Baccarani G, Brunetti E, Meringolo R
Divisione di Ortopedia e Traumatologia, Ospedale Ceccarini, Riccione.
Chir Organi Mov. 1993 Apr-Jun;78(2):77-80.
The authors present the results they obtained in the first 100 operations performed between January 1989 and November 1990 for the treatment of lumbar sciatic pain related to disc and/or bone compression: microsurgery according to the Caspar method was used. A total of 113 spaces were submitted to surgery; discectomy at two levels was performed in 13 patients. Nerve root compression observed was based on three causes: 1) pure disc hernia (57.5%), 2) pure lateral stenosis (15.9%), 3) combined pathology (hernia+stenosis) (25.6%). In one of the cases the pathology remained unknown. At an average two-year follow-up there were 94 excellent or good results, 2 fair results, and 4 poor results. Complications included dural lacerations in 3 cases, with no sequelae. Eight patients were submitted to further surgery for recurrence of symptoms; the final results after reintervention were excellent in 7 cases, and fair in 1. The authors emphasize the advantages to using microsurgery as compared to macrosurgery, and stress a frequent finding of pure lateral stenosis or associated with disc pathology (47 out of 113 levels operated, equal to 41%), as well as the reliability of CT scan when dealing with disc pathology (97% positive diagnosis) but its unreliability when diagnosis is lateral stenosis (19 out of 47, equal to 40%).
作者展示了他们在1989年1月至1990年11月间进行的首批100例治疗与椎间盘和/或骨质压迫相关的腰椎坐骨神经痛手术中所获得的结果：采用了根据卡斯帕方法进行的显微手术。总共113个间隙接受了手术；13例患者进行了两个节段的椎间盘切除术。观察到的神经根压迫基于三种原因：1）单纯椎间盘疝（57.5%），2）单纯侧隐窝狭窄（15.9%），3）合并病变（疝+狭窄）（25.6%）。其中1例病例的病变情况不明。平均两年的随访结果显示，94例结果为优或良，2例为中等，4例为差。并发症包括3例硬脊膜撕裂，无后遗症。8例患者因症状复发接受了再次手术；再次干预后的最终结果7例为优，1例为中等。作者强调了与传统手术相比使用显微手术的优势，并强调经常发现单纯侧隐窝狭窄或与椎间盘病变相关（113个手术节段中有47个，占41%），以及在处理椎间盘病变时CT扫描的可靠性（阳性诊断率97%），但在诊断侧隐窝狭窄时其不可靠性（47例中有19例，占40%）。
