Dalgic A, Uckun O, Ergungor M F, Okay O, Daglioglu E, Hatipoglu G, Pasaoglu L, Caglar Y S
Ankara Numune Educational and Research Hospital, Neurosurgery Clinic, Ankara, Turkey.
Minim Invasive Neurosurg. 2010 Apr;53(2):60-4. doi: 10.1055/s-0029-1246147. Epub 2010 Jun 14.
Unilateral hemilaminotomy (ULH) and/or bilateral hemilaminotomy (BLH) with limited facetectomy are defined approaches to decompress the thecal sac and exiting lumbar nerve roots without increasing the risk of subsequent spinal instability.
We retrospectively analyzed 18 cases with degenerative lumbar spinal stenosis (LSS) with BLH or ULH that was performed in 11 and 7 cases, respectively. Magnetic resonance imaging (MRI) was performed at the follow-up examination and dural sac area (DSA) was calculated on T(2)-weighted MRI images and then compared statistically. In addition, the economic and functional status of the patients were evaluated with the Prolo scale.
The mean preoperative values on the visual analogue scale (VAS) were 7.1 for lumbalgia and 7.0 for leg pain, respectively. These values were calculated as 4.8 and 4.4 at the follow-up, respectively. The VAS was significantly improved after operation compared to preoperative values (p=0.001). The mean value of the DSA was 84 (+/-32) mm(2) before the operation and 126 (+/-35) mm(2) at the follow-up and the comparison was statistically significant (p=0.001). No statistical correlation was found between VAS and DSA or between VAS and ULH-BLH groups, however, DSA of the BLH cases was significantly higher than in the ULH group (p=0.035). There was a significant negative correlation between VAS scores (back and leg pain) and Prolo status. However, there was no significant difference between DSA and Prolo scores, and between ULH or BLH groups in terms of Prolo scores.
A unilateral approach with bilateral decompression and bilateral approach with bilateral hemilaminotomy are both minimal invasive, adequate and safe approaches with excellent prognosis. However, BLH leads to a bigger expansion of DSA.
单侧半椎板切除术（ULH）和/或双侧半椎板切除术（BLH）联合有限的关节突切除术是用于减压硬膜囊和腰椎神经根出孔且不增加后续脊柱不稳定风险的既定手术方式。
我们回顾性分析了18例退行性腰椎管狭窄症（LSS）患者，其中11例行BLH，7例行ULH。随访时进行了磁共振成像（MRI）检查，并在T2加权MRI图像上计算硬膜囊面积（DSA），然后进行统计学比较。此外，采用普罗洛量表评估患者的经济和功能状况。
术前视觉模拟量表（VAS）上腰痛的平均评分为7.1，腿痛的平均评分为7.0。随访时这些值分别计算为4.8和4.4。与术前值相比，术后VAS有显著改善（p = 0.001）。术前DSA的平均值为84（±32）mm²，随访时为126（±35）mm²，比较具有统计学意义（p = 0.001）。未发现VAS与DSA之间或VAS与ULH - BLH组之间存在统计学相关性，然而，BLH病例的DSA显著高于ULH组（p = 0.035）。VAS评分（背痛和腿痛）与普罗洛状况之间存在显著负相关。但是，DSA与普罗洛评分之间以及ULH或BLH组之间在普罗洛评分方面没有显著差异。
单侧双侧减压法和双侧半椎板切除术双侧减压法都是微创、充分且安全的手术方式，预后良好。然而，BLH导致DSA扩张更大。
