选择性神经根封闭术在多节段腰椎管狭窄症诊治中的应用

The Value of Selective Diagnostic Nerve Root Block in the Treatment of Multilevel Degenerated Lumbar Spinal Stenosis

目的探讨选择性神经根封闭术在多节段腰椎管狭窄症定位诊断及术式选择中的作用。方法自2008年7月至2010年4月收治多节段腰椎管狭窄症患者共53例,男20例,女33例;年龄57～85岁,平均68岁。所有患者均采用选择性神经根封闭术明确责任节段。根据责任节段行手术治疗,A组采用开窗减压、间盘摘除术;B组采用椎板减压、椎间植骨融合、椎弓根螺钉固定术。术前、术后均采用视觉模拟评分法(visual analogue scale,VAS)及日本骨科协会(Japanese orthopaedic association,JOA)评分进行疗效评估。结果选择性神经根封闭术明确单节段责任间隙40例,两节段11例,有2例在神经根封闭后症状缓解不到30%,未再行手术治疗。A组(18例)手术前、后及最后随访时JOA评分分别为(5.8±2.3)分、(12.3±1.6)分、(11.9±1.3)分,VAS评分分别为(7.6±1.6)分、(2.3±1.5)分、(1.8±1.1)分。B组(33例)进行单节段融合29例,两节段融合4例,手术前、后及最后随访时JOA评分分别为(5.5±2.1)分、(11.8±1.8)分、(11.6±1.5)分,VAS评分分别为(7.4±2.3)分、(2.5±1.2)分、(2.1±1.5)分。术后及最后随访时JOA、VAS评分与术前比较差异有统计学意义(P<0.001),A组与B组术前、术后JOA、VAS评分差异无统计学意义(P>0.05)。结论在腰椎管狭窄症的定位诊断中,选择性神经根封闭是明确责任节段准确而有效的方法,有助于减小手术范围,提高手术疗效。

Objective To explore the value of selective diagnostic nerve root block in the treatment of multilevel degenerated lumbar spinal stenosis.Methods 53 cases of multilevel degenerated lumbar spinal stenosis were treated between July 2008 and April 2010.There were 20 males and 33 females with the mean age of 68 years old.Selective diagnostic nerve root block was used in all cases to identify ＇the responsible segments＇.Based on the results,surgical treatment was divided into two group.In Group A,18 cases were treated by decompression and discectomy,In Group B,33 cases were treated by hemi-laminectomy decompression,intervertebral bone graft with cage and pedicle screws instrumentation.The clinical outcomes were evaluated by Japanese Orthopedic Association（JOA） score and VAS score.Results The responsible segment was identified single level in 40 cases and two levels in 11 cases by selective diagnostic nerve root block.In which 2 cases did not receive further surgical treatment due to a low relief rate of 30%.Group A showed JOA scores of（5.8±2.3）,（12.3±1.6） and（11.9±1.3）,VAS scores of（7.6±1.6）,（2.3±1.5） and（1.8±1.1） in pre-op,post-op and final follow-up,respectively.29 cases were received single level fusion and 4 cases double level fusion in Group B,JOA scores were（5.5±2.1）,（11.8±1.8） and（11.6±1.5）,VAS scores were（7.4±2.3）,（2.5±1.2） and（2.1±1.5） in pre-op,post-op and final follow-up,respectively.Significant difference were found in pre-op and post-op JOA VAS scores（P0.001）.However,the comparison of pre-op/post-op JOA scores in group A and group B displayed no statistic difference（P0.05）.Conclusion Selective diagnostic nerve root block is an effective and accurate method to identify the responsible segment in the treatment of multilevel degenerated lumbar spinal stenosis,it can help to reduce surgical levels and enhance surgical effect.