复发性腰椎间盘突出症的单侧动态稳定化
Unilateral Dynamic Stabilization in Recurrent Lumbar Disc Herniation.
作者信息
Sezer Can, Acikalin Ridvan
机构信息
University of Health Sciences, Adana City Training and Research Hospital, Department of Neurosurgery, Adana, Turkey.
出版信息
Turk Neurosurg. 2023;33(2):334-340. doi: 10.5137/1019-5149.JTN.42533-22.2.
AIM
To evaluate the effectiveness and outcomes of unilateral dynamic stabilization in patients with recurrent lumbar disc herniation (RLDH).
MATERIAL AND METHODS
Patients requiring an operation due to RLDH at the L4?5 level were included in the study.They divided into the following two groups: SD group who had only revision discectomy (n=20) and DD group who had unilateral dynamic rod stabilization with discectomy (n=20). Low back and leg pain were evaluated with the visual analog scale (VAS), and functional results were evaluated with the Oswestry disability index (ODI). The VAS scores were evaluated in two different regions as VAS Low Back (VASLB) and VAS Leg (VASL). The results of each patient were evaluated preoperatively and at 1 and 12 months postoperatively. The anterior disc height (ADH), posterior disc height (PDH), and segmental angle (SA) were measured on the sagittal computed tomography (CT) scans of each patient?s lumbar spine. Modified Pfirrmann grades in the operated and adjacent segments on lumbar magnetic resonance imaging (MRI) were assessed preoperatively and at 12 months postoperatively.
RESULTS
A total of, 40 patients (17 women and 23 men; mean age, 47.9 years) were enrolled. There was no statistically significant difference in the VASLB scores between the two groups (p=0.42). The decrease in VASL scores was statistically significant between groups (p < 0.05). A statistically significant decrease in ODI scores was also observed (p < 0.05). When ADH and PDH obtained preoperatively and postoperatively were compared for the SD group, the differences were not statistically significant. Significant differences were found for ADH and PDH obtained preoperatively and postoperatively in the DD group (p < 0.05). However, for SA, the difference was not significant between the two groups (p=0.28).
CONCLUSION
Unilateral dynamic stabilization for RLDH leads to fewer surgical complications and provides sufficient stability by preserving segmental movements.
目的
评估单侧动态稳定术治疗复发性腰椎间盘突出症（RLDH）患者的有效性及治疗结果。
材料与方法
纳入因L4?5节段RLDH需行手术治疗的患者。将其分为以下两组：单纯翻修椎间盘切除术组（SD组，n = 20）和椎间盘切除联合单侧动态椎弓根稳定术组（DD组，n = 20）。采用视觉模拟量表（VAS）评估腰腿痛情况，采用Oswestry功能障碍指数（ODI）评估功能结果。VAS评分在两个不同区域进行评估，即腰部VAS（VASLB）和腿部VAS（VASL）。对每位患者在术前、术后1个月和12个月进行评估。在每位患者腰椎的矢状位计算机断层扫描（CT）上测量椎间盘前缘高度（ADH）、椎间盘后缘高度（PDH）和节段角度（SA）。在术前及术后12个月对腰椎磁共振成像（MRI）上手术节段及相邻节段的改良Pfirrmann分级进行评估。
结果
共纳入40例患者（17例女性，23例男性；平均年龄47.9岁）。两组间VASLB评分差异无统计学意义（p = 0.42）。两组间VASL评分降低有统计学意义（p < 0.05）。ODI评分也有统计学意义的降低（p < 0.05）。比较SD组术前和术后的ADH及PDH，差异无统计学意义。DD组术前和术后的ADH及PDH有显著差异（p < 0.05）。然而，对于SA，两组间差异无统计学意义（p = 0.28）。
结论
RLDH的单侧动态稳定术可减少手术并发症，并通过保留节段运动提供足够的稳定性。
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