Liu Wen-Jiunn, Hong Shih-Wun, Liou Da-Yon, Lu Tung-Wu
Orthopaedic Department, Taiwan Adventist Hospital, Taipei, Taiwan, ROC.
Eur Spine J. 2014 Jan;23(1):80-6. doi: 10.1007/s00586-013-2888-0. Epub 2013 Jul 13.
Current surgical approaches for treatment of lumbar canal stenosis are often associated with relatively high rates of reoperation and recurrent stenosis. We have developed a new approach for treatment of this condition: sublaminar-trimming laminoplasty. To describe the surgical approach of sublaminar-trimming laminoplasty and to assess associated outcomes.
Patients with extensive lumbar canal stenosis who received sublaminar-trimming laminoplasty from 2006 to 2008 were considered for inclusion in the study. The surgery comprised aspects of laminotomy and laminectomy. The following were assessed before surgery and 3 years after surgery: leg and back pain by visual analog scale (VAS), extent of disability by Oswestry Disability Index (ODI), severity of back pain by Japanese Orthopedic Association Score for Back Pain (JOA), walking tolerance, and leg numbness. Complications were noted.
A total of 49 patients were included in the study (mean age 65.6 ± 10.6 years). VAS leg and back pain, ODI, and JOA scores significantly changed from before surgery to 3 years after surgery (P < 0.001). Mean changes (95 % confidence interval) were -6.2 (-6.7, -5.7), -4.3 (-4.8, -3.8), -21.4 (-23.4, -19.5), and 13.4 (12.1, 14.7) for leg pain, back pain, ODI, and JOA scores, respectively. Patients experienced significant improvements in walking tolerance and leg numbness (P < 0.001). There were no instances of recurrent stenosis or postoperative spinal instability. Complications included intraoperative dural tear (n = 2), postoperative urinary tract infection (n = 2), and inadequate decompression and junctional stenosis during follow-up (both n = 1).
Sublaminar-trimming laminoplasty shows promise as an effective treatment for extensive lumbar canal stenosis.
目前用于治疗腰椎管狭窄症的手术方法常常伴随着相对较高的再次手术率和复发性狭窄发生率。我们研发了一种治疗该病症的新方法：椎板下修剪式椎板成形术。描述椎板下修剪式椎板成形术的手术方法并评估相关结果。
将2006年至2008年接受椎板下修剪式椎板成形术的广泛腰椎管狭窄症患者纳入本研究。手术包括椎板切开术和椎板切除术的各个方面。在手术前和手术后3年评估以下指标：采用视觉模拟评分法（VAS）评估腿痛和背痛，采用Oswestry功能障碍指数（ODI）评估残疾程度，采用日本骨科协会背痛评分（JOA）评估背痛严重程度，评估行走耐力和腿部麻木情况。记录并发症。
本研究共纳入49例患者（平均年龄65.6±10.6岁）。从手术前到手术后3年，VAS腿痛和背痛、ODI以及JOA评分均有显著变化（P<0.001）。腿痛、背痛、ODI和JOA评分的平均变化（95%置信区间）分别为-6.2（-6.7，-5.7）、-4.3（-4.8，-3.8）、-21.4（-23.4，-19.5）和13.4（12.1，14.7）。患者的行走耐力和腿部麻木情况有显著改善（P<0.001）。没有复发性狭窄或术后脊柱不稳定的情况。并发症包括术中硬脊膜撕裂（n=2）、术后尿路感染（n=2）以及随访期间减压不充分和交界区狭窄（均为n=1）。
椎板下修剪式椎板成形术有望成为治疗广泛腰椎管狭窄症的有效方法。
