经皮椎间孔镜治疗腰椎管狭窄症的临床效果

目的探讨经皮椎间孔镜治疗腰椎管狭窄症(LSS)的临床效果。方法回顾性分析43例单节段LSS患者的临床资料,根据不同术式将患者分为A组(经皮椎间孔镜,22例)与B组[后路腰椎体间融合术(PLIF),21例]。比较两组的治疗效果。结果A组患者的切口长度、住院时间均短于B组,手术时间长于B组,透视次数多于B组,出血量少于B组(P<0.05)。术前、术后6个月、1年及末次随访时,两组的VAS、ODI评分比较,差异无统计学意义(P>0.05);术后1个月,A组的VAS、ODI评分低于B组(P<0.05)。结论经皮椎间孔镜治疗LSS的临床效果显著,且具有手术创伤小、出血少、康复快的特点,值得临床推广应用。     

改良经皮椎间孔脊柱内镜技术、经皮椎间孔镜椎间盘切除术治疗腰椎间盘突出症的效果比较

目的 比较改良经皮椎间孔脊柱内镜技术、经皮椎间孔镜椎间盘切除术(PTED)治疗腰椎间盘突出症的效果.方法 选取2018年1月至2019年9月我院收治的69例腰椎间盘突出症患者作为研究对象,根据非随机同期对照研究及自愿原则将其分为A组(35例)和B组(34例).A组给予改良经皮椎间孔脊柱内镜技术治疗,B组给予PTED治疗...     

影响经皮椎间孔入路内镜下神经根减压治疗腰椎管狭窄症临床疗效的相关因素分析*

目的分析影响经皮椎间孔入路内镜下神经根减压治疗腰椎管狭窄症临床疗效的相关因素。方法回顾性分析2016年5月-2017年1月105例有完整随访记录的单节段腰椎管狭窄症患者,表现为单侧神经根症状,行经皮椎间孔入路内镜下神经根减压治疗,采用Oswestry功能障碍指数(ODI)评估手术疗效。对可能影响手术疗效的9个指标进行单因素分析,选取其中有统计学意义的指标进行Logistic回归分析。结果单因素分析显示:年龄、性别、跛行距离、病变节段分布、狭窄区域、椎间孔面积与手术疗效无明显相关(P0.05);而病程、术前ODI评分及侧隐窝矢状径与手术疗效相关(P 0.05)。Logistic回归分析显示:病程和术前ODI评分为独立预后因素。结论病程、术前ODI评分及侧隐窝矢状径是影响手术疗效的相关因素,其中病程和术前ODI评分为独立预后因素。     

经皮内镜下椎板减压术治疗腰椎管狭窄症患者的效果及对椎管微炎症因子水平、DSCA的影响

目的 探讨经皮内镜下椎板减压术治疗腰椎管狭窄症(LSS)患者的效果及对椎管微炎症因子水平、硬膜囊横截面积(DSCA)的影响.方法 将本院2017年3月至2020年4月收诊的112例LSS患者采用整群随机法分为试验组(56例,经皮内镜下椎板减压术)与对照组(56例,开放半椎板减压术).比较两组手术前、手术后3个月的椎管微...     

脊柱内镜下减压融合内固定术治疗腰椎管狭窄症的疗效

目的  探讨脊柱内镜下减压融合内固定术治疗腰椎管狭窄症的疗效。方法  选取2019年9月~2021年9月我院腰椎管狭窄症患者50例,将其随机分为观察组和对照组,25例1组,观察组给予全脊柱内镜下减压融合内固定术,对照组给予传统开放性手术治疗。比较两组手术时间、术中出血量、住院时间,术后24、48、72 h手术切口疼痛视觉模拟量表（VAS）评分,术后3月、12月随访Oswestry功能障碍指数（ODI）,术后12月随访融合率并观察术后并发症。结果  观察组手术时间、术中出血量、住院时间优于对照组（P < 0.05）,差异有统计学意义。两组患者术后24、48、72 h VAS评分差异有统计学意义（P < 0.05）。两组患者术后3月、12月随访ODI评分较术前明显改善（P < 0.05）。两组患者术后3月或12月融合节段Cobb角变化、术后12月融合率的差异无统计学意义（P > 0.05）。实验组并发症发生率为8%（2/25）,对照组并发症发生率为12%（3/25）,差异有统计学意义（P < 0.05）。结论  脊柱内镜下椎管减压、腰椎间融合、经皮椎弓根钉术治疗腰椎管狭窄症的治疗效果明显优于传统手术。     

Regression of intervertebral disc calcification combined with ossification of the posterior longitudinal ligament: A case report

BACKGROUNDIntervertebral disc calcification (IDC) combined with ossification of the posterior longitudinal ligament (OPLL) in cervical discs is rarely reported. This case study presents a rare case of IDC combined with OPLL in the C2-C3 segment.CASE SUMMARYHere, we present a case of a 6-year-old Asian boy with severe neck pain and stiffness. Physical examination showed no neurological or other abnormalities. Digital radiography and computed tomography (CT) revealed a calcified intervertebral disc and OPLL at the C2-C3 vertebrae. The spinal canal compromise at C2-C3 was approximately 50% on magnetic resonance imaging. The final diagnosis was IDC combined with OPLL. We applied a neck brace for the patient to protect the neck. The patient''s neck pain and stiffness recovered significantly within approximately 3 wk. At the 3 mo follow-up, the follow-up CT showed resolution of the ossified intervertebral disc herniation, and a small amount of calcification and slight OPLL remained at the involved segment.CONCLUSIONIDC combined with OPLL is a relatively rare condition in children. However, the majority of patients could have a favorable outcome, and the ossified mass in the canal would be spontaneously resolved with conservative therapy.     

Bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation: a case report

Polymyositis is a subgroup of idiopathic inflammatory myopathies characterized by symmetric proximal limb weakness and chronic skeletal muscle inflammation. We herein report the first case of bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation. A 52-year-old man presented with intermittent claudication and calf pain that had become gradually aggravated during the last 3 months. Magnetic resonance imaging showed spinal stenosis at the L3/4 and L4/5 levels and lumbar disc herniation at the L4/5 level. Preoperative laboratory investigations revealed elevated muscle enzyme concentrations. Magnetic resonance imaging also showed atrophy, fatty degeneration, and edema in both calf muscles. Histological examination showed inflammatory myositis and fibrosis in the perifascicular connective tissues. The patient was diagnosed with polymyositis. We performed decompressive laminectomy at the L3/4 and L4/5 levels and discectomy at the L4/5 level. After administration of prednisolone for 6 months and methotrexate for 3 months, the patient’s bilateral calf pain and abnormal laboratory findings improved. The combination of surgical decompression and adequate medical treatment resulted in a successful recovery. Polymyositis should be suspected in patients with lumbar spinal stenosis or lumbar disc herniation who exhibit increased muscle enzyme concentrations or lower extremity muscle atrophy.     

微创经椎间孔腰椎间融合术治疗腰椎椎管狭窄症的效果评价

目的 探讨微创经椎间孔腰椎间融合术(Mis-TLIF)治疗腰椎椎管狭窄症的临床效果.方法 回顾性分析2014年1月-2019年1月83例在该院住院的腰椎椎管狭窄症患者的临床资料,按手术方法不同分为Mis-TLIF组(n=40)和腰椎后路椎间融合(PLIF)组(n=43).Mis-TLIF组腰椎椎管狭窄原因:腰椎滑脱15...     

Percutaneous transforaminal endoscopic decompression combined with percutaneous vertebroplasty in treatment of lumbar vertebral body metastases: A case report

BACKGROUNDPercutaneous endoscopic lumbar discectomy (PTED) is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis. Despite its less invasiveness, this surgery is rarely used to treat spinal metastases. Percutaneous vertebroplasty (PVP) has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARYA 68-year-old woman presented with low back pain and radicular symptoms. She couldn''t straighten her legs because of severe pain. Computed tomography (CT) showed a mass lesion in the lung and bone destruction in the L4 vertebrae. The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma. PTED paired with PVP was performed on the patient due to the patient''s poor overall physical state and short survival time. Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation. The incision was scaled up with the TESSY technology. The pain was obviously relieved following the operation and no serious complications occurred. Postoperative CT showed that the decompression around the nerve root was successful, polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed. During the 1-year follow-up period, the patient was in a stable condition.CONCLUSIONPTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms. Because of the small sample size and short follow-up time, the long-term clinical efficacy of this method needs to be further confirmed.     

单侧入路椎间孔镜双侧减压治疗中老年腰椎管狭窄症的临床效果

目的分析单侧入路椎间孔镜双侧减压治疗中老年腰椎管狭窄症的临床效果。方法选取我院2018年8月至2019年1月收治的68例中老年腰椎管狭窄症患者,按随机投掷法将其分为参照组和研究组,各34例。参照组实施全椎板切除双侧减压治疗,研究组实施单侧入路椎间孔镜双侧减压治疗。比较两组患者的手术时间、切口长度、术中出血量、术后下床活动时间、术后并发症发生情况、腰椎功能和疼痛程度。结果两组手术时间无显著差异(P>0.05)。研究组的切口长度小于参照组,术中出血量少于参照组,且术后下床活动时间早于参照组(P<0.05)。参照组的并发症总发生率为29.41%,高于研究组的8.82%(P<0.05)。术后1、3个月,两组患者的ODI、VAS评分均低于术前,且研究组低于参照组(P<0.05)。结论单侧入路椎间孔镜双侧减压治疗腰椎管狭窄症的效果显著,手术创伤小且术后并发症发生率低,可有效改善患者腰椎功能障碍、减少术后疼痛,具有临床推广价值。     

椎间孔镜技术治疗极外侧型腰椎间盘突出症的近期疗效观察

目的探讨椎间孔镜技术治疗极外侧型腰椎间盘突出症的近期疗效。方法回顾性分析该院2011年7月-2013年3月23例极外侧型腰椎间盘突出症患者,均采用椎间孔镜技术治疗;年龄34~54岁,平均42.1岁;采用腰腿痛视觉模拟评分(VAS)测评入院时和椎间孔镜术后(术后即刻、术后1周、1个月、3个月及末次随访),末次随访采用改良Mac Nab标准评定临床疗效。结果 23例患者手术后随访9~18个月,平均12.6个月。所有患者腰痛、腿痛的VAS评分由术前的(6.87±1.38)和(8.58±1.42)分下降到术后末次随访时的(2.45±0.52)和(1.55±0.45)分,术后随访与术前比较差异均有显著性(P0.01)。末次随访采用改良Macnab疗效评定标准评估,术后优良率均为91.3%,1例患者于术后出现腰背部疼痛,于卧床休息服用非甾体消炎药3 d后症状消失。结论椎间孔镜技术治疗极外侧型腰椎间盘突出症近期疗效明显。     

Efficacy of percutaneous endoscopic lumbar discectomy for pediatric lumbar disc herniation and degeneration on magnetic resonance imaging: case series and literature review

ObjectivePediatric lumbar disc herniation (LDH), although uncommon, causes significant pain, discomfort, and sometimes disability. We examined the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for pediatric LDH and the degree of lumbar disc degeneration at 1 year after PELD.MethodsWe retrospectively reviewed the data of pediatric patients with LDH who underwent PELD from December 2007 to July 2018. The patients’ symptoms, physical examination findings, clinical images, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), and perioperative results (blood loss, length of hospital stay, and complications) were obtained from the medical records. Lumbar disc degeneration was graded using the modified Pfirrmann grading system at the 1-year postoperative magnetic resonance imaging (MRI) examination.ResultsSix boys and four girls who underwent PELD were evaluated. The patients’ mean age was 15.6 years (range, 13–17 years). The mean VAS score for low back pain, mean VAS score for lower limb pain, and mean ODI preoperatively and 1 year postoperatively were 6.2 and 0.3, 6.9 and 0.5, and 20 and 0.1, respectively. MRI showed significant disc degeneration after PELD.ConclusionsTreating pediatric LDH with PELD is safe and effective. It relieves pain and reduces disability. However, lumbar disc degeneration still occurs.     

手术治疗退变性腰椎管狭窄症及不稳

目的:观察手术方法治疗退变性腰椎管狭窄症合并腰椎不稳的疗效.方法:2001年1月～2003年1月治疗退变性腰椎管狭窄症合并腰椎不稳定共48例,平均年龄55.7岁,病程1～12年,平均4.5年.全部病例经后路全椎板切除减压、椎弓根螺钉系统内固定及横突间植骨融合手术治疗,其中1个节段椎管减压8例,2个节段减压35例,3节段减压5例.结果:术后随访平均14月(6月～24月),按日本矫形外科协会(JOA)下腰痛评分标准,优良率92%.植骨融合未发现骨不连或假关节形成.结论:手术治疗退变性腰椎管狭窄症合并腰椎不稳可以达到满意疗效.术中减压应彻底,植骨融合对后期腰椎的稳定性有重要作用,应注重植骨床的准备和植骨量.     

Preliminary report of modified expansive laminoplasty in the treatment of thoracic ossification of the ligamentum flavum

ObjectiveThis study was performed to evaluate the role of posterior suspension of the laminae–ossification of the ligamentum flavum complex combined with miniplate fixation (modified expansive thoracic laminoplasty) in treating thoracic ossification of the ligamentum flavum (TOLF).MethodsEight patients with TOLF treated by modified expansive thoracic laminoplasty were retrospectively analyzed. Their general information, operative time, intraoperative blood loss, and postoperative complications were recorded. Neurological functional recovery was evaluated by the modified Japanese Orthopaedic Association (mJOA) score and Hirabayashi recovery rate preoperatively, postoperatively, and at the final follow-up. Preoperative and postoperative imaging was performed, and the decompression range and internal fixation positioning were evaluated.ResultsThe mJOA score significantly improved from 4.63 points preoperatively to 9.0 points at the final follow-up (Hirabayashi recovery rate of 77.75%). Postoperative computed tomography and magnetic resonance imaging revealed sufficient decompression of the surgical segment. At the final follow-up, the internal implants were well-placed, the lamina–ligamentum flavum complex showed no significant displacement, and neurological functional recovery was satisfactory.ConclusionSurgical treatment of TOLF is complicated and high-risk. Characterized by simplicity and sufficient decompression, modified expansive thoracic laminoplasty can reduce the risk of cerebrospinal fluid leakage and nerve injury with satisfactory neurological functional recovery.     

Successful treatment of tuberculosis combined with drug-induced myopathy using corticosteroid therapy: a case report

A 39-year-old woman was admitted to our hospital on 19 January 2019 because of a 10-day history of intolerance to oils in her food, fatigue, and yellowing of the skin and sclera. In December 2018, the patient had been diagnosed with tuberculous pleurisy at a local hospital and received quadruple anti-tuberculosis treatment. Ten days before presentation to our hospital, she had developed anorexia, fatigue, nausea, loss of appetite, cough, and shortness of breath. She visited a local hospital, where she was considered to have drug-induced hepatitis. She discontinued the anti-tuberculosis drugs and liver protection treatment. After 3 days, her symptoms had not substantially improved. She visited the infection department of our hospital for further diagnosis and treatment. After 6 days of treatment, the patient’s symptoms were not significantly improved, her liver and muscle enzyme concentrations were further increased, and her limbs had become weaker and more difficult to move. We considered diagnoses of drug-induced hepatitis and drug-induced myopathy. The patient was treated with intravenous methylprednisolone at 40 mg once a day for 16 days and other symptomatic treatments. Her symptoms significantly improved and she was discharged.     

Quadrant可扩张通道下MIS-TLIF术治疗单节段退变性腰椎管狭窄症患者的近远期效果

目的探究Quadrant可扩张通道下微创经椎间孔入路腰椎椎体间融合术(MIS-TLIF)治疗单节段退变性腰椎管狭窄症患者的近远期效果。方法以2015年12月至2019年9月收治的84例单节段退变性腰椎管狭窄症患者为研究对象,根据简单随机化法将其分为对照组(n=42)和试验组(n=42)。对照组实施经椎间孔入路腰椎椎体间融合术(TLIF)治疗,试验组实施Quadrant可扩张通道下MIS-TLIF术治疗。比较两组患者的治疗效果。结果试验组患者的手术用时、切口长度、术后下床时间、住院时间均短于对照组,术中出血量、术后引流量均少于对照组(P<0.05)。术后6个月,两组的ODI、VAS评分均低于术前,JOA评分高于术前,且试验组均优于对照组(P<0.05)。试验组的并发症总发生率为4.76%,低于对照组的21.43%(P<0.05)。结论Quadrant可扩张通道下MIS-TLIF术治疗单节段退变性腰椎管狭窄症患者,能够缩短手术时间和住院时间,提高治疗效果,减少并发症。     

Management of pain due to cervical multilevel disk bulges and spinal stenosis with a focused vibro‐percussion wave treatment: A case report

A patient presenting with low back pain received 18 treatments of FDA‐approved low‐frequency vibro‐percussion wave stimulation known as Khan Kinetic Treatment (KKT). Following KKT, he demonstrated improvement in pain, function, quality of life, sleep, and trunk range of motion with no adverse events.     

Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review

Brown-Séquard syndrome (BSS) has many etiologies, including penetrating trauma, extramedullary tumors, and disc herniation. However, thoracic ossification of the ligamentum flavum (OLF) is an extremely rare cause of this syndrome. A 46-year-old woman with motor weakness in her right lower extremity and urinary retention was admitted to our department. Based on the results of physical examination, computed tomography, and magnetic resonance imaging, a diagnosis of BSS with OLF was considered. The patient underwent urgent conservative treatment. BSS is a rare condition characterized by hemisection or hemicompression of the spinal marrow. The herein-described case of incomplete BSS due to OLF responded to conservative treatment. However, the successful nonoperative management of this case is insufficient evidence to consider it as the standard of care. Therefore, emergency laminectomy decompression remains the standard of care for BSS.