42例腰椎融合术后难治性下腰痛的治疗体会

Treatment of low back pain following lumbar fusion: an experience of 42 cases

目的探讨腰椎融合术后骶髂关节病变的特点及治疗方法与疗效。方法回顾性分析42例因腰椎退变性滑脱、腰椎椎间盘突出、腰椎椎管狭窄曾行后路减压、后外侧或椎体间植骨融合及椎弓根内固定术,术后随访12～72个月(平均42.6个月)出现新的难治性持续性下腰痛症状的病例。本研究运用骶髂关节内封闭进行诊断性治疗。阳性标准:疼痛缓解≥75%,采用疼痛视觉模拟量表(visual analogue scale,VAS)进行定量分析。结果阳性12例(28.57%),是否融合L5/S1、术后疼痛缓解期是否≥3个月与诊断阳性率相关,有统计学意义(P<0.05)。结论腰椎融合术后下腰痛部分可能是由骶髂关节病变引起的,L5/S1融合可能促进骶髂关节发生退变。症状以下腰痛症状为主者,手术应慎重。

Objective To discuss the clinical characteristics, surgical procedures and clinical outcomes of Sacroiliac joint pain following lumbar fusion, Methods A total of 42 patients receiving operation for lumbar degenerative spodylolisthesis or lumbar disc herniation or lumbar canal stenosis were retrospectively reviewed. The surgical procedures included laminectomy, posterolateral fusion or posterior lumbar interbody fusion, and pedicle screw fixation. The patients who had refractory persistent low back pain for during 12-72 months （a mean of 42.6 months） after operation, were followed up. We used sacroiliac anes- thetic blocks for diagnostic treatment. The diagnostic criterion was a relief of pain by ≥75% on a visual analog scale（VAS）. Results Positive block rate was 28.57% （ 12 cases） in the present group. Positive block rate related to the level of fusion and the length of the pain-free interval, and it had statistical significance （ P 〈 0.05 ） Conclusion Sacroiliac joint pain follow- ing lumbar fusion is one of the causes for recurrence of low back pain. Range of lumbar fusion includes L5/S1 , which may contribute to degeneration of the sacroiliac joint. Operation should be carefully evaluated for patients with the main symptom as low back pain.