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减压融合术后因骨过度生长导致的复发性椎管狭窄:病例报告。

Recurrent Spinal Canal Stenosis after Decompression and Fusion Surgery Due to Bone Overgrowth: Case Report.

机构信息

Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea.

出版信息

Medicina (Kaunas). 2024 Sep 23;60(9):1554. doi: 10.3390/medicina60091554.

Abstract

Bone regrowth commonly occurs following lumbar decompression surgery. Although it is rare for neurological symptoms to occur due to bone regrowth, this study describes two patients who underwent both decompression and fusion surgeries but experienced spinal canal restenosisthat was severe enough to induce neurological symptoms. A 32-year-old man underwent posterior decompression and posterior lumbar interbody fusion for lumbar canal stenosis at the L4/L5 level 5 years prior. However, the sudden onset of lower back pain occurred 5 years later. Bone overgrowth on the left side was observed at the L4/L5 level. A second surgery was performed, and the patient's symptoms improved significantly. In the second case, a 56-year-old man underwent posterior decompression and posterior lumbar fusion at the L3/L4 and L4/L5 levels for an L4 burst fracture. One month later, he complained of lower back pain and underwent a second posterior decompression surgery. One year later, he presented to an outpatient clinic with lower back pain and neurological symptoms. Bone overgrowth was observed on both sides at the L4/L5 level. Thus, screw removal and laminectomy at the L3, L4, and L5 levels were performed as a third surgery. This study discusses the factors affecting bone regrowth and the methods that can be used to prevent it.

摘要

骨再生通常发生在腰椎减压手术后。尽管由于骨再生而发生神经症状的情况很少见,但本研究描述了两名接受减压和融合手术的患者,但出现了严重到足以引起神经症状的椎管再狭窄。一名 32 岁男性 5 年前因腰椎管狭窄症在 L4/L5 水平行后路减压和后路腰椎椎间融合术。然而,5 年后突然出现腰痛。在 L4/L5 水平观察到左侧骨过度生长。进行了第二次手术,患者的症状明显改善。在第二个病例中,一名 56 岁男性因 L4 爆裂性骨折在 L3/L4 和 L4/L5 水平行后路减压和后路腰椎融合术。一个月后,他抱怨腰痛并接受了第二次后路减压手术。一年后,他因腰痛和神经症状到门诊就诊。在 L4/L5 水平两侧均观察到骨过度生长。因此,作为第三次手术,进行了 L3、L4 和 L5 水平的螺钉取出和椎板切除术。本研究讨论了影响骨再生的因素以及可以用来预防骨再生的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea99/11433833/8ab7298339ba/medicina-60-01554-g007.jpg

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