Mullin B B, Rea G L, Irsik R, Catton M, Miner M E
Department of Radiology, Ohio State University, Columbus, USA.
J Spinal Disord. 1996 Apr;9(2):107-16.
Between 1986 and 1990, 37 of 72 patients undergoing decompressive lumbar laminectomy with medial facetectomy for lumbar stenosis at The Ohio State University were seen in follow-up at a mean of 31 months (range, 14-63 months) after their laminectomy and were evaluated by questionnaire, detailed neurologic examination, and static and dynamic lumbar radiographs. Thirteen patients who had undergone fusion or who had extenuating medical circumstances were excluded, leaving 24 patients for whom laminectomy was the sole treatment for lumbar stenosis. Postoperatively, normal walking improved from 4 to 45% of patients, sensory deficits decreased from 63 to 25%, and ability to perform most or all desired activities increased from 25 to 70%. Urinary function was unchanged. Thirteen patients (54%) showed radiographic signs of instability. All patients who were declared radiographically stable could walk without a prosthetic aid or normally; 62% of the unstable patients required aid for walking. All of the patients with a poor ambulatory outcome were radiographically unstable. Compared with stable patients, unstable patients had a significant (p < 0.01) decrease in their ambulatory ability. There was a clear correlation between the degree of listhesis and postoperative ambulatory status (p < 0.01). The unstable patients with a poor ambulatory outcome followed one of three clinical courses: improvement with later deterioration, improvement with a plateau at a poor functional level, or failure to improve from a poor functional level. In conclusion, (a) although instability did not necessarily preclude a good outcome, a poor ambulatory outcome was always associated with instability; (b) laminectomy can effectively ameliorate the symptoms of lumbar stenosis; however, there is a subset of patients in whom laminectomy is associated with instability and a poor clinical course.
1986年至1990年间，俄亥俄州立大学为72例因腰椎管狭窄症接受减压性腰椎椎板切除术并内侧小关节切除术的患者进行了随访，平均随访时间为椎板切除术后31个月（范围为14 - 63个月），通过问卷调查、详细的神经学检查以及静态和动态腰椎X线片进行评估。13例接受过融合手术或有其他特殊医疗情况的患者被排除在外，剩下24例患者，椎板切除术是其腰椎管狭窄症的唯一治疗方法。术后，能正常行走的患者比例从4%提高到45%，感觉障碍从63%降至25%，能够进行大部分或所有期望活动的能力从25%提高到70%。排尿功能未改变。13例患者（54%）出现影像学不稳定征象。所有影像学检查显示稳定的患者无需假肢辅助即可行走或行走正常；62%的不稳定患者行走需要辅助。所有步行结果不佳的患者影像学检查均不稳定。与稳定患者相比，不稳定患者的步行能力显著下降（p < 0.01）。滑脱程度与术后步行状态之间存在明显相关性（p < 0.01）。步行结果不佳的不稳定患者遵循以下三种临床病程之一：先改善后恶化、改善后在低功能水平维持平稳或未从低功能水平改善。总之，（a）虽然不稳定不一定排除良好的结果，但步行结果不佳总是与不稳定相关；（b）椎板切除术可有效改善腰椎管狭窄症的症状；然而，有一部分患者的椎板切除术与不稳定和不良临床病程相关。
