Song Joonsuk, Lee Jang-Bo, Suh Jung-Keun
Department of Neurosurgery, Anam Hospital, Korea Medical University, 126-1, Anam-Dong, Seongbuk-Ku, Seoul 136-705, Korea.
J Clin Neurosci. 2009 May;16(5):650-4. doi: 10.1016/j.jocn.2008.06.003. Epub 2009 Feb 28.
Lumbosacral extraforaminal stenosis is not uncommon among patients being treated for radicular symptoms. Patients who had lumbosacral extraforaminal stenosis were reviewed, and cadaver dissection was used to determine the anatomy of extraforaminal lesions. A total of 167 patients with lumbosacral spinal stenosis who underwent surgery from March 2004 to February 2006 were reviewed retrospectively. Among these, extraforaminal stenosis was observed in 26 patients (mean age 61.4 y; range 46-79). Leg pain and neurogenic claudication were common in patients with extraforaminal stenosis. One level was involved for 15 patients and 2 levels were involved for 11 patients. Complete decompression of the dorsal root ganglion or a root compressed by the fibrocartilagenous ligamentum flavum or a hypertrophied superior facet was performed. The mean follow-up was 8.3 months (range 6-26 months). The causes of extraforaminal stenosis were superior facet hypertrophy, especially hypertrophy of the superior lateral portion, or thickening of the ligamentum flavum, intertransverse ligament, or transforaminal ligament. T1-weighted, coronal MRI showed root impingement in the far-lateral zone. Postoperative outcomes were assessed using the Prolo scale; 13 patients demonstrated excellent outcomes, while 11 patients had good outcomes. No major complications or recurrences were observed during follow-up. Therefore, lumbosacral extraforaminal stenosis should be included in the differential diagnosis of lumbar radicular pain. A precise diagnosis using MRI is important, and complete decompression with an understanding of the extraforaminal anatomy is required.
腰骶部椎间孔外狭窄在因神经根症状接受治疗的患者中并不少见。对患有腰骶部椎间孔外狭窄的患者进行了回顾性研究，并通过尸体解剖来确定椎间孔外病变的解剖结构。对2004年3月至2006年2月期间接受手术的167例腰骶部椎管狭窄患者进行了回顾性分析。其中，26例患者（平均年龄61.4岁；范围46 - 79岁）存在椎间孔外狭窄。腿痛和神经源性间歇性跛行在椎间孔外狭窄患者中很常见。15例患者累及1个节段，11例患者累及2个节段。对背根神经节或被纤维软骨性黄韧带或肥大的上关节突压迫的神经根进行了完全减压。平均随访时间为8.3个月（范围6 - 26个月）。椎间孔外狭窄的原因是上关节突肥大，尤其是上外侧部分肥大，或黄韧带、横突间韧带或椎间韧带增厚。T1加权冠状位MRI显示远外侧区神经根受压。使用普罗洛量表评估术后结果；13例患者结果优秀，11例患者结果良好。随访期间未观察到重大并发症或复发。因此，腰骶部椎间孔外狭窄应纳入腰椎神经根性疼痛的鉴别诊断。使用MRI进行精确诊断很重要，并且需要在了解椎间孔外解剖结构的情况下进行完全减压。
