侧方入路腰椎椎间融合术治疗腰椎管狭窄症伴马尾神经冗余征的疗效分析

Clinical outcome of lateral lumbar interbody fusion in the treatment of lumbar spinal stenosis with redundant nerve roots

中文关键词:  腰椎  椎管狭窄症  马尾神经冗余  脊柱融合术

英文关键词:Lumbar spine  Spinal stenosis  Redundant nerve roots  Spinal fusion

中文摘要:

  【摘要】 目的：探讨侧方入路腰椎椎间融合术治疗腰椎管狭窄症伴马尾神经冗余征（redundant nerve roots，RNRs）的临床疗效。方法：回顾性分析2018年1月～2022年7月在我院接受侧方入路腰椎椎间融合术治疗48例腰椎管狭窄症伴马尾神经冗余征的病例资料，男23例，女25例，年龄45～81岁，平均65.4±7.5岁，接受单节段手术17例，多节段手术31例。患者术前及术后均进行腰椎MRI扫描，按术后的RNRs是否解除分为RNRs解除组（A组）与RNRs未解除组（B组）。测量两组患者术前术后马尾神经冗余节段的椎间隙高度、椎间隙角度、椎管横截面积等指标进行影像学评估。术前和术后1个月时采用疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association Scores，JOA）评分评估手术疗效。结果：所有患者均顺利完成手术。A组术前的椎管横截面积为65.2±21.5mm2，B组为35.9±11.5mm2，两组间有显著性差异（P＜0.05）。A组术后的椎间隙后缘高度和椎管横截面积分别为8.3±1.7mm和92.6±25.8mm2，B组分别为6.0±2.3mm和45.4±12.1mm2，两组间比较均有显著性差异（P＜0.05）。术后1个月A组的腿痛VAS评分、ODI和JOA评分分别为2.4±0.8分、（24.1±3.0）%和22.8±1.9分，B组分别为3.3±0.8分、（30.2±4.4）%和17.7±2.5分，两组间比较均有显著性差异（P＜0.05）。术后的并发症发生率为10.4%，出现大腿前方疼痛4例，腰大肌肌力减退1例，均在术后3个月随访时完全缓解。结论：侧方入路腰椎椎间融合术可通过椎间隙后缘高度的恢复和椎管横截面积的扩大消除马尾神经冗余现象，为大多数腰椎管狭窄症伴马尾神经冗余征患者提供有效的治疗方式。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy and outcome of lateral lumbar interbody fusion in the treatment of lumbar spinal stenosis(LSS) with redundant nerve roots(RNRs). Methods: The data of 48 LSS patients with RNRs(23 males and 25 females, aged 45-81 years, on average 65.4±7.5 years) treated with lateral lumbar interbody fusion between January 2018 and July 2022 in our hospital were analyzed retrospectively. Among the patients, 17 cases received single-level surgery and 31 cases received multi-level surgery. On the basis of the postoperative supine MRI scans, the patients were divided into RNRs relieved group(group A) and RNRs unrelieved group(group B). Radiographic assessments included disc heights, segmental angle and cross-sectional area of the spinal canal at the RNRs segment before and after operation were performed. The visual analogue scale(VAS), Oswestry disability index(ODI) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical outcomes at preoperation and 1 month after surgery. Results: All patients underwent surgery successfully. The preoperative cross-sectional area of the spinal canal was 65.2±21.5mm2 in group A and 35.9±11.5mm2 in group B, with a significant difference(P＜0.05). The posterior disk height and cross-sectional area of the spinal canal was 8.3±1.7mm and 92.6±25.8mm2 respectively in group A, and that of group B was 6.0±2.3mm and 45.4±12.1mm2 respectively, the differences were significantly statistical(P＜0.05). Furthermore, in 1 month after operation the VAS leg pain, ODI and JOA scores was 2.4±0.8, (24.1±3.0)％ and 22.8±1.9 respectively in group A, and that of group B was 3.3±0.8, (30.2±4.4)％ and 17.7±2.5 respectively, the differences were significantly statistical(P＜0.05). The total incidence of complications was 10.4%, including anterolateral thigh pain in 4 cases and hip flexor weakness in 1 case, which were released at 3 months of follow-up. Conclusions: Lateral lumbar interbody fusion can eliminate RNRs by restoring postoperative posterior disc height and enlarging the cross-sectional area of spinal canal, which provides an effective treatment for most LSS patients with RNRs.