Benini A
Neurochirurgische Klinik, Kantonsspital St. Gallen.
Neurochirurgia (Stuttg). 1990 Sep;33(5):146-57. doi: 10.1055/s-2008-1053574.
Clinical, radiological, surgical and experimental observations make it possible to construct a rational theory of the segmental lumbar instability which explains the pathogenesis of spondylosis, of stenosis and of several cases of disc displacement as well. This theory helps us to choose the right surgical procedure. Spinal stenosis, degenerative spondylolisthesis and some cases of disc displacement are seen as part of a degenerative process with its starting point in regressive changes of the intervertebral disc and lateral joint. This leads to a marked instability of the affected mobile segment. Signs and symptoms of unstable lumbar spine are discussed. In such cases, if decompression of the roots by laminectomy, facetectomy or discectomy is performed without fusion, the consequences are usually treated but not the main cause of the trouble, namely the instability. Finally, we describe a procedure which we prefer as the safest and best of all, using selected decompression by means of joint screws (spondylodesis) as suggested by F. Magerl (41-44).
临床、放射学、外科手术及实验观察使得构建一种关于节段性腰椎不稳的合理理论成为可能，该理论解释了脊柱病、椎管狭窄以及数例椎间盘移位的发病机制。这一理论有助于我们选择正确的外科手术方式。椎管狭窄、退变性椎体滑脱以及一些椎间盘移位病例被视为一种退变过程的一部分，其起始点为椎间盘和侧方关节的退行性改变。这会导致受累活动节段明显不稳。文中讨论了腰椎不稳的体征和症状。在这类病例中，如果通过椎板切除术、小关节切除术或椎间盘切除术对神经根进行减压而不进行融合，后果通常只是对症状进行了治疗，而未针对问题的主要根源即不稳进行处理。最后，我们描述了一种我们认为是所有方法中最安全、最佳的手术方式，即按照F. 马格勒（41 - 44）所建议的，通过关节螺钉进行选择性减压（脊柱融合术）。
