选择性神经根阻滞在非典型腰椎间盘突出症微创手术中的应用

Treatment of atypical lumbar disc herniation by nerve root injection plus minimally invasive spinal surgery

目的探讨选择性神经根封闭术在非典型腰椎间盘突出症微创手术中的临床应用价值。方法回顾性分析自2014-05—2016-12诊治的58例非典型腰椎间盘突出症,术中采用选择性神经根封闭术进行责任椎间盘定位,29例采用经皮内窥镜下椎间盘摘除术(PELD)治疗,29例采用微创经椎间孔椎间融合术(MIS-TLIF)治疗。比较术前、术后3 d及末次随访时的疼痛VAS评分及ODI指数。结果 PELD组27例获得随访,MIS-TLIF组26例获得随访,随访时间平均12(3~18)个月。PELD组与MIS-TLIF组术后3 d疼痛VAS评分、ODI指数较术前明显改善,且末次随访时疼痛VAS评分、ODI指数较术后3 d明显改善,差异有统计学意义(P<0.05)。结论选择性神经根封闭术作为一种辅助性诊断方法,操作简单、定位准确可靠,能弥补CT、MRI等影像学检查的不足,为多节段非典型腰椎间盘突出症患者提供精确的定位诊断,从而有针对性地进行有限却有效的微创减压手术治疗,效果满意。

Objective To explore the value of nerve root injection in the treatment of atypical lumbar disc herniation.Methods Fifty-eight patients with atypical lumbar disc protrusion were included between May 2014 and December 2016.Selective lumbar nerve root block was carried out to fix the responsible section before minimally invasive surgery. The patients were divided into two groups： 29 patients were treated by percutaneous endoscopic lumbar discectomy（PELD）, while 29 patients underwent the operation of minimally invasive spinal surgery transforaminal lumbar interbody fusion（MIS-TLIF）.Visual analogue scale（VAS） and Oswestry disability index（ODI） were applied to evaluate the effect of surgery at the time of last follow-up, 3 days before and after the operation. Results All cases included in our study（excluding 5 defaulters） had a mean follow-up of 1 year（range 3-18 months）. The VAS and ODI score after the surgery were significantly improved than that before the operation. Compared with the data after the operation, VAS and ODI score at the last follow-up were notably improved. Conclusion Selective nerve root block is a simple, accurate and effective method in the location and diagnosis of segmental lumbar diseases. It can help to improve the curative effect and decrease invalid operative trauma, which could also compensate for the deficiency of CT MRI and other imaging examinations, providing accurate localization diagnosis for patients with multisegment atypical lumbar disc herniation. Therefore selective nerve root block is a limited but effective minimally invasive decompression surgery with satisfactory results.