Silvers H R, Lewis P J, Asch H L
Southtowns Neurological Surgeons Associates, Buffalo, New York.
J Neurosurg. 1993 May;78(5):695-701. doi: 10.3171/jns.1993.78.5.0695.
A total of 258 consecutive decompressive lumbar laminectomies performed on 244 individuals presenting with spinal stenosis were analyzed retrospectively. Spinal fusion was avoided in all but two patients. Outcome in terms of pain relief and return to normal activity was evaluated in two stages, one derived from patient charts and having a relatively short-term follow-up time (mean 8.4 months) and a second derived from patient responses to a questionnaire (which also scored for satisfaction with the results of surgery), which had a longer follow-up time (mean 4.7 years). More than 20 clinical and operative parameters were analyzed. Overall, a high degree of success (93% pain relief, 95% return to normal activity) was achieved in the short term, which was supported by the longer-term follow-up data (64% pain relief, 56% activity return, 75% satisfaction). The following factors were not significantly correlated with outcome: patient age; sex; worker's compensation or no-fault insurance status; employed versus not employed; a history of back surgery prior to the laminectomy studied; existence of degenerative spondylolisthesis or scoliosis; complete versus incomplete myelographic block; or the level of the lumbar spine undergoing surgery. The major conclusions arising from these data are: 1) for all age groups through at least the eighth decade of life, decompressive lumbar laminectomy is a relatively safe operation having a high medium-to-long-term success rate; 2) lumbar instability following laminectomy is rare, even in individuals presenting prior to surgery with degenerative instability conditions; and 3) lumbar fusion in addition to the decompressive laminectomy procedure is rarely required for degenerative spinal stenosis.
对244例因脊柱狭窄接受减压性腰椎椎板切除术的患者连续进行的258例手术进行了回顾性分析。除两名患者外，所有患者均未进行脊柱融合术。从疼痛缓解和恢复正常活动两方面对结果进行了两阶段评估，一个阶段的数据来自患者病历，随访时间相对较短（平均8.4个月），另一个阶段的数据来自患者对问卷的回答（问卷也对手术结果满意度进行评分），随访时间较长（平均4.7年）。分析了20多个临床和手术参数。总体而言，短期内取得了高度成功（93%疼痛缓解，95%恢复正常活动），长期随访数据也支持这一结果（64%疼痛缓解，56%恢复活动，75%满意）。以下因素与结果无显著相关性：患者年龄、性别、工伤赔偿或无过失保险状态、就业与否、本次椎板切除术之前的背部手术史、退行性椎体滑脱或脊柱侧弯的存在、脊髓造影完全性或不完全性梗阻，或接受手术的腰椎节段。这些数据得出的主要结论是：1）至少到八十岁的所有年龄组，减压性腰椎椎板切除术是一种相对安全的手术，中长期成功率较高；2）椎板切除术后腰椎不稳很少见，即使是术前存在退行性不稳情况的患者；3）对于退行性脊柱狭窄，除减压性椎板切除术外很少需要进行腰椎融合术。
