椎间孔高度改变与退变性腰4椎体滑脱症术后根性神经痛的相关性

Correlation between radicular pain and dropping of intervertebral foramina height at L_(4-5) after operation for degenerative spondylolisthesis

目的探讨退变性L_4椎体滑脱症手术前、后椎间孔高度改变与术后L_4根性神经痛的关系。方法 47例退变性L_4椎体滑脱症患者,均行腰椎后路椎弓根钉棒复位固定+椎管减压+椎间植骨融合术,术后发生L_4根性神经痛者23例为根性疼痛组,无根性神经痛者24例为无症状组;记录2组手术时间、术中出血量等,根据手术前、后X线平片检查结果,应用PACS系统测量侧位片上椎间孔高度,并进行2组间比较。结果 2组手术过程均顺利,根性疼痛组手术时间[(97.0±11.0)min]、术中出血量[(235.0±19.0)mL]与无症状组[(95.5±12.1)min、(230.2±21.0)mL]比较差异无统计学意义(P>0.05),2组术后影像学检查显示腰椎滑脱复位良好;根性疼痛组手术前、后椎间孔高度[(21.79±2.09)、(18.93±1.53)mm]与无症状组[(20.87±1.12)、(19.55±1.10)mm]比较差异均无统计学意义(P>0.05),术后2组椎间孔高度均较术前降低(P<0.05),根性疼痛组椎间孔高度改变值[(2.86±1.00)mm]大于无症状组[(1.32±0.76)mm](P<0.05)。结论退变性腰椎滑脱症术后发生根性神经痛与术后椎间孔高度改变有关,手术应尽可能恢复椎间孔高度。

Objective To explore the correlation between radicular pain and dropping of intervertebral foramina height at L_(4-5)after operation for degenerative spondylolisthesis.Methods Forty-seven patients with degenerative spondylolisthesis at L_(4-5)received pedicle screw pulling technique combining with distraction reduction technique,spinal canal decompression and interbody fusion,and were divided into radicular pain group(n=23)and symptomless group(n=24)according to whether there were radical pain after operation.The operation lasting time and bleeding volume were recorded.Intervertebral foramina heights on pre-and post-operative X-ray were measured with PACS system and were compared between two groups.Results Operations were performed smothly in both groups.There were no significant differences in the average operation lasting time((97.0±11.0)min vs(95.5±12.1)min)and the average blood loss((235.0±19.0)mL vs(230.2±21.0)mL)between radicular pain group and symptomless group(P>0.05).The postoperative radiographic examination showed a good reposition of lumbar olisthe.The mean intervertebral foramina heights before and after operation((21.79±2.09),(18.93±1.53)mm)in radicular pain group showed no significant differences in comparison with those in symptomless group((20.87±1.12),(19.55±1.10)mm)(P>0.05),and were reduced after operation in both groups(P<0.05).The intervertebral foramina height reduced by((2.86±1.00)mm),significantly larger in radicular pain group than that in symptomless group((1.32±0.76)mm)(P<0.05).Conclusion Radicular pain is correlated with the dropping of intervertebral foramina height after operation of degenerative spondylolisthesis,therefore the height should be remained in operation.