腰椎管狭窄症手术治疗的功能和放射学结果——一项比较研究

M. Sriraghavan, Kandasamy Natesan, Pavalan Louis, Harish Punniakotti, Naveenraj Venkidusamy, Namala Bharadwaj
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摘要

背景:腰椎管狭窄症(LSS)是一种临床综合征,伴有神经性跛行,腰背痛,下肢放射痛,由于椎管尺寸减小。退变是最常见的病因,由小关节病变和椎间盘突出引起。当保守方法失败或体征或症状逐渐恶化时,应考虑手术干预。大多数手术技术是基于减压的原则,有或没有稳定和融合。两段或两段以上椎板切除术结合稳定融合可有效稳定脊柱,但不良反应有限。方法:本研究纳入了2016年7月1日至2022年8月1日在Thoothukudi医学院附属医院收治的40例腰椎管狭窄患者。入院患者被随机分为两组,分别为单纯减压组和减压稳定融合组各20例。结果:根据人口学标准、临床病史、x线角度测量和Oswestry残疾指数对两组患者进行术前和术后分析。结论:LSS的诊断往往具有挑战性,需要对患者及其症状进行适当的临床评估,并与影像学表现相关。考虑到这些,我们建议对于狭窄小于两节段且融合稳定大于两节段的患者,可以考虑单独减压,而不是进行稳定融合。
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Functional and radiological outcome of surgical management in lumbar spinal stenosis – A comparative study
Background: Lumbar spinal stenosis (LSS) is a clinical syndrome with neurogenic claudication, low back ache, with radiating pain to lower limbs, due to a decrease in spinal canal dimensions. Degeneration is the most common etiology, resulting due to facet joint arthropathy and intervertebral disc protrusion. Surgical intervention should be considered when conservative methods fail or if there is a progressive worsening of signs or symptoms. Most of surgical techniques are based on the principles of decompression with or without stabilization and fusion. Two or more levels of laminectomy with stabilization and fusion provide effective spinal stability but have limited adverse effect. Methodology: This is a study of 40 patients with lumbar canal stenosis, who were admitted in Thoothukudi Medical College Hospital, from July 01, 2016, to August 01, 2022. The patients admitted were allocated alternatively into two groups, decompression alone and decompression with stabilization/fusion with 20 cases each, respectively. Results: Both the groups were analyzed preoperatively and postoperatively based on demographic criteria and on clinical history, radiographic angle measurements, and Oswestry Disability Index. Conclusion: The diagnosis of LSS is often challenging and requires proper clinical assessment of the patients and their symptoms and correlates with the radiological findings. Considering these, we suggest decompression alone may be considered rather than stabilization and fusion in patients with less than two-level stenosis and stabilization with fusion more than two levels.
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