Matsui H, Ohmori K, Kanamori M, Ishihara H, Tsuji H
Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Japan.
Spine (Phila Pa 1976). 1998 Feb 1;23(3):338-42. doi: 10.1097/00007632-199802010-00010.
The authors retrospectively reviewed the relation between the location of disc herniation and pre- and postoperative changes in sciatic scoliotic list in 40 patients with surgically confirmed lumbar disc herniation who had sciatic scoliotic list with postoperative recovery. Clinical factors associated with scoliosis also were included.
To evaluate the significance and pathomechanism of sciatic scoliotic list.
The proposed causes of lumbar sciatic scoliosis mainly imply an alleviation of nerve root irritation in relation to the anatomic location of disc herniation relative to the nerve root.
The pre- and postoperative serial Cobb angle between L1 and L5 in anteroposterior lumbar radiographs in the standing position were measured. The relation between the convex side of scoliosis and clinical parameters in terms of the side of symptoms, age, gender, duration of low back pain or leg pain, the angle of a positive straight leg raising test, and the time required for recovery of sciatic scoliosis were investigated. In addition, magnetic resonance imaging also was performed in five recent cases from 40 patients.
The average Cobb angle decreased from 10.7 degrees to 2.7 degrees within an average of 7.5 months after surgery. The preoperative Cobb angle of patients with disc herniation medial to the nerve root was significantly higher than that just beneath or lateral to the nerve root. Thirty-two of 40 patients (80.0%) had a lumbar disc herniation at the convex side of scoliosis, irrespective of the transverse location of the herniation. The time required for scoliosis disappearance in disc herniation located lateral to the nerve root tended to be longer than that for other types of disc herniation. Magnetic resonance imaging through the paramedian planes showed enlargement of the intervertebral foramen at the convex side of scoliosis, compared with that at the concave side in five recent cases from the current study.
These results suggest that sciatic scoliotic list is not a predictive factor of the anatomic location of disc herniation; rather, it is only suggestive of the side of disc herniation. The location of disc herniation may aide in the preoperative estimation of the recovery of the scoliosis.
作者回顾性分析了40例经手术证实为腰椎间盘突出症且伴有坐骨神经侧弯并术后恢复的患者中，椎间盘突出位置与术前及术后坐骨神经侧弯变化之间的关系。还纳入了与脊柱侧弯相关的临床因素。
评估坐骨神经侧弯的意义及发病机制。
腰椎坐骨神经侧弯的推测病因主要暗示椎间盘突出相对于神经根的解剖位置与神经根刺激减轻有关。
测量站立位腰椎前后位X线片上L1至L5的术前及术后连续Cobb角。研究脊柱侧弯凸侧与症状侧、年龄、性别、腰痛或腿痛持续时间、直腿抬高试验阳性角度以及坐骨神经侧弯恢复所需时间等临床参数之间的关系。此外，对40例患者中的5例近期病例进行了磁共振成像检查。
术后平均7.5个月内，平均Cobb角从10.7度降至2.7度。神经根内侧椎间盘突出患者的术前Cobb角显著高于神经根正下方或外侧的患者。40例患者中有32例（80.0%）在脊柱侧弯凸侧有腰椎间盘突出，无论突出的横向位置如何。神经根外侧椎间盘突出患者脊柱侧弯消失所需时间往往比其他类型的椎间盘突出患者更长。在本研究的5例近期病例中，经旁正中平面的磁共振成像显示，脊柱侧弯凸侧的椎间孔比凹侧扩大。
这些结果表明，坐骨神经侧弯不是椎间盘突出解剖位置的预测因素；相反，它仅提示椎间盘突出的侧别。椎间盘突出的位置可能有助于术前评估脊柱侧弯的恢复情况。
