Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, PR China.
Department of Spine, the Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China.
J Int Med Res. 2020 Mar;48(3):300060519884817. doi: 10.1177/0300060519884817. Epub 2019 Nov 27.
To establish a management strategy for multi-segment lumbar lateral recess stenosis.
A retrospective study was performed in patients in whom suspected responsible nerve roots underwent sequential selective nerve root block (SNRB). Based on pain remission rate after blocking, the contribution of nerve root compression to symptoms was classified as absolutely (≥70%) or relatively (30-70%) responsible or non-responsible (<30%). Conservative treatment was continued if visual analogue scale (VAS) at 3 days after blocking a single nerve root or VAS at 3 days after blocking multiple nerve roots was ≥50%; otherwise, percutaneous transforaminal endoscopic discectomy (PTED) was performed. Pain and functional scores were evaluated on day 3, 6 months and 1 year after SNRB or PTED.
Fifty-seven of 80 patients had a single absolutely responsible root, 20 had 2 responsible roots, and 3 had 3 responsible roots. Among them, 41, 10, and 1 patient underwent PTED, respectively. Both the PTED and conservative groups improved significantly in VAS remission rate and functional scores compared with admission. Moreover, the PTED group had a better VAS remission rate compared with the conservative group.
A combination of SNRB with PTED was effective for diagnosing and treating multi-segment lumbar lateral recess stenosis.
建立多节段腰椎侧隐窝狭窄症的管理策略。
对怀疑责任神经根的患者进行连续选择性神经根阻滞（SNRB），对其进行回顾性研究。根据阻滞后疼痛缓解率，将神经根受压对症状的影响分为绝对（≥70%）、相对（30%-70%）或非责任（<30%）。如果阻滞单根神经根后 3 天或阻滞多根神经根后 3 天的视觉模拟评分（VAS）≥50%，则继续行保守治疗；否则，行经皮椎间孔内镜椎间盘切除术（PTED）。在 SNRB 或 PTED 后 3 天、6 个月和 1 年分别评估疼痛和功能评分。
80 例患者中，1 例有单根绝对责任根，20 例有 2 根责任根，3 例有 3 根责任根。其中，分别有 41、10 和 1 例患者接受了 PTED 治疗。与入院时相比，PTED 和保守治疗组的 VAS 缓解率和功能评分均显著改善。此外，PTED 组的 VAS 缓解率优于保守组。
SNRB 联合 PTED 对诊断和治疗多节段腰椎侧隐窝狭窄症有效。
