微创经椎间孔入路腰椎椎间融合术后发生非症状侧肢体疼痛的原因探讨

Causes of asymptomatic side limb pain after minimally invasive transforaminal lumbar interbody fusion

目的:探讨微创经椎间孔入路腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)术后对侧肢体疼痛发生的可能原因和预防措施。方法:对2019年1月至2020年9月采用MIS-TLIF手术治疗的50例腰椎退行性疾病患者进行回顾性分析,男29例,女21例,年龄33~72(65.30±7.13)岁,其中22例采取单侧减压,28例采取双侧减压。记录术前、术后3 d和术后3个月疼痛发生的侧别(患侧或对侧)和部位(腰部、臀部、下肢),采用疼痛视觉模拟评分(visual analogue scale,VAS)评估各时间点患者的疼痛程度。再根据术后是否发生对侧疼痛进行分组(对侧疼痛组8例,无对侧疼痛组42例),分析发生疼痛的原因和预防措施。结果:所有手术顺利完成,50例患者术后均获得至少3个月随访,术前症状侧(患侧)的疼痛均获得改善,VAS由术前的(7.00±1.79)分降低至术后3 d的(3.38±1.32)分,以及术后3个月的(1.98±1.17)分,8例术后3 d内出现术前非症状侧(对侧)的疼痛症状,占16%(8/50),疼痛部位分布包括腰部1例,臀部6例,下肢1例。术后3个月随访,对侧肢体疼痛均较术后减轻。结论:单侧减压MIS-TLIF术后发生对侧肢体疼痛的比例较高,可能的原因包括对侧椎间孔狭窄、脊神经后内侧支压迫等。通过适当恢复椎间隙高度、横置融合器、少量退钉等操作可能有助于减少这一并发症的发生。

Objective To investigate possible causes and preventive measures for asymptomatic pain in the limbs after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).Methods Clinical data from 50 patients with lumbar degenerative disease who underwent MIS-TLIF between January 2019 and September 2020 were retrospectively analyzed.The group included 29 males and 21 females aged from 33 to 72 years old,with an average age of(65.3±7.13)years.Twenty-two patients underwent unilateral decompression,and 28 underwent bilateral decompression.The side(ipsilateral or contralateral)and site(low back,hip,or leg)of the pain were recorded before surgery,3 days after surgery,and 3 months after surgery.The pain degree was evaluated using the visual analogue scale(VAS)at each time point.The patients were further grouped based on whether contralateral pain occurred postoperatively(8 cases in the contralateral pain group and 42 in the no contralateral pain group),and the causes and preventive measures of pain were analyzed.Results All surgeries were successful,and the patients were followed up for at least 3 months.Preoperative pain on the symptomatic side improved significantly,with the VAS score decreasing from(7.00±1.79)points preoperatively to(3.38±1.32)points at 3 days postoperatively and(3.98±1.17)points at 3 months postoperatively.Postoperative asymptomatic side pain(contralateral pain)occurred in 8 patients within 3 days after surgery,accounting for 16%(8/50)of the group.The sites of contralateral pain included the lumbar area(1 case),hip(6 cases),and leg(1 case).The contralateral pain was significantly relieved 3 months after surgery.Conclusion More cases of contralateral limb pain occur after unilateral decompression MIS-TLIF,and the reason may include contralateral foramen stenosis,compression of medial branches,and other factors.To reduce this complication,the following procedures are recommended:restoring intervertebral height,inserting a transverse cage,and withdrawing screws minimally.