胸腰椎间盘多节段突出导致椎管狭窄的外科治疗

目的 探讨胸腰椎间盘多节段突出导致椎管狭窄的手术治疗方法.方法 1999年1月至2007年1月采用选择性开窗﹑"责任"椎间盘摘除﹑椎板切除、后路椎间植骨融合联合椎弓根钉固定系统内固定治疗108例胸腰椎间盘多节段突出导致椎管狭窄患者,其中男77例,女31例;年龄43～81岁.病程6个月至18年,平均1.5年.经详细询问病史﹑全面体格检查、腰椎X线片、CT、MRI检查,确定"责任"椎间盘及狭窄间隙.胸椎间盘突出11例、腰椎间盘突出84例、胸腰椎间盘突出13例.术中摘除腰椎间盘髓核153个﹑胸椎间盘髓核8个,椎间植骨融合78个间隙,椎弓根钉系统内固定20例.手术疗效根据Oswestry功能障碍指数判断.结果 108例获随访1-2年,平均13个月.优62例,良25例,可21例,无差级病例,总的优良率为80.6%.未出现断钉、松动及骨不融合现象.术后复查X线片所有患者均于6-12个月骨性愈合,未见假关节形成.结论 选择性开窗神经根管减压﹑准确切除"责任"椎间盘﹑必要时椎板切除、后路椎间植骨融合联合椎弓根钉固定系统内固定治疗胸腰椎间盘多节段突出导致椎管狭窄,可取得良好的疗效.

Surgical treatment for spinal stenosis caused by multi-segmental thoracic and/or lumbar intervertebral disc herniation

Objective To investigate the surgical procedures in the treatment of spinal stenosis caused by multi-segmental thoracic and/or lumbar intervertebral disc herniation. Methods From January 1999 to January 2007, 108 patients （77 males, 31 females） with spinal stenosis caused by multi-segmental thoracic and/or lumbar intervertebral disc herniation were treated with selective fenestration, removal of affected disc, vertebral plate excision, and posterior lumbar interbody fusion （PLIF） plus internal fixation with pedicle screw system. Their ages ranged from 43 to 81 years. The average course of disease was 1.5 years （range, 6 months-18 years）. For all the patients, the affected intervertebral discs and narrowing disc space were confirmed through detailed inquiry of the clinical history, overall physical examination as well as X-ray, CT and MRI imaging tests of lumbar spine. 11 cases were with thoracic intervertebral disc herniation, 84 cases with lumbar intervertebral disc herniation and 13 cases with thoracic and lumbar intervertebral disc herniation. 153 lumbar nucleus pulposus and 8 thoracic nucleus pulposus were excised intra-operatively. PLIF was performed to fuse 78 intervertebral spaces. 20 cases underwent internal fixation with pedicle screw system. Oswestry disability index （ODI） was applied to assess the surgical efficacy. Results All the 108 patients were followed up with an average period of 13 months （range, 1-2 years）. The results were excellent （n=62）, good （n=25）, fair （n=21）, and bad （n=0）. The overall excellent and good rate was 80.6%. No pedicle screw breakage and loosening, nor non-union of bone occured. Post-operatively, all patients achieved bony union in 6-12 months according to the X-ray re-examination. No formation of pseudo-articulation was seen. Conslusions It can achieve good efficacy in the treatment of spinal stenosis caused by multi-segmental thoracic and/or lumbar intervertebral disc herniation through selective fenestration decompression for nerve root, accurate removal of affected disc, vertebral plate excision when necessary, and PLIF plus internal fixation with pedicle screw system.