Raabe Andreas, Beck Jürgen, Ulrich Christian
Universitätsklinik für Neurochirurgie, Inselspital Bern.
Ther Umsch. 2014 Dec;71(12):701-5. doi: 10.1024/0040-5930/a000614.
Patients with complaints and symptoms caused by spinal degenerative diseases demonstrate a high rate of spontaneous improvement. Except of severe neurological symptoms such as high grade motor deficits, medically intractable pain and vegetative symptoms (cauda syndrome) operations require 1) symptoms, 2) a mechanical cause visible on imaging that sufficiently explains the symptoms, 3) a completed conservative treatment protocol performed over a 4) 6-12 week period. According to the evidence found in the literature, patients with lumbar disk herniation significantly benefit from surgery by a faster relieve of pain and return to social and professional activity, however, the results are converging after a period of 1-2 years. Surgery of lumbar spinal stenosis is considered a gold standard and superior to conservative care when symptoms are severe and leg pain is present. Bilateral microsurgical decompression using a bilateral or a unilateral approach with over-the-top decompression of the contralateral nerve root are superior to laminectomy as the decompression procedure. Lumbar fusion is only indicated in patients with spinal stenosis when a major or mobile spondylolisthesis is diagnosed. There is no indication of prophylactic surgery to avoid a "dangerous" deficit that might develop in the future.
患有脊柱退行性疾病引起的不适和症状的患者显示出较高的自发改善率。除了严重的神经症状，如高级运动功能缺损、药物治疗难以缓解的疼痛和自主神经症状（马尾综合征）外，手术需要满足以下条件：1）有症状；2）影像学上可见的机械性病因，足以解释症状；3）在4）6至12周期间完成保守治疗方案。根据文献中的证据，腰椎间盘突出症患者通过手术能更快缓解疼痛并恢复社交和职业活动，从而显著受益，然而，1至2年后结果趋于一致。当症状严重且存在腿痛时，腰椎管狭窄症的手术被认为是金标准且优于保守治疗。使用双侧或单侧入路并对侧神经根进行经顶减压的双侧显微减压术作为减压手术优于椎板切除术。腰椎融合术仅适用于诊断出严重或可活动的椎体滑脱的腰椎管狭窄症患者。没有预防性手术以避免未来可能出现的“危险”功能缺损的指征。
