Watanabe Kazuyuki, Otani Koji, Nikaido Takuya, Kato Kinshi, Kobayashi Hiroshi, Yabuki Shoji, Konno Shin-Ichi, Matsumoto Yoshihiro
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
Medicina (Kaunas). 2024 Apr 15;60(4):636. doi: 10.3390/medicina60040636.
: In the diagnosis of lumbar spinal stenosis (LSS), finding stenosis with magnetic resonance imaging (MRI) does not always correlate with symptoms such as sciatica or intermittent claudication. We perform decompression surgery only for cases where the levels diagnosed from neurological findings are symptomatic, even if multiple stenoses are observed on MRI. The objective of this study was to examine the time course of asymptomatic stenosis in patients with LSS after they underwent decompression surgery for symptomatic stenosis. : The participants in this study comprised 137 LSS patients who underwent single-level L4-5 decompression surgery from 2003 to 2013. The dural sac cross-sectional area at the L3-4 disc level was calculated based on preoperative MRI. A cross-sectional area less than 50 mm was defined as stenosis. The patients were grouped, according to additional spinal stenosis at the L3-4 level, into a double group (16 cases) with L3-4 stenosis, and a single group (121 cases) without L3-4 stenosis. Incidences of new-onset symptoms originating from L3-4 and additional L3-4-level surgery were examined. : Five years after surgery, 98 cases (72%) completed follow-up. During follow-up, 2 of 12 patients in the double group (16.7%) and 9 of 86 patients in the single group (10.5%) presented with new-onset symptoms originating from L3-4, showing no significant difference between groups. Additional L3-4 surgery was performed for one patient (8.3%) in the double group and three patients (3.5%) in the single group; again, no significant difference was shown. : Patients with asymptomatic L3-4 stenosis on preoperative MRI were not prone to develop new symptoms or need additional L3-4-level surgery within 5 years after surgery when compared to patients without preoperative L3-4 stenosis. These results indicate that prophylactic decompression for asymptomatic levels is unnecessary.
在腰椎管狭窄症（LSS）的诊断中，通过磁共振成像（MRI）发现的狭窄并不总是与坐骨神经痛或间歇性跛行等症状相关。即使在MRI上观察到多个狭窄，我们仅对根据神经学检查结果诊断出的有症状节段进行减压手术。本研究的目的是检查LSS患者在接受有症状狭窄减压手术后无症状狭窄的时间进程。
本研究的参与者包括137例在2003年至2013年期间接受单节段L4-5减压手术的LSS患者。根据术前MRI计算L3-4椎间盘水平的硬脊膜囊横截面积。横截面积小于50平方毫米被定义为狭窄。根据L3-4水平是否存在额外的椎管狭窄，将患者分为L3-4狭窄的双节段组（16例）和无L3-4狭窄的单节段组（121例）。检查源自L3-4的新发症状发生率以及额外的L3-4节段手术情况。
术后五年，98例（72%）完成随访。随访期间，双节段组12例患者中有2例（16.7%）、单节段组86例患者中有9例（10.5%）出现源自L3-4的新发症状，两组之间无显著差异。双节段组有1例患者（8.3%）、单节段组有3例患者（3.5%）接受了额外的L3-4手术；同样，两组之间无显著差异。
与术前无L3-4狭窄的患者相比，术前MRI显示有L3-4无症状狭窄的患者在术后5年内不易出现新症状或需要额外的L3-4节段手术。这些结果表明，对无症状节段进行预防性减压是不必要的。
