Li Fang, Zhang Zhi-cheng, Zhao Guang-min, Guan Kai, Shan Jian-lin, Ren Da-jiang
Institute of Traumatology and Orthopedics, General Hospital of Beijing Military Command, Beijing 100700, China.
Zhonghua Wai Ke Za Zhi. 2009 Oct 15;47(20):1553-6.
To suggest the clinical classification of the far-lateral lumbar disc herniation and offer the considerations for clinical choice of different surgical procedures.
According to the locations of the herniated disc and relevant clinical symptoms, the far-lateral lumbar disc herniation was divided into three types: Type I: posterolateral and foraminal herniation(double herniations); Type II: foraminal disc herniation and Type III: extraforaminal herniation. From January 2002 to January 2007, 38 patients with far lateral lumbar disc herniation underwent surgery in the institute. The surgical options were decided by means of the classification. The surgical procedures included (1) discectomy by inter-TP (transverse process) approach, (2) discectomy with partial facetectomy and (3) discectomy with facetectomy and PLIF (posterior lumbar interbody fusion). Among the 38 patients, there were 25 males and 13 females. The mean age was 58.4 years old. The herniated discs located at L(3-4) in 17, L(4-5) in 13, and 8 cases at L(5)S(1). Twenty-three patients were simple disc herniation, 15 cases with concomitant lumbar spinal stenosis. The symptoms and signs of exiting root compression at herniated disc level were presented in all patients and passing root compression presented in 7 Type I cases as well; while intermittent claudication being presented in 15 and low back pain in 21 patients. The VAS (visual analog pain scale) of radicular leg pain was taken before and after the operation. The postoperative outcomes were evaluated through the MacNab's method in all the patients.
By using the new classification system, the 38 patient were divided into Type I 10 cases, Type II 19 cases and Type III 9 cases. The adopted surgeries included discectomy by intertransverse approach in 5, discectomy with partial facetectomy in 7, and discectomy with facetectomy and PLIF in the rest 26 cases. The mean follow-up period was ranging from 6 months to 4 years and 10 months, average 2 years and 11 months. The mean VAS scores of radicular pain was 7.4 preoperatively, 2.7 at 2 weeks after the operation and 3.1 at final follow-up. The final clinical outcomes by MacNab's method were as follow: excellent results in 20 cases, good in 12, fair in 5 and poor in 1 case. The overall improvement ratio was 84.2%. The postoperative complications included superficial wound infection in 1 case, insufficient decompression in 1 case and leakage of cerebrospinal fluid in 1 case respectively. No breakage and loosening of internal fixation were detected.
A new clinical classification of far lateral lumbar disc herniation was suggested, which is significant to understanding the relevant pathology and choosing the surgical procedures.
提出远外侧腰椎间盘突出症的临床分类，并为不同手术方式的临床选择提供参考。
根据椎间盘突出的位置及相关临床症状，将远外侧腰椎间盘突出症分为三型：Ⅰ型：后外侧及椎间孔型突出（双突出）；Ⅱ型：椎间孔型椎间盘突出；Ⅲ型：椎间孔外型突出。2002年1月至2007年1月，本研究所对38例远外侧腰椎间盘突出症患者进行了手术。手术方式根据分类决定。手术方法包括：（1）经横突间入路椎间盘切除术；（2）部分椎板切除术联合椎间盘切除术；（3）椎板切除术联合椎间盘切除术及后路腰椎椎间融合术（PLIF）。38例患者中，男25例，女13例。平均年龄58.4岁。突出椎间盘位于L（3-4）节段17例，L（4-5）节段13例，L（5）S（1）节段8例。单纯椎间盘突出23例，合并腰椎管狭窄15例。所有患者均有突出椎间盘节段的出口神经根受压症状和体征，7例Ⅰ型患者同时有过路神经根受压症状；15例患者有间歇性跛行，21例患者有腰痛。术前及术后采用视觉模拟疼痛评分（VAS）评估下肢放射性疼痛。所有患者术后采用MacNab法评估疗效。
采用新的分类系统，38例患者分为Ⅰ型10例，Ⅱ型19例，Ⅲ型9例。采用的手术方式包括经横突间入路椎间盘切除术5例，部分椎板切除术联合椎间盘切除术7例，其余26例采用椎板切除术联合椎间盘切除术及PLIF。平均随访时间为6个月至4年10个月，平均2年11个月。术前下肢放射性疼痛VAS平均评分为7.4分，术后2周为2.7分，末次随访时为3.1分。采用MacNab法评估的最终临床疗效如下：优20例，良12例，可5例，差1例。总改善率为84.2%。术后并发症包括表浅伤口感染1例、减压不充分1例、脑脊液漏1例。未发现内固定断裂及松动。
提出了一种新的远外侧腰椎间盘突出症临床分类方法，这对于理解相关病理及选择手术方式具有重要意义。
