Nakanishi Kazuyoshi, Tanaka Nobuhiro, Fujimoto Yoshinori, Okuda Teruaki, Kamei Naosuke, Nakamae Toshio, Izumi Bun-Ichiro, Ohta Ryo, Fujioka Yuki, Ochi Mitsuo
*Department of Orthopaedic Surgery, Programs for Applied Biomedicine, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University †Department of Orthopaedic Surgery, Hiroshima General Hospital, Hiroshima, Japan.
J Spinal Disord Tech. 2013 Oct;26(7):351-8. doi: 10.1097/BSD.0b013e318247f1fd.
A retrospective study of medium-term results.
To describe a technique for posterior decompression using microsurgical lumbar flavectomy (MLF) without facetectomy, which is based on the anatomic features of the ligamentum flavum, and to examine the clinical outcomes of patients with lumbar spinal spondylolisthesis with lower extremity symptoms rather than low back pain, who underwent this procedure by 2 different approaches.
Posterior decompression with fusion has been the optimal and standard operative treatment for lumbar degenerative spondylolisthesis. Alternatively, minimally invasive procedures have been used for the treatment of lumbar degenerative spondylolisthesis with favorable outcomes.
A bilateral laminotomy (BL group) was performed on 44 consecutive patients, and bilateral decompression by a unilateral approach (BDU group) was performed on 23 consecutive patients. The mean follow-up period was 7.0 years. The Japanese Orthopaedic Association score and recovery rate were obtained, and radiographic assessment was performed using plain radiograms on the lateral view while standing in flexion, neutral, and extension postures before surgery and at the final follow-up.
The Japanese Orthopaedic Association score at the final follow-up was improved in the BL and BDU groups, compared with that before MLF. The mean recovery rate was 72.4% and 68.4%, respectively. The mean % slip increased at the final follow-up, compared with that before surgery in both groups, except for the % slip in the extension posture in the BDU group. However, there was no significant difference in the dynamic % slip in the flexion-extension posture between before surgery and at the final follow-up.
Clinical and radiologic parameters were not significantly different between the 2 groups. This technique of MLF using either approach did not increase the dynamic % slip and showed favorable medium-term clinical results in cases of lumbar degenerative spondylolisthesis.
一项中期结果的回顾性研究。
描述一种基于黄韧带解剖特征的不进行关节突切除术的显微外科腰椎黄韧带切除术（MLF）后路减压技术，并研究采用两种不同方法接受该手术的下肢症状而非腰痛的腰椎滑脱症患者的临床结果。
后路减压融合术一直是腰椎退行性滑脱的最佳和标准手术治疗方法。另外，微创手术已被用于治疗腰椎退行性滑脱，效果良好。
对44例连续患者进行双侧椎板切开术（BL组），对23例连续患者进行单侧入路双侧减压术（BDU组）。平均随访期为7.0年。获得日本骨科协会评分和恢复率，并在术前和末次随访时，使用站立位前屈、中立和后伸姿势的侧位平片进行影像学评估。
与MLF术前相比，BL组和BDU组末次随访时的日本骨科协会评分均有所改善。平均恢复率分别为72.4%和68.4%。与术前相比，两组末次随访时的平均滑脱百分比均增加，但BDU组后伸姿势下的滑脱百分比除外。然而，术前与末次随访时屈伸姿势下的动态滑脱百分比无显著差异。
两组之间的临床和影像学参数无显著差异。采用任何一种方法的MLF技术均未增加动态滑脱百分比，并且在腰椎退行性滑脱病例中显示出良好的中期临床结果。
