腰椎椎间孔镜手术治疗伴神经根管狭窄的腰椎椎间盘突出症

Percutaneous endoscopic lumbar discectomy and foraminalplasty for lumbar intervertebral disc herniation with stenosis of spinal nerve root canal

目的退变性腰椎椎间盘突出、黄韧带肥厚、关节突关节增生内聚引起神经根管狭窄,利用椎间孔镜对神经根管进行减压。方法对20例退变性神经根管狭窄症患者行腰椎椎间孔镜下神经根管扩大成形术,记录术前术后腰腿痛疼痛视觉模拟量表(visual analogue scale,VAS)评分,采用Macnab标准评价疗效。结果 20例患者术前平均腰痛VAS评分为5分,术后即刻为1.5分,术后3个月为0.5分。术前平均腿痛VAS评分为7分,术后即刻为0.3分,术后3个月为0.1分。18例患者术后3个月的改良Macnab疗效评定为优,2例患者为良。结论对腰椎退变性神经根管狭窄症,椎间孔镜可对突出的腰椎椎间盘、关节突关节以及黄韧带进行减压,有效地扩大神经根管,可获得很好的疗效。

Objective Degenerative lumbar intervertebral disc herniation, hypertrophy of the ligamentum flavum and hyperplasy of zygapophysial joint were the main cause of nerve root canal stenosis. To find out a effective way for the treatment of lumbar nerve root canal stenosis by percutaneous endoscopic lumbar discectomy （PELD）. Methods A totla of 20 patients of lumbar intervertebral disc herniation with stenosis of nerve root canal underwent PELD and foraminalplasty from Octomber 2013 to May 2014. Preoperative and postoperative clinical results were analyzed by visual analogue scale（VAS） scroes and Macnab evaluation standardization. Results During the operation, stenosis of nerve root-canal was detected at the symptomatic side of the operative level in all the patients. PELD and foraminalplasty was performed for all the patients. In the 3-month follow-up, the average VAS score decreased to 0. 1. Curative effect was excellent for 18 patients and fair for 2 patients according to Macnab evaluation standardization. Conclusion PELD and foraminalplasty is a useful way for the treatment of lumbar intervertebral disc herniation with stenosis of nerve root canal.