极外侧型腰椎间盘突出症的诊断与治疗

Diagnosis and Treatment of Extreme Lateral Prolapse of Intervertebral disc

目的 :探讨极外侧型腰椎间盘突出症的诊断与手术入路选择。方法 :本症 8例有 6例压迫 L3和 L4神经根 ,股四头肌不完全瘫合并萎缩 ,而腰痛轻微甚至无腰痛是其临床特征。 8例均作 CT扫描 ,4例同时行 MRI检查 ,3例采用椎管内入路切除椎板 ,椎弓峡部及上、下关节突 ,4例采用椎旁椎板外侧入路 ,仅切除峡部外缘及上关节突外上缘 ,1例采用椎管内外联合入路摘除突出或脱出髓核。结果 :8例均得到随访 ,优 6例 ,良 2例 ,效果满意。结论 :极外侧型腰椎间盘突出症不同于中央型 ,后外型突出 ,依据临床、CT或 MRI检查 ,可明确诊断。采用椎旁椎板外侧入路显露充分。

Objective:To investigate diagnosis and operation approach of extreme lateral prolapse of Intervertebral disc.Methods:We studied 8 cases,6 of them suffered from compression of L 3 or L 4 nerve root,partial paralysis.Complicated atrophy of quadriceps femoris.The clinical features is patients suffered slight of even no Lumbodynia.All cases underwent CT examination and 4 of them also underwent MRI examination.3 cases accepted intravertebral approach and removal of vertebral lamina,isthmus of verebral arch and zygapophysis.4 cases accepted approach of paravertebral and vertebral lamina.only removed periphery of vertebral arch,Lateral and upper edge of prezygapophysis.1 case underwent resection of nucleus pulposus of intervertebral disc through union approach of intra and extravertabral.Results:all cases were followed up.The effect was satisfied;6 excellent and 2 good.Conclusion:Extreme Lateral prolapes of intervertebral disc is differ from types of central and posteroexternal.Confirmend diagnosis can be made according to clinical features and CT or MRI examination.Approach of paravertebral and veretbral lamina can get fully expose with convenient and without affeeting stable of spine.