椎间盘源性腰痛的诊断与治疗方法

Diagnosis and treatment of discogenic low back pain

目的探讨腰椎间盘源性疼痛的诊断方法及经后路椎体间植骨融合椎弓根螺钉内固定术的临床疗效。方法 35例经保守治疗无效的椎间盘源性腰痛患者均行经后路椎体间植骨融合椎弓根螺钉内固定术。患者平均年龄45岁。L4~5为22例,L5S1为13例。术后5d下地活动,腰围固定3个月。结果所有患者随访12~48个月,平均24个月。VAS评分由术前平均82分降至术后平均15分;ODI评分由术前平均54分,降至随访6个月时的平均16分。椎间隙高度由术前平均8.9mm增加至术后平均13.3mm。结论椎间盘源性腰痛由于临床和影像学表现的不典型,常常被漏诊和误诊,可以结合MRI和椎间盘造影进行诊断。经后路椎体间植骨融合椎弓根螺钉内固定术是治疗椎间盘源性腰痛的有效方法 。

Objective To explore disgnostic method to discogenic low back pain and evaluate the effect of transforaminal lumber interbody fusion. Methods 35 patients who underwent a failed conservative trealment for at least 3 months received surgery.The surgically treatd patients aged 45 years on average.The treated dics located:22 in L4~5,13 in L5S1;35 cases (35 discs) received transforaminal lumber interbody fusion.The patients were allowed to leave bed with a brace 5 days postoperatively,and the brace was used for 3 months. Results All the cases were followed up for 24 months on average (12 ~48 months),at the end of follow up,all the patients recovered normal social life and work without any symptoms.VAS decreased from 82 preoperatively to 15 postoperatively;ODI decreased from 54 preoperatively to average 16 at 6 months postoperatively. Disc height increased from 8.9mm preoperatively to 13.3mm postoperatively. Conclusion Because of alypical symptoms,discogenic low back pain which is easily misdiagnosed should always be kept in mind when alypical back and leg pain are encountered.Discography provides good different diagnosis.Surgical treatment provides satisfactory outcome.