Sachs B L, Zindrick M R, Beasley R D
Department of Orthopaedics, New England Medical Center, Boston, Massachusetts 02111.
J Bone Joint Surg Am. 1993 May;75(5):721-5. doi: 10.2106/00004623-199305000-00012.
Between July 1987 and April 1991, reflex sympathetic dystrophy developed in eleven patients after a posterior operation on the lumbar spine. The average age of the patients was forty-four years (range, twenty-eight to sixty years). The preoperative diagnosis had been lumbar spondylolisthesis or lumbar instability, associated with degenerative disc disease or with osteoarthrosis of a facet joint. Ten patients had posterior stabilization with bilateral arthrodesis and interpedicular fixation, with use of plates or screws; the remaining patient had a posterior hemilaminotomy of the fourth and fifth lumbar vertebrae, partial discectomy, and foraminal decompression of the fifth lumbar-nerve root. After the operation, all patients had burning pain, vasomotor dysfunction, and dystrophic changes in the lower limb and foot; in four patients, the symptoms were bilateral. The symptoms began four days to twenty weeks after the operation. The patients were followed for nine months to four years. Treatment was most successful in four of six patients who had had at least one nerve-block of the sympathetic lumbar trunk in addition to physiotherapy.
1987年7月至1991年4月期间，11例患者在腰椎后路手术后发生反射性交感神经营养不良。患者的平均年龄为44岁（范围为28至60岁）。术前诊断为腰椎滑脱或腰椎不稳，伴有椎间盘退变或小关节骨关节炎。10例患者采用钢板或螺钉进行双侧关节融合和椎弓根内固定的后路稳定手术；其余1例患者接受了第四和第五腰椎后路半椎板切除术、部分椎间盘切除术以及第五腰神经根的椎间孔减压术。术后，所有患者均出现下肢和足部灼痛、血管舒缩功能障碍及营养性改变；4例患者症状为双侧性。症状在术后4天至20周开始出现。对患者进行了9个月至4年的随访。在6例患者中，4例除接受物理治疗外还至少进行了1次腰交感神经干阻滞，治疗最为成功。
