腰椎间盘突出合并侧隐窝狭窄症33例报告

Lumbar Disc Herniation Accompanied with Lateral Recess Stenosis (A Report of 33 Cases)

本文报告了手术治疗腰间盘突出合并侧隐窝狭窄３３例。其中单侧２８例，双侧５例。４例合并中央管狭窄，２例合并马尾综合征，１例合并椎体滑脱。根据各自的病理特点分别行全椎板、半椎板或开窗减压。手术处理包括摘除突出的椎间盘，切除增生的黄韧带、小关节突和椎体后缘骨赘，从而扩大狭窄的侧隐窝，使神经根充分减压。经１２月～４年６个月（平均２８年）随访，优２２例，良８例，无改善３例。作者认为手术摘除突出髓核后，必须探查神经根的其他致压因素，以防遗漏。手术既要减压充分。

Objective:To report experience in surgical treatment of lumbar disc herniation combined with stenosis of lateral recess.Methods:33 cases of lumbar disc herniation accompanied with lateral recess stenosis were treated surgically.28 cases were unilateral and 5 were bilateral.Of 33 cases,4 were accompanied with central stenosis,2 with cauda equina syndrome and one with spondylolisthesis.Laminectomy,hemilaminectomy or minimal laminectomy were performed respectively according to each patients local pathologic feature.The procedures include removal of nucleus pulposus,excision of hypertrophic ligament flavum,abscission of enlarged of facet and posterior vertebral osteophytes,in order to enlarge the confined lateral recess and relieve the neural roots compression.Results:After 12 to 54 months follow up,the results were excellent in 22 cases,good in 8 and not improved in 3. Conclusion:It is important that the other factors compressing the neural roots should be explored after removal of nucleus pulposus.The objectives of operation are relief the compression of neural roots and maintain the stability of lumbar spine.