Matsudaira Ko, Yamazaki Takashi, Seichi Atsushi, Hoshi Kazuto, Hara Nobuhiro, Ogiwara Satoshi, Terayama Sei, Chikuda Hirotaka, Takeshita Katsushi, Nakamura Kozo
Department of Orthopedics, Faculty of Medicine, Tokyo University, Bunkyo-ku, Tokyo, Japan.
J Neurosurg Spine. 2009 Jun;10(6):587-94. doi: 10.3171/2009.2.SPINE08358.
The authors developed an original procedure, modified fenestration with restorative spinoplasty (MFRS) for the treatment of lumbar spinal stenosis. The first step is to cut the spinous process in an L-shape, which is caudally reflected. This procedure allows easy access to the spinal canal, including lateral recesses, and makes it easy to perform a trumpet-style decompression of the nerve roots without violating the facet joints. After the decompression of neural tissues, the spinous process is anatomically restored (spinoplasty). The clinical outcomes at 2 years were evaluated using the Japanese Orthopaedic Association (JOA) scale and patients' satisfaction. Radiological follow-up included radiographs and CT. Between January 2000 and December 2002, 109 patients with neurogenic intermittent claudication with or without mild spondylolisthesis underwent MFRS. Of these, 101 were followed up for at least 2 years (follow-up rate 93%). The average score on the self-administered JOA scale in 89 patients without comorbidity causing gait disturbance improved from 13.3 preoperatively to 22.9 at 2 years' follow-up. Neurogenic intermittent claudication disappeared in all cases. The patients' assessment of treatment satisfaction was "satisfied" in 74 cases, "slightly satisfied" in 12, "slightly dissatisfied" in 2, and "dissatisfied" in 1 case. In 16 cases (18%), a minimum progression of slippage occurred, but no symptomatic instability or recurrent stenosis was observed. Computed tomography showed that the lateral part of the facet joints was well preserved, and the mean residual ratio was 80%. The MFRS technique produces an adequate and safe decompression of the spinal canal, even in patients with narrow and steep facet joints in whom conventional fenestration is technically demanding.
作者研发了一种原创手术方法，即改良开窗联合修复性椎体成形术（MFRS）用于治疗腰椎管狭窄症。第一步是将棘突切成L形，然后向尾侧翻转。该手术能轻松进入椎管，包括侧隐窝，便于在不破坏小关节的情况下对神经根进行喇叭形减压。神经组织减压后，将棘突进行解剖复位（椎体成形术）。使用日本骨科协会（JOA）评分量表和患者满意度对2年时的临床结果进行评估。影像学随访包括X线片和CT。在2000年1月至2002年12月期间，109例有或无轻度椎体滑脱的神经源性间歇性跛行患者接受了MFRS手术。其中，101例患者接受了至少2年的随访（随访率93%）。89例无导致步态障碍合并症的患者，自我管理的JOA评分量表平均分从术前的13.3分提高到随访2年时的22.9分。所有病例的神经源性间歇性跛行均消失。患者对治疗满意度的评价为“满意”74例，“稍满意”12例，“稍不满意”2例，“不满意”1例。16例（18%）出现了最小程度的滑脱进展，但未观察到有症状的不稳定或复发性狭窄。计算机断层扫描显示小关节外侧部分保存良好，平均残留率为80%。即使在小关节狭窄且陡峭、传统开窗技术要求较高的患者中，MFRS技术也能对椎管进行充分且安全的减压。
