Kida H, Tabata S
Nihon Seikeigeka Gakkai Zasshi. 1984 Dec;58(13):1217-35.
In surgical treatment of lumbar spinal canal stenosis, the stenotic area related to the clinical symptoms was determined and the stenotic form and stenotic factors in this stenotic area were estimated before operation. The most appropriate decompression of the stenotic area was performed taking the stenotic form into consideration and retaining the spinous process and interspinous ligament. In cases of stenosis of the spinal canal, posterolateral decompression of the dural sheath was performed by means of resection of the medial edge of the bilateral inferior articular processes and the yellow ligaments. In cases of stenosis of the spinal canal associated with stenosis of the lateral recess, the root was decompressed by unroofing the lateral recess in addition to posterolateral decompression of the dural sheath. And in cases with stenosis of the lateral recess, the root in an affected area was decompressed. Neither operation on the intervertebral disc nor incision of the dural sheath was performed. After operation as described above, symptoms, operative findings and postoperative results were investigated in 70 cases which could be directly examined. In this paper we discuss the relationship between the symptoms and the stenotic area, stenotic forms and stenotic factors. When our postoperative results were compared with those of cases with extensive laminectomy, it was seen that none of the patients we treated had low back pain nor recurrence of intermittent claudication and that lessening of paralysis was sufficient.
在腰椎管狭窄症的外科治疗中，术前需确定与临床症状相关的狭窄区域，并评估该狭窄区域的狭窄形式和狭窄因素。根据狭窄形式，在保留棘突和棘间韧带的情况下，对狭窄区域进行最适当的减压。对于椎管狭窄病例，通过切除双侧下关节突内侧边缘和黄韧带进行硬脊膜鞘后外侧减压。对于合并侧隐窝狭窄的椎管狭窄病例，除硬脊膜鞘后外侧减压外，还通过开放侧隐窝对神经根进行减压。对于侧隐窝狭窄病例，对受累区域的神经根进行减压。未进行椎间盘手术和硬脊膜鞘切开。按照上述方法手术后，对70例可直接检查的病例进行了症状、手术所见和术后结果的调查。在本文中，我们讨论了症状与狭窄区域、狭窄形式和狭窄因素之间的关系。将我们的术后结果与广泛椎板切除术病例的结果进行比较时发现，我们治疗的患者中无一例出现腰痛或间歇性跛行复发，且瘫痪减轻程度足够。
