Gelalis Ioannis D, Arnaoutoglou Christina, Christoforou Giorgos, Lykissas Marios G, Batsilas Ioannis, Xenakis Theodoros
Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece.
Acta Orthop Traumatol Turc. 2010;44(3):235-40. doi: 10.3944/AOTT.2010.2278.
The aim of this study was to evaluate the outcome of wide surgical decompression and concomitant posterior instrumentation in patients with degenerative lumbar spinal stenosis.
Thirty-seven consecutive patients (14 men, 23 women; mean age 64 years; range 36 to 82 years) with degenerative lumbar spinal stenosis were prospectively evaluated following surgical treatment with spinal decompression and concomitant instrumented posterior fusion. The mean duration of symptoms before surgery was 24 months (range 12 to 60 months). Preoperatively, six patients had degenerative spondylolisthesis (grade 1) and two patients had degenerative lumbar scoliosis. Decompression was performed at one level in four patients, at two levels in 16 patients, at three levels in 11 patients, and at four levels in six patients. Discectomy was also performed in seven patients. Preoperatively and postoperatively, the patients were assessed by the Oswestry Disability Index and a visual analog scale for overall pain (leg and low back pain). The satisfaction level of the patients for surgical outcome was also questioned. The mean follow-up period was 4.6 years (range 1 to 7 years).
Preoperatively, the mean Oswestry Disability Index score was 60.5% and the mean overall pain score was 7.5. Postoperatively, the Oswestry Disability Index score significantly decreased to 36.8% and the overall pain score significantly decreased to 3.5 (p<0.001). Preoperative and postoperative walking distances of the patients were as follows, respectively: more than 1,000 meters (6 and 14 patients), 500 to 1,000 meters (5 and 7 patients), less than 500 meters (26 and 16 patients). Twenty patients did not use any analgesics and eight patients used analgesics on a weekly basis. Twenty-six patients were satisfied with the surgical outcome, nine patients were somewhat satisfied, and two patients were dissatisfied. Overall, the outcomes were excellent to good in 22 patients (59.5%). None of the patients required revision surgery.
Most patients with degenerative lumbar spinal stenosis benefit from decompressive surgery. Patients with long-standing preoperative symptoms and concomitant diseases often have poor results and are less satisfied with the postoperative outcome.
本研究旨在评估退行性腰椎管狭窄症患者行广泛手术减压及同期后路内固定的疗效。
对37例连续性退行性腰椎管狭窄症患者（14例男性，23例女性；平均年龄64岁；范围36至82岁）进行前瞻性评估，这些患者接受了脊柱减压及同期后路器械融合手术治疗。术前症状的平均持续时间为24个月（范围12至60个月）。术前，6例患者有退行性椎体滑脱（1级），2例患者有退行性腰椎侧弯。4例患者在一个节段进行减压，16例患者在两个节段进行减压，11例患者在三个节段进行减压，6例患者在四个节段进行减压。7例患者还进行了椎间盘切除术。术前和术后，通过Oswestry功能障碍指数和总体疼痛视觉模拟量表（腿部和下背部疼痛）对患者进行评估。还询问了患者对手术结果的满意度。平均随访期为4.6年（范围1至7年）。
术前，Oswestry功能障碍指数平均评分为60.5%，总体疼痛平均评分为7.5。术后，Oswestry功能障碍指数评分显著降至36.8%，总体疼痛评分显著降至3.5（p<0.001）。患者术前和术后的步行距离分别如下：超过1000米（6例和14例），500至1000米（5例和7例），小于500米（26例和16例）。20例患者未使用任何镇痛药，8例患者每周使用镇痛药。26例患者对手术结果满意，9例患者 somewhat 满意，2例患者不满意。总体而言，22例患者（59.5%）的结果为优至良。所有患者均无需翻修手术。
大多数退行性腰椎管狭窄症患者从减压手术中获益。术前症状持续时间长且伴有其他疾病的患者往往效果不佳，对术后结果的满意度较低。
