Rousseaux P, Bernard M H, Scherpereel B, Guyot J F
Neurochirurgie. 1979;25(3):154-9.
These 53 operated patients were divided into 2 groups: 29 had an intermittent claudication as Verbiest first described it soon as 1949, whereas 24 had permanent radicular pain in legs as Epstein emphasized it. We think emulsified Duroliopaque myelography to be the best investigation to make sure the diagnosis and to forecast the operative tactics: we gave up Dimer X myelography which occasioned serious complications in 2 cases and gas myelography which seems to us inadequate to this radicular pathology. Total-Body Scanner is rather an elegant method but a discontinuous one. The radiographic and operative findings have shown the stenosis of the lumbar canal to be congenital in 5 cases, development in 20 cases, degenerative in 27 cases (with 15 pseudo-spondylolisthesis) and tabetic in one case. A disc herniation was found in 25 cases over 53. The extent of the bone resection has been in relation with clinical picture, myelography and mainly operative findings, aiming at a "cut-to-measure costum". In every case the initial laminectomy was made easier by trenching the thickened laminae on each side of the spinal process prior to remove it. Only soft disc hernations were removed; the dura was never opened; no vertebral fusion was performed; for 2 years we have tried to avoid the "laminectomy membrane" by interposing an autogenous fat and aponevrotic graft between the dura and the overlying paraspinal muscles. The operative results are satisfactory with 75% of excellent and good; they are much better in patients with intermittent claudication than in those with permanent radicular pain. It is a question of functional surgery in one case, of pain surgery in the other. The major trick seems to us to be that of the associated disc hernation with the risk of missing the narrow canal.
这53例接受手术的患者被分为两组：29例有间歇性跛行，这是1949年Verbiest首次描述的症状；而24例有腿部持续性神经根性疼痛，这是Epstein所强调的症状。我们认为乳化碘苯酯脊髓造影是确保诊断和预测手术策略的最佳检查方法：我们放弃了在2例患者中引发严重并发症的碘卡明脊髓造影以及在我们看来对这种神经根性病变不适用的气体脊髓造影。全身扫描仪是一种相当精巧的方法，但却是不连续的。影像学和手术结果显示，5例腰椎管狭窄为先天性，20例为发育性，27例为退行性（其中15例有假性椎体滑脱），1例为梅毒性。53例中有25例发现椎间盘突出。骨切除的范围与临床表现、脊髓造影以及主要是手术结果相关，目标是“量体裁衣”。在每例手术中，在切除棘突之前，先在其两侧切开增厚的椎板，这样初始的椎板切除术就更容易进行。仅切除软性椎间盘突出物；从未打开硬脊膜；未进行椎体融合；两年来，我们试图通过在硬脊膜和覆盖其上的椎旁肌之间植入自体脂肪和腱膜移植物来避免“椎板切除膜”。手术结果令人满意，优良率为75%；间歇性跛行患者的手术效果比持续性神经根性疼痛患者好得多。一种情况是功能性手术问题，另一种情况是疼痛手术问题。在我们看来，主要的难点似乎是合并椎间盘突出伴有遗漏狭窄椎管的风险。
