T10 和 L1 之间单节段椎间盘突出导致足下垂。
Foot drop caused by single-level disc protrusion between T10 and L1.
机构信息
*Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin, China †Department of Orthopaedics, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Nankai District, Tianjin, China.
出版信息
Spine (Phila Pa 1976). 2013 Dec 15;38(26):2295-301. doi: 10.1097/BRS.0000000000000034.
STUDY DESIGN
Retrospective investigation of surgical treatment of 25 patients with foot drop from single-level disc protrusion in the region of T10 to L1.
OBJECTIVE
To describe cases of foot drop from single-level disc protrusion in the region of T10 to L1 and surgical outcomes.
SUMMARY OF BACKGROUND DATA
Three cases of foot drop from T12-L1 disc protrusion are reported in the literature. Little is known, however, about foot drop resulting from single-level disc protrusion between T10 and L1 or its surgical outcomes.
METHODS
Between January 1995 and October 2010, a total of 25 patients (mean age: 44 yr; range, 21-68 yr) presented to our department with single-level disc protrusion between T10 and L1 (6 at T10-T11, 7 at T11-T12, and 12 at T12-L1) with associated foot drop and without cervical or lumbar spinal stenosis or other neurological disease. The average follow-up period was 46.5 months. We treated all cases surgically with circumferential decompression with fixation. We assessed neurological status, tibialis anterior muscle strength, magnitude of local kyphosis, and cross-sectional area at the level of compression of the dural sac preoperatively and at the final follow-up.
RESULTS
Preoperatively, all 25 patients exhibited both foot drop resulting from a lower motor neuron lesion and pathological reflexes resulting from an upper motor neuron lesion. Postoperatively, the mean calculated muscle strength recovery rate was 95%. Mean Japanese Orthopaedic Association score increased from 5.92 ± 1.22 points preoperatively to 9.56 ± 0.92 points at the final follow-up. Magnetic resonance imaging indicated that the cross-sectional area increased from 36.3 ± 7.3 mm2 preoperatively to 133.1 ± 6.1 mm2 postoperatively.
CONCLUSION
Foot drop can be caused by single-level disc protrusion between T10 and L1 and is usually associated with an upper motor neuron lesion. Pathological reflexes resulting from disc protrusion occurring between T10 and L1 differ depending on the level of the protrusion. Circumferential decompression with fixation may be an effective treatment option for this syndrome.
LEVEL OF EVIDENCE
研究设计
回顾性研究 25 例 T10 至 L1 单节段椎间盘突出导致足下垂的手术治疗。
目的
描述 T10 至 L1 单节段椎间盘突出导致足下垂的病例，并总结手术治疗效果。
背景资料概要
文献中仅报道过 3 例 T12-L1 椎间盘突出导致足下垂的病例。然而，对于 T10 至 L1 单节段椎间盘突出导致足下垂的病例及其手术治疗效果，目前知之甚少。
方法
1995 年 1 月至 2010 年 10 月，我科共收治 25 例 T10 至 L1 单节段椎间盘突出症患者（平均年龄：44 岁；年龄范围：21-68 岁），均表现为单节段椎间盘突出（6 例 T10-T11，7 例 T11-T12，12 例 T12-L1）合并足下垂，且均无颈椎或腰椎管狭窄或其他神经疾病。平均随访时间为 46.5 个月。所有患者均接受了环形减压固定术治疗。我们在术前和末次随访时评估了患者的神经状态、胫骨前肌肌力、局部后凸角度和硬脊膜受压水平的横截面积。
结果
术前，25 例患者均表现为下运动神经元病变导致的足下垂和上运动神经元病变导致的病理反射。术后，平均计算肌力恢复率为 95%。日本矫形协会评分由术前的 5.92±1.22 分增加至末次随访时的 9.56±0.92 分。磁共振成像显示，术前横截面积为 36.3±7.3mm2，术后为 133.1±6.1mm2。
结论
T10 至 L1 单节段椎间盘突出可导致足下垂，通常伴有上运动神经元病变。T10 至 L1 节段椎间盘突出所致的病理反射取决于突出的水平。环形减压固定术可能是治疗这种综合征的有效方法。
证据等级
4 级。
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