Lemaire J J, Sautreaux J L, Chabannes J, Irthum B, Chazal J, Reynoso O, Thierry A
Service de Neurochirurgie, Hôpital Fontmaure, CHU Clermont-Ferrand, Chamalières.
Neurochirurgie. 1995;41(2):89-97.
The authors report the results of a retrospective study of 158 lumbar spinal stenosis (LSS), all operated (111 degenerative, 26 congenital, 21 mixed). Eighty seven percent of the patients had a low-back pain and 81.6% a radicular pain. Only 57.6% of them had a polyradicular claudication. A neurological deficit (motor, sensitive, or involving sphincters) was present in 36.6% of cases. A myelographic block was noted in 23.4% of cases, and in 20.3% a spondylolisthesis with an intact neural arch was found. Surgery consisted of a posterior lateral spinal canal calibration, sometimes associated with a ventral canal calibration (via the posterior route) (6.3%), and/or excision of a disc herniation at one (47.5%) or two levels (3.8%). Mean follow-up after surgery was 7.8 months. The global result was good or excellent in 75.2% of cases. Radicular pain was relieved in 89.1% of cases, and polyradicular claudication in 90.1% of cases. Neurological deficit improved in 50.6% of cases. In only 59.8% of cases relief of low-back pain was achieved. Statistically low-back pain (lasting for over 2 years) improved less, but a preoperative spondylolisthesis didn't influence the quality of the result regarding this symptom. Semiology, pathophysiology, and surgery particularly regarding spine stability are discussed.
作者报告了一项对158例腰椎管狭窄症(LSS)患者的回顾性研究结果,所有患者均接受了手术(111例为退行性,26例为先天性,21例为混合型)。87%的患者有腰痛,81.6%有神经根性疼痛。其中只有57.6%的患者有多根性间歇性跛行。36.6%的病例存在神经功能缺损(运动、感觉或涉及括约肌)。23.4%的病例发现脊髓造影阻滞,20.3%的病例发现神经弓完整的椎体滑脱。手术包括后路外侧椎管减压,有时联合前路椎管减压(经后路)(6.3%),和/或在一个节段(47.5%)或两个节段(3.8%)切除椎间盘突出。术后平均随访7.8个月。75.2%的病例总体结果良好或优秀。89.1%的病例神经根性疼痛得到缓解,90.1%的病例多根性间歇性跛行得到缓解。50.6%的病例神经功能缺损有所改善。只有59.8%的病例腰痛得到缓解。统计学上,腰痛(持续超过2年)改善较少,但术前椎体滑脱对该症状的结果质量没有影响。文中讨论了症状学、病理生理学,特别是关于脊柱稳定性的手术。