Ikuta Ko, Masuda Keigo, Tominaga Fuyuki, Sakuragi Takahide, Kai Kazuhiro, Kitamura Takahiro, Senba Hideyuki, Shidahara Satoshi
Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Karatsu, Saga, Japan.
Spine (Phila Pa 1976). 2016 Dec 15;41(24):E1434-E1443. doi: 10.1097/BRS.0000000000001813.
A retrospective study.
The aim of the present study was to identify the clinical and radiological features of low back pain (LBP) that was relieved after decompression alone of lumbar spinal stenosis (LSS) associated with grade I lumbar degenerative spondylolisthesis (LDS).
Although decompression and fusion are generally the recommended surgical treatments of LDS, several authors have reported that some patients with LDS could obtain good clinical results including relief from LBP by decompression alone. The pathogenesis of relief from LBP after decompression is, however, not known.
Forty patients with LSS associated with grade I LDS, who underwent a minimally invasive surgical-decompression were enrolled in the present study. All patients complained preoperatively of predominantly leg-related symptoms and LBP (≥ 4 points on Numeric Rating Scale). Clinical and radiological assessments were performed 1 year after surgery (a relief of LBP: Numeric Rating Scale reduction ≥3 points and valuation ≤3 points) and at the last follow-up. We conducted a comparative study between patient groups with and without the relief from LBP (groups R and N, respectively).
Twenty-nine patients were distributed to group R and the remaining 11 patients to group N. Preoperatively, there was a significant difference between the two groups for age and radiographic flexibility for lumbar extension. Postoperatively, there was a positive correlation between improvement in both LBP and leg symptoms. The clinical outcomes of group R were significantly better than those of group N throughout follow-up period (mean 37 mo). In group R, sagittal lumbopelvic radiographic parameters improved significantly after surgery.
Although the causes of LBP are varied in each patients, our results show that concomitant LSS itself might cause LBP in some patients with grade I LDS, because it involves impingement of the neural tissue and discordant sagittal lumbopelvic alignment.
一项回顾性研究。
本研究旨在确定单纯减压治疗与I度腰椎退行性滑脱（LDS）相关的腰椎管狭窄症（LSS）后缓解的下腰痛（LBP）的临床和影像学特征。
尽管减压和融合通常是LDS推荐的手术治疗方法，但一些作者报告称，一些LDS患者仅通过减压就能获得良好的临床效果，包括缓解LBP。然而，减压后LBP缓解的发病机制尚不清楚。
本研究纳入了40例与I度LDS相关的LSS患者，他们接受了微创外科减压手术。所有患者术前主要抱怨与腿部相关的症状和LBP（数字评分量表≥4分）。在术后1年（LBP缓解：数字评分量表降低≥3分且评估≤3分）和最后一次随访时进行临床和影像学评估。我们对有和没有LBP缓解的患者组（分别为R组和N组）进行了比较研究。
29例患者被分配到R组，其余11例患者被分配到N组。术前，两组在年龄和腰椎后伸的影像学柔韧性方面存在显著差异。术后，LBP和腿部症状的改善之间存在正相关。在整个随访期间（平均37个月），R组的临床结果明显优于N组。在R组中，矢状位腰骶骨盆影像学参数在术后有显著改善。
尽管每位患者LBP的原因各不相同，但我们的结果表明，在一些I度LDS患者中，伴随的LSS本身可能导致LBP，因为它涉及神经组织受压和矢状位腰骶骨盆排列不协调。
3级。
