Kulkarni Arvind G, Patel Ravish, Dutta Shumayou, Patil Vishwanath
Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, 400020, Maharashtra, India.
Spine (Phila Pa 1976). 2017 Jul 1;42(13):984-991. doi: 10.1097/BRS.0000000000001944.
A prospective study.
The aim of this study was to analyze the outcomes of stand-alone lateral recess decompression without discectomy in patients with claudicant radicular pain and magnetic resonance imaging (MRI) showing LRS (lateral recess stenosis) with lumbar disc herniation.
Discectomy is the gold standard treatment for symptomatic lumbar disc herniations refractory to conservative care. Typically, patients with positive SLR (Straight leg raising test) and flexion dominant leg pain are the ideal candidates who can be benefited from discectomy. There is a subset of patients with morphological features of lumbar disc herniation with LRS on MRI and presenting with diametrically opposite symptoms such as claudicant leg pain, extension dominant leg pain, relief on flexion, and a negative SLR. Until now, no focused prospective study in the literature highlights stand-alone lateral recess decompression in this group of patients.
From January 2007 to June 2013, 55 patients having unilateral claudicant radicular pain were selected to undergo stand-alone lateral recess decompression with tubular retractors. Intraoperatively, disc consistency and presence of sequestrated fragments were analyzed. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) score, and Macnab criteria were used to measure outcomes.
Out of 55 patients, stand-alone lateral recess decompression was successfully executed in 51 patients and remaining four patients had sequestrated discs that required removal. Mean age at presentation was 54.5 years (41-67 years), male:female ratio was 1.12:1, and mean follow-up was 3.8 years (3-5.8 years). Significant improvement (P < 0.0001) was noticed between preoperative and postoperative VAS score (8.39 ± 0.84 vs. 2.5 ± 0.48) and ODI score (46.79 ± 1.85 vs. 18.71 ± 2.41). As per Macnab criteria, 94% patients were satisfied with surgery.
Stand-alone lateral recess decompression without discectomy is clinically effective for a large majority of patients with claudicant radicular pain and MRI evidence of LRS with associated lumbar disc herniation. The ability to perform it with minimal invasive techniques makes it focused and targeted with minimal morbidity.
前瞻性研究。
本研究旨在分析单纯侧隐窝减压术（不进行椎间盘切除术）治疗伴有神经根性间歇性跛行且磁共振成像（MRI）显示侧隐窝狭窄（LRS）合并腰椎间盘突出症患者的疗效。
椎间盘切除术是保守治疗无效的有症状腰椎间盘突出症的金标准治疗方法。通常，直腿抬高试验（SLR）阳性且以屈曲时腿部疼痛为主的患者是能从椎间盘切除术中获益的理想人选。有一部分患者在MRI上有腰椎间盘突出合并LRS的形态学特征，但其症状却截然相反，如间歇性跛行性腿痛、伸展时腿部疼痛为主、屈曲时疼痛缓解以及SLR阴性。到目前为止，文献中尚无针对该组患者单纯侧隐窝减压术的专门前瞻性研究。
从2007年1月至2013年6月，选择55例单侧神经根性间歇性跛行患者，采用管状牵开器进行单纯侧隐窝减压术。术中分析椎间盘的质地和游离碎片的情况。采用视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）评分和Macnab标准来评估疗效。
55例患者中，51例成功实施了单纯侧隐窝减压术，其余4例患者有游离椎间盘需要切除。就诊时的平均年龄为54.5岁（41 - 67岁），男女比例为1.12:1，平均随访时间为3.8年（范围3 - 5.8年）。术前和术后VAS评分（8.39 ± 0.84 vs. 2.5 ± 0.48）和ODI评分（46.79 ± 1.85 vs. 18.71 ± 2.41）有显著改善（P < 0.0001）。根据Macnab标准，94%的患者对手术满意。
对于大多数伴有神经根性间歇性跛行且MRI显示LRS合并腰椎间盘突出症的患者，单纯侧隐窝减压术（不进行椎间盘切除术）在临床上是有效的。采用微创技术进行该手术能够使其具有针对性，且发病率最低。
4级。
