Hashimoto Kunihiko, Kitaguchi Kazuma, Tateiwa Daisuke, Oshima Kazuya, Wada Eiji
Department of Orthopedic Surgery, Spine and Spinal Cord Center, Osaka International Medical and Science Center, Osaka, JPN.
Department of Orthopedic Surgery, Sumitomo Hospital, Osaka, JPN.
Cureus. 2024 Dec 20;16(12):e76097. doi: 10.7759/cureus.76097. eCollection 2024 Dec.
Lumbar canal stenosis (LCS) is a common degenerative lumbar spinal disease (DLSD) widely treated by decompression surgery, also known as laminectomy. Few cases have been observed where DLSD has progressed postoperatively, thus requiring reoperation. However, data on such cases are limited.
We included 247 patients (148 men and 99 women; mean age = 73.3 years) with a mean follow-up of 2.3 years in this single-center retrospective study. Among them, 129 patients underwent bilateral partial laminectomy (BPL), 91 patients underwent lumbar spinous process-splitting laminectomy (LSPSL), and 27 underwent microendoscopic laminotomy (MEL).
Of all the patients, 34 (13.8%) exhibited progression of lumbar spine degeneration symptoms, with nine (3.6%) requiring reoperation. Over 90% of new symptoms developed within one year of the initial surgery. Reoperation rates were significantly higher in patients with foraminal stenosis (P = <0.001). Additionally, 35 patients (14.2%) exhibited slippage progression. LSPSL resulted in significantly less slippage progression (P = 0.026). Spinal canal and foraminal stenosis were significantly associated with slippage progression (P< 0.001 and P = 0.010, respectively).
LSPSL reduced the incidence of canal and foraminal stenosis. Symptomatic DLSD was more common within one year post surgery, with foraminal stenosis more frequently requiring reoperation.
腰椎管狭窄症（LCS）是一种常见的退变性腰椎疾病（DLSD），广泛采用减压手术治疗，即椎板切除术。观察到少数DLSD病例在术后病情进展，因此需要再次手术。然而，关于此类病例的数据有限。
在这项单中心回顾性研究中，我们纳入了247例患者（148例男性和99例女性；平均年龄 = 73.3岁），平均随访2.3年。其中，129例患者接受了双侧部分椎板切除术（BPL），91例患者接受了腰椎棘突劈开椎板切除术（LSPSL），27例接受了显微内镜下椎板切开术（MEL）。
在所有患者中，34例（13.8%）出现腰椎退变症状进展，9例（3.6%）需要再次手术。超过90%的新症状在初次手术后一年内出现。椎间孔狭窄患者的再次手术率显著更高（P = <0.001）。此外，35例患者（14.2%）出现滑脱进展。LSPSL导致的滑脱进展显著更少（P = 0.026）。椎管和椎间孔狭窄与滑脱进展显著相关（分别为P<0.001和P = 0.010）。
LSPSL降低了椎管和椎间孔狭窄的发生率。有症状的DLSD在术后一年内更为常见，椎间孔狭窄更常需要再次手术。
