Oh Seung-Uk, Yi Jungmin, Moon Sunyoung, Park Suk Hee, Shin Hojin, Cho Jaeho, Kim Young Uk
Department of Cardiology, Catholic Kwandong University of Korea College of Medicine, International ST. Mary's Hospital, Incheon, Korea.
Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary's Hospital, Incheon, Korea.
Medicine (Baltimore). 2025 Apr 11;104(15):e42151. doi: 10.1097/MD.0000000000042151.
Lumbar spondylolisthesis is a degenerative status in the spine. Posterior lumbar interbody fusion (PLIF) with instrumentation has considered as the standard surgical treatment for lumbar instability. Spinal canal and dural sac cross-sectional area (CSA) has been major parameters for evaluating neurologic symptoms. This study is aimed at finding the radiological change using the dural sac CSA and spinal canal CSA as an objective morphological parameter after PLIF. Of the 74 patients (24 men, 50 women; mean age 66.49 years) who had PLIF surgery were checked for preoperative magnetic resonance imaging (MRI) and MRI within 1 week after surgery. T2-weighted axial MRI scans were obtained from each patient. We measured the dural sac and spinal canal CSA on an axial MRI image at the center of L4 to L5 intervertebral disc. The average spinal canal CSA was 70.28 ± 27.77 mm2 in the preoperative MR images and 149.59 ± 35.20 mm2 in the postoperative MR images. The average dural sac CSA was 42.46 ± 18.49 mm2 in the preoperative MR images and 98.93 ± 29.32 mm2 in the postoperative MR images. After the PLIF operation, the mean spinal canal CSA was 112.84 percent increase, and the measn dural sac CSA was 132.99 percent increase. After PLIF, patients had significantly higher dural sac CSA (P < .001) and spinal canal CSA (P < .001). Spinal canal CSA have increased by 112.84 percent and Dural sac CSA have increased by 132.99 percent after PLIF. Thus, before PLIF, the treating physician should carefully explain this result to patient.
腰椎滑脱是脊柱的一种退行性病变。后路腰椎椎间融合术（PLIF）加内固定已被视为治疗腰椎不稳的标准手术方法。椎管和硬膜囊横截面积（CSA）一直是评估神经症状的主要参数。本研究旨在以硬膜囊CSA和椎管CSA作为客观形态学参数，观察PLIF术后的影像学变化。对74例行PLIF手术的患者（24例男性，50例女性；平均年龄66.49岁）进行术前磁共振成像（MRI）检查，并在术后1周内进行MRI检查。从每位患者获取T2加权轴向MRI扫描图像。我们在L4至L5椎间盘中心的轴向MRI图像上测量硬膜囊和椎管CSA。术前MR图像中椎管平均CSA为70.28±27.77mm²，术后MR图像中为149.59±35.20mm²。术前MR图像中硬膜囊平均CSA为42.46±18.49mm²，术后MR图像中为98.93±29.32mm²。PLIF手术后，椎管平均CSA增加了112.84%，硬膜囊平均CSA增加了132.99%。PLIF术后，患者的硬膜囊CSA（P<.001）和椎管CSA（P<.001）显著更高。PLIF术后椎管CSA增加了112.84%，硬膜囊CSA增加了132.99%。因此，在PLIF手术前，主治医生应向患者仔细解释这一结果。
