Poletti C E
Hartford Hospital, University of Connecticut School of Medicine, Connecticut.
Neurosurgery. 1995 Aug;37(2):343-7. doi: 10.1227/00006123-199508000-00025.
Degenerative central lumbar stenosis has traditionally been considered to be a result of bony narrowing of the spinal canal. In two consecutive patients with degenerative central lumbar stenosis and complete myelographic blocks, the cauda equina was compressed by a thickened ligamentum flavum (cross-sectional area [CSA], > 150 mm2). This ligamentous stenosis occurred within bony canals of normal dimensions (anteroposterior diameter, interpediculate distance, interfacet distance, and CSA). High-resolution computed tomographic myelography was used to calculate quantitative values for the CSA, the length, and the volume of the lumbar ligamentum flavum. Excision of the thickened ligamentum flavum restored the dural sac to normal (CSA, 130-230 mm2), and both patients received relief from their symptoms. Unilateral laminotomy was used successfully to achieve bilateral ligamentectomy. Therefore, in a well-defined subgroup of patients with degenerative central lumbar stenosis, the dural sac can be decompressed by selective resection of the ligamentum flavum, and bilateral ligamentectomy can be performed via unilateral laminotomy.
退行性中央型腰椎管狭窄症传统上被认为是椎管骨质狭窄的结果。在连续两名患有退行性中央型腰椎管狭窄症且脊髓造影完全阻塞的患者中，马尾神经被增厚的黄韧带压迫（横截面积[CSA]，>150平方毫米）。这种韧带性狭窄发生在正常尺寸的骨性椎管内（前后径、椎弓根间距、关节突间距和CSA）。使用高分辨率计算机断层脊髓造影术来计算腰椎黄韧带的CSA、长度和体积的定量值。切除增厚的黄韧带可使硬膜囊恢复正常（CSA，130 - 230平方毫米），两名患者的症状均得到缓解。成功地采用单侧椎板切开术进行双侧韧带切除术。因此，在一个明确界定的退行性中央型腰椎管狭窄症患者亚组中，通过选择性切除黄韧带可对硬膜囊进行减压，并且可通过单侧椎板切开术进行双侧韧带切除术。
