Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea.
Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea.
Medicine (Baltimore). 2022 Sep 9;101(36):e30171. doi: 10.1097/MD.0000000000030171.
Ligamentum flavum hypertrophy (LFH) is a known contributor to lumbar spinal canal stenosis (LSCS). However, the clinical significance and quantitative role of LFH compared to other components, such as disc bulging and facet hypertrophy, have not yet been examined. We investigated the correlation between the quantitative radiological factors, clinical symptoms, and outcomes in patients with LSCS. In total, 163 patients diagnosed with single-level (L4-L5) stenosis were included. The patients were divided into 2 groups according to claudication severity: >100 m for mild (n = 92) and < 100 m for severe (n = 71). The visual analog scale (VAS) was used to quantify back and leg pain, and the Oswestry Disability Index (ODI) and Short form-36 (SF-36) physical component summary (PCS) scores, and Macnab criteria were evaluated as clinical factors 6 months after treatment. We measured the baseline canal cross-sectional area, ligamentum flavum (LF) area, disc herniation area, dural sac area, fat area, and LF thickness using MRI. A comparative analysis was performed to evaluate the association between radiologic and clinical factors. Additionally, further comparative analyses between the types of surgeries were performed. Among various radiologic factors, the baseline LF thickness (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.25-2.41) was the only major contributing factor to the severity of claudication in the multivariate logistic regression analysis. The types of surgery (decompression alone vs fusion) did not significantly differ in terms of their clinical outcomes, including back and leg VAS, ODI, SF-36 PCS, and satisfaction with the MacNab classification. LF thickness is a major factor contributing to claudication severity.
黄韧带肥厚（LFH）是腰椎管狭窄症（LSCS）的已知病因。然而，与椎间盘膨出和小关节肥大等其他成分相比，LFH 的临床意义和定量作用尚未得到研究。我们研究了 LSCS 患者定量放射学因素、临床症状和结果之间的相关性。共纳入 163 例单节段（L4-L5）狭窄患者。根据跛行严重程度将患者分为 2 组：>100 m 为轻度（n=92），<100 m 为重度（n=71）。采用视觉模拟评分（VAS）量化腰背和下肢疼痛，采用 Oswestry 功能障碍指数（ODI）和简明 36 健康调查量表（SF-36）躯体成分综合评分（PCS）和 Macnab 标准评估治疗后 6 个月的临床因素。我们使用 MRI 测量基线椎管横截面积、黄韧带（LF）面积、椎间盘突出面积、硬脊膜囊面积、脂肪面积和 LF 厚度。进行对比分析以评估放射学和临床因素之间的关系。此外，还对不同手术类型之间进行了进一步的对比分析。在各种放射学因素中，基线 LF 厚度（比值比[OR]1.73；95%置信区间[CI]1.25-2.41）是多变量逻辑回归分析中导致跛行严重程度的唯一主要因素。单纯减压与融合手术在腰背和下肢 VAS、ODI、SF-36 PCS 和 MacNab 分类满意度等临床结果方面无显著差异。LF 厚度是导致跛行严重程度的主要因素。
