Krayenbühl H, Benini A
Z Orthop Ihre Grenzgeb. 1979 Apr;117(2):167-71.
The intense radicular pain of sciatica may result from nerve root entrapment in a narrowed lateral vertebral recess without discal herniation. In such cases relief of pain is achieved by unroofing the lateral recess and excising the overhanging portion of the superior articular facet, without removing the disc. The narrowing of the lateral recess is congenital, but the compression of the root occurs first in adult life. The thinning of the disc causes backward displacement of the vertebral body above and forward displacement of the cranial articular facet of the vertebral body below the thinned disc. In a large lateral recess such subluxation does not cause any entrapment of the root. If the lateral recess is congenitally narrowed the root is tightly wedged laterally and sometimes can be decompressed only by a complete arthrotomy. The same entrapment can occur as a consequence of removing of a disc (pseudorecurrence).
坐骨神经痛剧烈的神经根性疼痛可能源于神经根在侧隐窝狭窄处受压,而无椎间盘突出。在此类病例中,通过切除侧隐窝顶部并切除上关节突的悬垂部分来缓解疼痛,而不摘除椎间盘。侧隐窝狭窄是先天性的,但神经根受压首先发生在成年期。椎间盘变薄导致上方椎体向后移位,下方椎体的上关节突向前移位。在大的侧隐窝中,这种半脱位不会导致神经根受压。如果侧隐窝先天性狭窄,神经根会在外侧被紧紧挤压,有时只能通过完全关节切开术才能减压。摘除椎间盘(假性复发)也可能导致同样的压迫。