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腰椎管狭窄症的减压与层间稳定:一项队列研究和二维手术视频。

Decompression and Interlaminar Stabilization for Lumbar Spinal Stenosis: A Cohort Study and Two-Dimensional Operative Video.

机构信息

Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.

出版信息

Medicina (Kaunas). 2022 Apr 5;58(4):516. doi: 10.3390/medicina58040516.

Abstract

Background and Objectives: Lumbar spinal stenosis is one of the most common causes of disability in the elderly and often necessitates surgical intervention in patients over the age of 65. Our study aimed to evaluate the clinical efficacy of interlaminar stabilization following decompressive laminectomy in patients with lumbar stenosis without instability. Materials and Methods: Twenty patients with lumbar stenosis underwent decompressive laminectomy and interlaminar stabilization at our academic institution. Clinical outcomes were measured using the visual analog scale (VAS) and Oswestry disability index (ODI) at the 2-month, 6-month, and 1-year postoperative visits, and these outcomes were compared to the preoperative scores. Results: The average VAS scores for low back pain significantly improved from 8.8 preoperatively to 4.0, 3.7, and 3.9 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average VAS scores for lower extremity pain significantly improved from 9.0 preoperatively to 2.7, 2.5, and 2.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average ODI scores significantly improved from 66.6 preoperatively to 23.8, 23.3, and 24.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). There was no statistical significance for difference in VAS or ODI scores between 2 months, 6 months, and 1 year. One patient had an intraoperative durotomy that was successfully treated with local repair and lumbar drainage. Another patient had progression of stenosis and had to undergo bilateral facetectomy and fusion. Conclusions: Decompressive laminectomy and interlaminar stabilization in patients with spinal claudication and low back pain is a good surgical option in the absence of instability and may provide significant clinical improvement of pain and functional disability.

摘要

背景与目的

腰椎管狭窄症是老年人最常见的致残原因之一,对于 65 岁以上的患者常需要手术干预。我们的研究旨在评估减压性椎板切除术联合椎板间稳定术治疗无不稳定腰椎管狭窄症患者的临床疗效。

材料与方法

在我们的学术机构,20 例腰椎管狭窄症患者接受了减压性椎板切除术联合椎板间稳定术。通过视觉模拟评分(VAS)和 Oswestry 功能障碍指数(ODI)在术后 2 个月、6 个月和 1 年评估临床结果,并与术前评分进行比较。

结果

术后 2 个月、6 个月和 1 年时,腰痛的平均 VAS 评分分别从术前的 8.8 分显著改善至 4.0 分、3.7 分和 3.9 分(p<0.001)。下肢疼痛的平均 VAS 评分分别从术前的 9.0 分显著改善至 2.7 分、2.5 分和 2.5 分(p<0.001)。ODI 评分分别从术前的 66.6 分显著改善至 23.8 分、23.3 分和 24.5 分(p<0.001)。术后 2 个月、6 个月和 1 年时,VAS 和 ODI 评分无统计学差异。1 例患者术中发生硬脊膜撕裂,经局部修补和腰椎引流成功治疗。另 1 例患者出现狭窄进展,需要行双侧关节突切除术和融合术。

结论

对于无不稳定的脊柱跛行和腰痛患者,减压性椎板切除术联合椎板间稳定术是一种较好的手术选择,可显著改善疼痛和功能障碍。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/719c/9031522/d9360223cbfd/medicina-58-00516-g001.jpg

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