Yoo Seokha, Han Yeji, Kim Youngwon, Park Sun-Kyung, Lim Young-Jin, Kim Jin-Tae
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.
Anaesth Intensive Care. 2023 Jul;51(4):254-259. doi: 10.1177/0310057X231159682. Epub 2023 Jun 20.
The cerebrospinal fluid volume affects the block height of spinal anaesthesia. Laminectomy of the lumbar spine may result in increased lumbosacral cerebrospinal fluid volume. This study aimed to test the hypothesis that the lumbosacral cerebrospinal fluid volume of patients with a history of lumbar laminectomy would be larger than that of patients with normal lumbar spine anatomy using magnetic resonance imaging. Lumbosacral spine magnetic resonance images of 147 patients who underwent laminectomy at the L2 vertebrae or below (laminectomy group) and 115 patients without a history of spinal surgery (control group) were retrospectively reviewed. The lumbosacral cerebrospinal fluid volumes between the L1-L2 intervertebral disc level and the end of the dural sac were measured and compared between the two groups. The mean (standard deviation) lumbosacral cerebrospinal fluid volume was 22.3 (7.8) ml and 21.1 (7.4) ml in the laminectomy and control groups, respectively (mean difference 1.2 ml; 95% confidence interval -0.7 to 3.0 ml; = 0.218). In the prespecified subgroup analysis according to the number of laminectomy levels, patients who underwent more than two levels of laminectomy exhibited slightly larger lumbosacral cerebrospinal fluid volume ( = 17, 30.5 (13.5) ml) compared with those who underwent two ( = 40, 20.7 (5.6) ml; = 0.014) or one level of laminectomy ( = 90, 21.4 (6.2) ml; = 0.010) and the control group (21.1 (7.4) ml; = 0.012). In conclusion, the lumbosacral cerebrospinal fluid volume did not differ between patients who underwent lumbar laminectomy and those without a history of laminectomy. However, patients who underwent laminectomy at more than two levels had a slightly larger volume of lumbosacral cerebrospinal fluid than those who underwent less extensive laminectomy and those without a history of lumbar spine surgery. Further studies are warranted to confirm the subgroup analysis findings and elucidate the clinical implications of such differences in the lumbosacral cerebrospinal fluid volume.
脑脊液容量会影响脊髓麻醉的阻滞高度。腰椎椎板切除术可能导致腰骶部脑脊液容量增加。本研究旨在验证以下假设：通过磁共振成像，有腰椎椎板切除术病史的患者腰骶部脑脊液容量会大于腰椎解剖结构正常的患者。回顾性分析了147例在L2椎体或更低水平接受椎板切除术的患者（椎板切除术组）和115例无脊柱手术史的患者（对照组）的腰骶部脊柱磁共振图像。测量并比较两组在L1-L2椎间盘水平至硬脊膜囊末端之间的腰骶部脑脊液容量。椎板切除术组和对照组的腰骶部脑脊液平均（标准差）容量分别为22.3（7.8）ml和21.1（7.4）ml（平均差异1.2ml；95%置信区间为-0.7至3.0ml；P=0.218）。在根据椎板切除节段数量进行的预先设定的亚组分析中，接受超过两个节段椎板切除术的患者腰骶部脑脊液容量略大于接受两个节段（n=40，20.7（5.6）ml；P=0.014）或一个节段椎板切除术的患者（n=90，21.4（6.2）ml；P=0.010）以及对照组患者（21.1（7.4）ml；P=0.012）。总之，接受腰椎椎板切除术的患者与无椎板切除术病史的患者之间腰骶部脑脊液容量并无差异。然而，接受超过两个节段椎板切除术的患者腰骶部脑脊液容量略大于接受范围较小的椎板切除术的患者以及无腰椎手术史的患者。有必要进行进一步研究以证实亚组分析结果，并阐明腰骶部脑脊液容量差异的临床意义。
