Lee Seung Yeop, Kim Tae-Hwan, Oh Jae Keun, Lee Seung Jin, Park Moon Soo
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
Asian Spine J. 2015 Oct;9(5):818-28. doi: 10.4184/asj.2015.9.5.818. Epub 2015 Sep 22.
Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall. However, although the physical findings and clinical symptoms in lumbar stenosis are not acute, the radiographic findings are comparatively severe. Magnetic resonance imaging is a noninvasive and good method for evaluation of lumbar stenosis. Though there are very few studies pertaining to the natural progression of lumbar spinal stenosis, symptoms of spinal stenosis usually respond favorably to non-operative management. In patients who fail to respond to non-operative management, surgical treatments such as decompression or decompression with spinal fusion are required. Restoration of a normal pelvic tilt after lumbar fusion correlates to a good clinical outcome.
椎间盘退变会导致最初的相对不稳定、活动过度以及小关节肥大,尤其是在上关节突处。这最终会导致椎管尺寸减小和神经组织受压,进而可能导致神经根周围静脉充血和动脉高血压引起的神经源性间歇性跛行。大多数有症状的腰椎管狭窄症患者存在神经源性间歇性跛行并有跌倒风险。然而,尽管腰椎管狭窄症的体格检查结果和临床症状并不严重,但影像学检查结果相对严重。磁共振成像(MRI)是评估腰椎管狭窄症的一种无创且有效的方法。虽然关于腰椎管狭窄症自然进展的研究很少,但椎管狭窄症的症状通常对非手术治疗反应良好。对于非手术治疗无效的患者,则需要进行减压或减压加脊柱融合等手术治疗。腰椎融合术后恢复正常骨盆倾斜与良好的临床结果相关。