Takenaka Shota, Tateishi Kosuke, Hosono Noboru, Mukai Yoshihiro, Fuji Takeshi
Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
J Neurosurg Spine. 2016 Apr;24(4):592-601. doi: 10.3171/2015.6.SPINE15288. Epub 2015 Dec 11.
In this study, the authors aimed to identify specific risk factors for postdecompression lumbar disc herniation (PDLDH) in patients who have not undergone discectomy and/or fusion.
Between 2007 and 2012, 493 patients with lumbar spinal stenosis underwent bilateral partial laminectomy without discectomy and/or fusion in a single hospital. Eighteen patients (herniation group [H group]: 15 men, 3 women; mean age 65.1 years) developed acute sciatica as a result of PDLDH within 2 years after surgery. Ninety patients who did not develop postoperative acute sciatica were selected as a control group (C group: 75 men, 15 women; mean age 65.4 years). Patients in the C group were age and sex matched with those in the H group. The patients in the groups were also matched for decompression level, number of decompression levels, and surgery date. The radiographic variables measured included percentage of slippage, intervertebral angle, range of motion, lumbar lordosis, disc height, facet angle, extent of facet removal, facet degeneration, disc degeneration, and vertebral endplate degeneration. The threshold for PDLDH risk factors was evaluated using a continuous numerical variable and receiver operating characteristic curve analysis. The area under the curve was used to determine the diagnostic performance, and values greater than 0.75 were considered to represent good performance.
Multivariate analysis revealed that preoperative retrolisthesis during extension was the sole significant independent risk factor for PDLDH. The area under the curve for preoperative retrolisthesis during extension was 0.849; the cutoff value was estimated to be a retrolisthesis of 7.2% during extension.
The authors observed that bilateral partial laminectomy, performed along with the removal of the posterior support ligament, may not be suitable for lumbar spinal stenosis patients with preoperative retrolisthesis greater than 7.2% during extension.
在本研究中，作者旨在确定未接受椎间盘切除术和/或融合术的患者发生减压后腰椎间盘突出症（PDLDH）的特定危险因素。
2007年至2012年期间，493例腰椎管狭窄症患者在一家医院接受了双侧部分椎板切除术，未进行椎间盘切除术和/或融合术。18例患者（疝组[H组]：15例男性，3例女性；平均年龄65.1岁）在术后2年内因PDLDH出现急性坐骨神经痛。90例未发生术后急性坐骨神经痛的患者被选为对照组（C组：75例男性，15例女性；平均年龄65.4岁）。C组患者在年龄和性别上与H组患者匹配。两组患者在减压节段、减压节段数量和手术日期方面也进行了匹配。测量的影像学变量包括滑脱百分比、椎间角、活动范围、腰椎前凸、椎间盘高度、小关节角、小关节切除范围、小关节退变、椎间盘退变和椎体终板退变。使用连续数值变量和受试者工作特征曲线分析评估PDLDH危险因素的阈值。曲线下面积用于确定诊断性能，大于0.75的值被认为代表良好性能。
多因素分析显示，伸展时术前椎体后移是PDLDH唯一显著的独立危险因素。伸展时术前椎体后移的曲线下面积为0.849；估计临界值为伸展时椎体后移7.2%。
作者观察到，在切除后支韧带的同时进行双侧部分椎板切除术可能不适用于伸展时术前椎体后移大于7.2%的腰椎管狭窄症患者。
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