Pugely Andrew J, Ries Zachary, Gnanapragasam Gnanapradeep, Gao Yubo, Nash Rachel, Mendoza-Lattes Sergio A
Department of Orthopaedic Surgery, The University of Iowa, Iowa City, IA.
Clin Spine Surg. 2017 Mar;30(2):E111-E118. doi: 10.1097/BSD.0b013e3182aab1e3.
Retrospective cohort study.
To demonstrate a correlation between radiculopathy symptoms, foraminal morphology, and curve types.
Patients with degenerative scoliosis frequently present with foraminal stenosis and radiculopathy, the origin of which is not well understood.
A total of 48 patients (384 foraminas) were included: 14 with low back pain (B); 16 with femoral nerve pain (F); and 18 with sciatic nerve pain (S). The symptomatic foramen of groups F and S were compared with asymptomatic foramina. Alignment was measured from standardized radiographs; 3D-CT reconstructions were used to measure foraminal height and area. Data are presented as mean±SD. The χ, t test, and Pearson coefficients were calculated; as well as interobserver and intraobserver reproducibility (Cohen κ).
Seventeen of the 18 patients with sciatic nerve pain (S) presented foraminal stenosis (<40 mm) at the concavity of the fractional curve distal to the main lumbar structural curve. The symptomatic foramina were significantly smaller in height (7.8±2.5 vs. 12.1±3.1 mm, P<0.0001) and area (30.1±14.3 vs. 57.6±28.7 mm, P<0.0001) compared with asymptomatic foramen; 7/7 patients with femoral nerve pain (F) and lumbar structural curves (apex L3 or lower) had foraminal stenosis at the concavity of the fractional curve. Eight of the 9 patients with femoral nerve pain (F) and thoracic, thoracolumbar, or lumbar (apex L2 or higher) curves, presented foraminal stenosis in the concavity of the caudal fractional curve. The symptomatic foraminal spaces were significantly smaller in height (9.2±3.2 vs. 12.1±3.1 mm, P<0.0001) and area (30.1±15.2 vs. 57.6±28.7 mm, P<0.0001). Foraminal height correlated with foraminal area (r=0.68-0.85; P<0.0001). Interobserver agreement was between 0.6092 and 0.8679.
A correlation between curve types and symptomatic foraminal stenosis exists. Adult scoliosis patients with sciatic nerve pain typically present with foraminal stenosis at the concavity of the caudal fractional curve. Similarly, patients with femoral nerve pain present with foraminal stenosis at the concavity of the caudal fractional curve when the main structural curve is thoracic, thoracolumbar, or lumbar (apex L2 or higher).
回顾性队列研究。
证明神经根病症状、椎间孔形态和脊柱侧凸类型之间的相关性。
退行性脊柱侧凸患者常出现椎间孔狭窄和神经根病，其病因尚不完全清楚。
共纳入48例患者（384个椎间孔）：14例有下腰痛（B组）；16例有股神经痛（F组）；18例有坐骨神经痛（S组）。将F组和S组有症状的椎间孔与无症状的椎间孔进行比较。通过标准化X线片测量脊柱对线情况；使用三维CT重建测量椎间孔高度和面积。数据以均值±标准差表示。计算χ检验、t检验和Pearson系数；以及观察者间和观察者内的可重复性（Cohen κ）。
18例坐骨神经痛（S组）患者中有17例在主腰椎结构曲线远端的分数曲线凹侧出现椎间孔狭窄（<40 mm）。与无症状椎间孔相比，有症状的椎间孔高度（7.8±2.5 vs. 12.1±3.1 mm，P<0.0001）和面积（30.1±14.3 vs. 57.6±28.7 mm，P<0.0001）明显更小；7/7例股神经痛（F组）且有腰椎结构曲线（顶点在L3或更低）的患者在分数曲线凹侧出现椎间孔狭窄。9例股神经痛（F组）且有胸椎、胸腰段或腰椎（顶点在L2或更高）曲线的患者中有8例在尾侧分数曲线凹侧出现椎间孔狭窄。有症状的椎间孔间隙高度（9.2±3.2 vs. 12.1±3.1 mm，P<0.0001）和面积（30.1±15.2 vs. 57.6±28.7 mm，P<0.0001）明显更小。椎间孔高度与椎间孔面积相关（r=0.68 - 0.85；P<0.0001）。观察者间一致性在0.6092至0.8679之间。
脊柱侧凸类型与有症状的椎间孔狭窄之间存在相关性。患有坐骨神经痛的成人脊柱侧凸患者通常在尾侧分数曲线凹侧出现椎间孔狭窄。同样，当主结构曲线为胸椎、胸腰段或腰椎（顶点在L2或更高）时，患有股神经痛的患者在尾侧分数曲线凹侧出现椎间孔狭窄。
Zotero 插件