腰骶部神经根畸形的诊断及治疗

Diagnosis and treatment of lumbosacral nerve roots anomalies

[目的]探讨腰骶部神经根畸形的诊断及治疗。[方法]分析经手术证实的腰骶部神经根畸形的致病因素、分类、诊断及治疗。采用腰椎全椎板、半椎板减压各8例,扩大开窗9例。[结果]腰骶部神经根畸形多因椎间盘突出或椎管狭窄引起症状。本组发现联合神经根10例,神经根紧密相靠8例,神经根增粗2例,神经根低起点2例,神经根分裂1例,复根1例,神经根吻合1例。其中L4神经根畸形1例,L5神经根畸形14例,S1神经根畸形10例。术前脊髓造影、CT及MRI仅发现5例,其余均在术中探查发现。术后随访2年以上,疗效优12例,良8例,可4例。1例残留下肢放射痛,足背伸力差。[结论]腰骶部神经根畸形神经根症状多变,术前脊髓造影、CT及MRI(轴位、矢状位)诊断困难,需改进诊断方法。增强医生认识腰骶部神经根畸形的意识,术中仔细探查神经根,充分暴露,彻底减压,能提高手术疗效。

[ Objective] To investigate the diagnosis and treatment of lumbosacral nerve roots anomalies. [ Method] Etiological factors, typing, diagnosis and treatment of lumbosacral nerve roots anomalies confirmed by operation were analyzed. Operative treatment included wide laminectomy （ n = 8 ）, hemilaminectomy （ n = 8 ） and enlargement fenestration （ n = 9 ） . [ Resuit] The presenting symptoms of lumbosacral nerve roots anomalies often resulted from lumbar disc herniation or spinal canal stenosis. The typs of lumbosacral nerve roots anomalies included conjoined nerve roots （n = 10）, closely adjacent roots （n = 8 ）, thickening of nerve roots （ n = 2 ）, caudal origin roots （ n = 2 ）, division of nerve roots （ n = 1 ）, double nerve roots （ n = 1 ）, and anastomosis of nerve roots （ n = 1 ） . The levels of nerve roots anomalies were L4 in 1, L5 in 14 , and S1 in 10. Only 5 cases were diagnosed preoperatively by myelography, CT or MRI. The others were found at operation. All patients were followed up for more than 2 years. Postoperatively, the results were rated as excellent in 12 , good in 8, and fair in 4. One patient had residual radiating pain in the lower lims and weakness in dorsiflexion of the foot. [ Conclusion] Radicular symptoms of lumbosacral nerve roots anomalies are changeable. The preoperative diagnosis is difficult to establish by myelography, CT or MRI （axial and sagittal plane） . It is necessary to heighten the sensitivity of diagnostic modalities. It may improve the surgical outcomes to expose sufficiently, to explore the nerve roots carefully and to decompress thoroughly.