrecovery group were significantly smaller than those in the recovery group (lordosis: 25.3+/-15.8 degrees vs. 37.8+/-13.6 degrees, P=0.006 and ROM: 22.1+/-10.6 degrees vs. 31.2+/-9.9 degrees, P=0.006). In addition, increase of the postoperative lumbar ROM was significantly larger in the nonrecovery than that in the recovery group (P=0.009).
Our results indicate that preoperative lordosis angle and lumbar ROM were the significant radiographic predictors for residual LBP after laminectomy for LCS. Patient with flatback and limited lumbar mobility before surgery are prone to suffer residual LBP. It is suggested that these sagittal radiographic parameters should be taken into account when choosing laminectomy as the surgical option for LCS.
对接受椎板切除术进行融合的患者进行回顾性研究。
确定腰椎管狭窄症（LCS）椎板切除术后残留下腰痛（LBP）的影像学预测指标。
残留LBP是椎板切除术的常见并发症，此前尚未确定其发生的影像学预测指标。
回顾性分析49例行单节段LCS椎板切除术患者（男21例，女28例，至少随访5年）的临床结果和影像学表现。随访期间日本骨科协会（JOA）评分系统中LBP评分改善的患者分为恢复组，未改善的患者分为未恢复组。分析患者的临床资料（性别、症状持续时间、手术年龄、JOA评分）和影像学参数（包括腰椎前凸角、腰椎活动度（ROM）和椎间旋转角），以检测与残留LBP发生显著相关的因素。
术前平均JOA评分为14.8±5.1分，末次随访时提高至21.6±5.5分，平均恢复率为48.1±36.8%。分别有34例和15例患者被分为恢复组和未恢复组。二元逻辑回归分析显示，残留LBP的显著预测指标为术前腰椎前凸角和腰椎ROM。未恢复组术前腰椎前凸和ROM的平均值显著低于恢复组（前凸：25.3±15.8度对37.8±13.6度，P=0.006；ROM：22.1±10.6度对31.2±9.9度，P=0.006）。此外，未恢复组术后腰椎ROM的增加显著大于恢复组（P=0.009）。
我们的结果表明，术前前凸角和腰椎ROM是LCS椎板切除术后残留LBP的重要影像学预测指标。术前平背和腰椎活动受限的患者容易出现残留LBP。建议在选择椎板切除术作为LCS的手术方案时应考虑这些矢状面影像学参数。
