Hurme M, Katevuo K, Nykvist F, Aalto T, Alaranta H, Einola S
Department of Surgery, Turku City Hospital, Finland.
Acta Radiol. 1991 Jul;32(4):286-9.
Fifty-seven patients were examined with CT 5 years after primary myelography for disabling sciatica and suspected herniated lumbar disk. Forty were in an operated group, 22 with good and 18 with poor results evaluated by occupational handicap (21) 5 years after surgery. Seventeen patients had myelography indicating disk herniation, but were treated conservatively, 9 with good and 8 with poor result. Various spinal dimensions measured at CT did not correlate with outcome. Operated patients had narrower canals than others, and male canals were broader than those in females. Increased amount of scar tissue at L4 level correlated with poor result (p = 0.008). Operated patients with poor result had more advanced lateral stenosis than those treated conservatively (p less than 0.001). Patients with good result after operation had more degeneration observed on CT of erector spinae muscle than those treated conservatively with good outcome. Only 9% of operated patients did not have muscle degeneration. A tendency for more frequent recurrent disk herniations could be seen for conservatively treated patients. The narrowing of the spinal canal 5 years after operation did not correlate with the 5-year outcome.
57例因严重坐骨神经痛和疑似腰椎间盘突出症在初次脊髓造影后5年接受CT检查。40例为手术组，术后5年根据职业残疾情况评估，22例效果良好，18例效果不佳(21)。17例脊髓造影显示椎间盘突出，但接受保守治疗，9例效果良好，8例效果不佳。CT测量的各种脊柱尺寸与结果无关。手术患者的椎管比其他人窄，男性椎管比女性宽。L4水平瘢痕组织增多与效果不佳相关(p = 0.008)。手术效果不佳的患者比保守治疗的患者有更严重的侧隐窝狭窄(p < 0.001)。手术效果良好的患者比保守治疗效果良好的患者在竖脊肌CT上观察到更多退变。仅9%的手术患者没有肌肉退变。保守治疗的患者有更频繁复发性椎间盘突出的趋势。术后5年椎管狭窄与5年结果无关。
