显微神经根减压术治疗腰椎管狭窄症

Microsurgical nerve root decompression for the treatment of lumbar spinal stenosis

目的探讨显微镜下微创小切口脊神经根减压术治疗腰椎管狭窄症的疗效。方法回顾性分析110例腰椎管狭窄症病例资料,均行神经电生理监测与显微镜下神经减压治疗。在术前1 d、术后3个月、术后6个月及术后12个月进行疼痛视觉模拟评分(visual analogue score,VAS)与腰椎Oswestry功能障碍指数(Oswestry dysfunction index,ODI)评价。结果一侧入路单侧减压86例,双侧减压24例。术前1 d、术后3个月、术后6个月及术后12个月VAS分别为(5.81±0.93)、(1.77±0.72)、(0.78±0.34)与(0.56±0.32),而ODI分别为(53.04±20.98)、(30.91±6.78)、(25.06±5.61)与(21.85±5.39);其中任意两个时间点比较,差异均有统计学意义(P <0.001)。ODI改善率:优76例(69%),良25例(22.7%),可5例(4.5%),差4例(3.6%);总优良率91.8%(101/110)。术中神经损伤2例,硬膜囊撕裂2例,无椎间隙感染和腰椎不稳发生。结论显微神经根减压术能完成脊神经根精确、充分减压,并具有明显微创特点,是治疗腰椎管狭窄症安全、优良的术式,值得在神经外科临床推广应用。

Objective To explore the efficacy of minimally invasive small incision spinal nerve root decompression under a microscope for the treatment of lumbar spinal stenosis. Methods The data of 110 patients with lumbar spinal canal stenosis were analyzed retrospectively, and all were treated with neuroelectrophysiological monitoring and nerve decompression under the microscope. The visual analogue score(VAS) and lumbar spine Oswestry dysfunction index(ODI) were evaluated 1 day before surgery, 3 months after surgery, 6 months after surgery, and 12 months after surgery. Results Eighty-six patients received unilateral decompression via one side approach and 24 underwent bilateral decompression. The VAS at 1 day before surgery, 3 months after surgery, 6 months after surgery and 12 months after surgery was 5.81 ± 0.93, 1.77 ± 0.72, 0.78 ± 0.34 and 0.56 ± 0.32, while ODI was 53.04 ± 20.98, 30.91 ± 6.78, 25.06 ± 5.61 and 21.85 ± 5.39 respectively. The difference between any two time points was statistically significant(P < 0.001). The ODI improvement rate was excellent in 76 cases(69%), good in 25(22.7%), fair in 5(4.5%), poor in 4(3.6%);the overall excellent or good clinical outcome rate was 91.8%(101/110). There was intraoperative nerve injury in 2 cases and dural sac tear in 2, no intervertebral space infection and lumbar instability occurred. Conclusions Microsurgical nerve root decompression can complete the precise and adequate decompression of spinal nerve roots, and has obvious minimally invasive characteristics. It is a safe and excellent surgical method for the treatment of lumbar spinal stenosis, and it is worthy of wider clinical application in neurosurgery.