Adilay Utku, Guclu Bülent
Balikesir University School of Medicine, Balikesir, Turkey.
Kartal Dr Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey.
World Neurosurg. 2018 Mar;111:e235-e240. doi: 10.1016/j.wneu.2017.12.033. Epub 2017 Dec 16.
This study aimed to clarify whether multiple compressions of nerve roots resulted in poorer surgical outcome when patients were treated with single-level decompressive laminectomy or multilevel decompressive laminectomy. To reach this we compared preoperative and postoperative Oswestry Disability Index (ODI) scores, Visual Analogue Scale (VAS) scores, and walking duration of multilevel lumbar spinal stenosis (LSS) patients treated with single-level and multilevel decompressive laminectomy.
This retrospective study included 112 consecutive patients undergoing lumbar decompressive surgery without arthrodesis for LSS between March 2010 and September 2013. Forty-eight patients were treated with single-level laminectomy and 64 patients were treated with multilevel laminectomy. ODI scores, VAS scores, and walking duration were measured for all patients preoperatively and 30 months after decompressive surgery.
The mean age of the patients was 64.41 ± 13.4 years. The ODI scores, VAS scores, and walking duration difference between patients treated with single-level laminectomy and multilevel laminectomy were statistically significant and higher for the first group (P < 0.05). There were more operative complications in patients treated with multilevel decompressive laminectomy; however, there was no statistically significant difference between single-level and multilevel decompressed patients regarding complications (P = 0.119). Four of the patients treated with multilevel decompressive laminectomy experienced postoperative spondylolisthesis needing posterior instrumented fusion.
Recovery in terms of ODI scores, VAS scores, and walking duration was better in LSS patients undergoing single-level laminectomy than in those undergoing multilevel laminectomy. Also, the rates of operative complications and postoperative follow-up spondylolisthesis were higher in patients treated with multilevel laminectomy.
本研究旨在明确当患者接受单节段减压椎板切除术或多节段减压椎板切除术治疗时，神经根的多次受压是否会导致手术效果较差。为实现这一目的，我们比较了接受单节段和多节段减压椎板切除术治疗的多节段腰椎管狭窄症（LSS）患者术前和术后的奥斯威斯利功能障碍指数（ODI）评分、视觉模拟量表（VAS）评分以及步行时间。
这项回顾性研究纳入了2010年3月至2013年9月期间连续112例因LSS接受非融合腰椎减压手术的患者。48例患者接受了单节段椎板切除术，64例患者接受了多节段椎板切除术。对所有患者在术前及减压手术后30个月测量ODI评分、VAS评分和步行时间。
患者的平均年龄为64.41±13.4岁。接受单节段椎板切除术和多节段椎板切除术的患者之间，ODI评分、VAS评分和步行时间差异具有统计学意义，且第一组更高（P<0.05）。接受多节段减压椎板切除术的患者手术并发症更多；然而，单节段和多节段减压患者在并发症方面无统计学显著差异（P = 0.119）。接受多节段减压椎板切除术的患者中有4例术后发生椎体滑脱，需要后路器械融合。
接受单节段椎板切除术的LSS患者在ODI评分、VAS评分和步行时间方面的恢复情况优于接受多节段椎板切除术的患者。此外，接受多节段椎板切除术的患者手术并发症发生率和术后随访椎体滑脱率更高。
