von Wild K
Neurochirurgische Abteilung, Clemenshospital, Akademisches Lehrkrankenhaus, Westfälischen Wilhelms-Universität Münster.
Zentralbl Neurochir. 1990;51(1):34-41.
The frequencies of required surgery of lumbar disc protrusion as the cause of resistant lumbar compression of the nerve root, including the rare cauda equina compression, is according to literature for patients over 70 years of age only 1% of the total number of lumbar disc surgery. However, probably as a course of the improved preclinical diagnostical methods as EMG, spinal CT scan, MRT and the increased number of these examination techniques the percentage was 3.2% in our material thus a higher share of operated patients at the age of 71 and older. 50% of those patients even had a sequestered lumbar disc protrusion. Because the additional, clinical relevant bone narrowment of the spinal canal, lateral processus and the foramina intervertebralia it is necessary for this group of patients to perform a wide microsurgical decompression as modification of the normal surgery with a sufficient resection of compressing bone parts through laminotomy, hemilaminectomie and laminectomy. We did not observe serious intra- and postsurgery complications with persistent damages. The surgical mortality of 68 consecutive operated patients at the age of 71 up to 93 years was zero. The subjective valuation of the surgical longterm results was in 68% of the interviewed patients well or excellent, including the influence of the presurgical torturing pain (66%) and clinically relevant neurological deficits (72%). 10.6% of all cases judged the long term results as insufficient or bad. Especially considering the increasing life expectation one should think of lumbar, even sequestered disc protrusion as the course of a therapy resistant lumbar compression of the nerve root and its successful surgical decompression of the older people before irreversible damages and torturing pains decrease the quality of life significantly.
作为神经根顽固性腰椎压迫病因的腰椎间盘突出症所需手术的频率，包括罕见的马尾神经压迫，根据文献，70岁以上患者仅占腰椎间盘手术总数的1%。然而，可能是由于肌电图、脊柱CT扫描、磁共振成像等临床前诊断方法的改进以及这些检查技术数量的增加，在我们的资料中这一比例为3.2%，因此71岁及以上接受手术患者的比例更高。这些患者中有50%甚至患有游离型腰椎间盘突出症。由于椎管、侧突和椎间孔在临床上存在相关的骨质狭窄，对于这组患者，有必要进行广泛的显微手术减压，作为常规手术的改良，通过椎板切开术、半椎板切除术和椎板切除术充分切除压迫性骨部分。我们未观察到伴有持续性损伤的严重手术中和手术后并发症。68例年龄在71岁至93岁之间连续接受手术患者的手术死亡率为零。在接受访谈的患者中，68%对手术长期效果的主观评价为良好或优秀，包括术前剧痛（66%）和临床上相关神经功能缺损（72%）的影响。10.6%的所有病例认为长期效果不足或不佳。特别是考虑到预期寿命的增加，在不可逆转的损伤和剧痛显著降低生活质量之前，应将腰椎甚至游离型椎间盘突出症视为神经根顽固性腰椎压迫的一种治疗方式，并考虑对老年人进行成功的手术减压。
