Watanabe Kei, Yamazaki Akiyoshi, Morita Osamu, Sano Atsuki, Katsumi Keiichi, Ohashi Masayuki
Niigata Central Hospital, 1-18Shinkocho, Chuoku, Niigata City, Niigata, Japan.
J Spinal Disord Tech. 2011 May;24(3):137-41. doi: 10.1097/BSD.0b013e3181e1cd99.
A retrospective case study of the use of posterior lumbar interbody fusion (PLIF) to treat lumbar foraminal stenosis (LFS).
To characterize the features of clinical symptoms, radiographic evaluation, and surgical outcomes of PLIF in LFS.
There is no gold standard for the surgical treatment of foraminal stenosis, which occurs in 8% to 10% of surgical cases of lumbar degenerative disease.
Data from 31 patients (33 segments) who underwent PLIF from 2001 to 2005 at our institution were analyzed. Exclusion criteria included the patients having both LFS and central canal stenosis, plus extraforaminal or intraforaminal disc herniation. There were 22 males and 9 females, with an average age of 61 (31~78 y). The affected levels were as follows: L3/4 in 1 patient, L4/5 in 4, and L5/S1 in 28. All patients underwent PLIF with the combination of segmental pedicle screws, interbody cages, and autogenous local bone graft.
The frequencies of Kemp sign (+), intermittent claudication, leg pain in a sitting position, and leg pain at night, were high. Radiographic evaluation showed severe disc degeneration such as loss of disc height, massive osteophyte formation, and transverse offset angles of the nerve root at the corresponding level. Magnetic resonance imaging and 3D-reconstraction computed tomography clearly showed intraforaminal stenosis in sagittal, axial, and coronal planes. The PLIF procedure provided complete root decompression, restoration of disc height, and preservation of lumbar lordosis at final follow-up. The Japanese Orthopedic Association score improved from 17.1 points preoperatively to 24.9 points at final follow-up, and the overall fusion rate was 100%.
Lumbar foraminal stenosis could be reliably diagnosed by distinctive clinical symptoms, and various radiographic examinations such as plain x-ray, Magnetic resonance imaging, and 3D-reconstraction computed tomography. The PLIF procedure, in combination with segmental pedicle screws, interbody cages, and autogenous local bone graft provides excellent clinical outcomes, and is a rational and useful surgical option for lumbar foraminal stenosis.
一项关于使用后路腰椎椎间融合术（PLIF）治疗腰椎椎间孔狭窄症（LFS）的回顾性病例研究。
描述PLIF治疗LFS的临床症状、影像学评估及手术结果的特征。
椎间孔狭窄的外科治疗尚无金标准，其在腰椎退行性疾病手术病例中占8%至10%。
分析了2001年至2005年在我院接受PLIF手术的31例患者（33个节段）的数据。排除标准包括同时患有LFS和中央管狭窄，以及椎间孔外或椎间孔内椎间盘突出的患者。其中男性22例，女性9例，平均年龄61岁（31至78岁）。受累节段如下：L3/4节段1例，L4/5节段4例，L5/S1节段28例。所有患者均采用节段性椎弓根螺钉、椎间融合器及自体局部骨移植联合进行PLIF手术。
Kemp征阳性、间歇性跛行、坐位腿痛及夜间腿痛的发生率较高。影像学评估显示严重的椎间盘退变，如椎间盘高度丢失、大量骨赘形成以及相应节段神经根的横向偏移角度。磁共振成像和三维重建计算机断层扫描在矢状面、轴位和冠状面清晰显示椎间孔狭窄。PLIF手术在末次随访时实现了神经根的完全减压、椎间盘高度的恢复以及腰椎前凸的保留。日本骨科协会评分从术前的17.1分提高到末次随访时的24.9分，总体融合率为100%。
腰椎椎间孔狭窄可通过独特的临床症状以及多种影像学检查如X线平片、磁共振成像和三维重建计算机断层扫描可靠诊断。PLIF手术联合节段性椎弓根螺钉、椎间融合器及自体局部骨移植可提供优异的临床结果，是治疗腰椎椎间孔狭窄合理且有用的手术选择。
