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背景：侧隐窝狭窄是腰椎开放术后再次或残留下肢反射痛的常见病理原因。对于侧隐窝狭窄引起的症状的诊断标准和治疗策略尚不完善。 方法：在我们的前瞻性患者数据库（n=146）中，我们筛选了10例因单侧侧隐窝狭窄引起症状而接受内窥镜椎板间减压的患者。在轴位T2加权MRI上测量侧隐窝高度和角度。从症状侧的值与对侧无症状对照进行比较。分别于术前、术后、随访时收集Oswestry残疾指数（ODI）及视觉模拟评分（VAS）。 结果：术前MRI显示症状侧隐窝角度和高度均明显小于无症状侧（角度：19.3°vs.35.7°；高度：2.9mm vs.5.7mm；P<0.01）。所有患者均耐受内镜下层间减压，半数患者手术当日出院。最后随访（12.6±1.7个月），10例患者中有8例vas在临床上有最低改善从术前的7.2±0.5提高到术后的2.5±0.8（p=0.001）。术后腰背疼痛改善（术前5.1±1.1> 结论：侧隐窝高度和角度与症状性侧隐窝狭窄有关，经椎板间内窥镜侧隐窝减压术是治疗侧隐窝狭窄的有效方法。
图1L4／5侧隐窝狭窄的术中观察。(A)L5神经行走根(箭头)见于侧隐窝内，可看见侧隐窝及覆盖小关节前部的黄色韧带(y)；(B)部分切除黄色韧带(y)显示由下关节突(i)和上关节突(s)构成的L4/5小关节。行走根用箭头标记。
图2所示：在L4／5上的轴位片T2加权图像上测量侧隐窝角度和距离。行走神经根用红色标记。侧隐窝角度测量方法为在椎间盘纤维环切线和关节突关节所构成的夹角（行走根被夹于中间）。高度是在侧隐窝内侧缘沿矢状面走形行走根内侧的距离。
图3所示：椎板间入路。(A)术中正位 X光描绘L4/5内侧小关节切除术皮肤切口的标记；(B)卡通显示腰椎；(C)B图中的方形区域描绘的侧隐窝的特写。绿色区域表示下关节突的骨切除区域，蓝色区域表示上关节突的骨切除区域。注意的是尝试进行下关节突下切。 Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results Zeinab Birjandian1, Samuel Emerson1, Albert E. Telfeian2, Christoph P. Hofstetter1 1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; 2Brown University, Providence, Rhode Island Contributions: (I) Conception and design: CP Hofstetter, AE Telfeian; (II) Administrative support: Z Birjandian; (III) Provision of study materials or patients: CP Hofstetter, AE Telfeian; (IV) Collection and assembly of data: Z Birjandian, S Emerson; (V) Data analysis and interpretation: Z Birjandian, CP Hofstetter; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Christoph P. Hofstetter, MD, PhD. Assistant Professor, Director of Spine Surgery, UWMC, Department of Neurological Surgery, Campus Box 356470, Room RR744A, 1959 NE Pacific Street, University of Washington, Seattle 98195-6470, USA. Email: chh9045@uw.edu. Background: Lateral recess stenosis is a common pathology causing de-novo or residual radicular pain following lumbar spine surgery. Diagnostic criteria and treatment strategies for symptomatic lateral recess stenosis are not well established. Methods: We identified ten patients in our prospective patient database (n=146) who underwent endoscopic interlaminar decompression for unilateral symptomatic lateral recess stenosis. Lateral recess height and angle were measured on axial T2-weighted MRI. Values from the symptomatic side were compared to the contralateral side which served as asymptomatic control. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain were collected preoperatively, postoperatively and at last follow-up. Results: Preoperative MRI revealed that both lateral recess angle and height were significantly smaller on the symptomatic compared to the asymptomatic side (angle: 19.3° vs. 35.7°; height: 2.9 vs. 5.7 mm; P<0.01). all="" patients="" tolerated="" endoscopic="" interlaminar="" decompression="" well="" and="" half="" of="" the="" patients="" were="" discharged="" on="" the="" day="" of="" surgery.="" at="" last="" follow-up="" (12.6±1.7="" months),="" 8="" out="" of="" 10="" patients="" experienced="" a="" minimally="" clinically="" important="" improvement="" of="" their="" vas="" for="" ipsilateral="" leg="" pain,="" which="" improved="" from="" 7.2±0.5="" preoperatively="" to="" 2.5±0.8="" postoperatively="" (p="0.001)." the="" back="" pain="" vas="" also="" improved="" (preoperatively="" 5.1±1.1 vs. postoperatively="" 1.7±0.9,=""><0.05). the="" odi="" improved="" from="" 50±5.8="" preoperatively="" to="" 22.2±5.1="" at="" last="" follow-up="" (p="0.001)." one="" patient="" experienced="" persistent="" leg=""> Conclusions: Lateral recess height and angle correlate with symptomatic lateral recess stenosis which is effectively treated utilizing interlaminar endoscopic lateral recess decompression. Keywords: Endoscopic spine surgery; stenosis; lateral recess; radiculopathy Journal of spine surgery Submitted Mar 02, 2017. Accepted for publication May 31, 2017. doi: 10.21037/jss.2017.06.08 |
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