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首页> 外文期刊>Spine >Development of degenerative spondylosis of the lumbar spine after partial discectomy. Comparison of laminotomy, discectomy, and posterolateral discectomy.
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Development of degenerative spondylosis of the lumbar spine after partial discectomy. Comparison of laminotomy, discectomy, and posterolateral discectomy.

机译：椎间盘部分切除后腰椎退行性脊柱病的发展。椎间盘切开术，椎间盘切除术和后外侧椎间盘切除术的比较。

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摘要

STUDY DESIGN. The development of degenerative spondylosis after successful operative decompression of the affected nerve root was prospectively evaluated in a comparative case series of 100 patients with a herniated lumbar nucleus pulposus. OBJECTIVES. The objective of this study was to compare the relative incidence of degenerative spondyloarthrosis after successful posterior laminotomy and discectomy and posterolateral extradural discectomy for decompression of a compromised lumbar nerve root. SUMMARY OF BACKGROUND DATA. The relationship between the radiographic appearance of degenerative spondylosis and prior operative procedures has been controversial and at times contradictory. The posterior operative approach with a partial discectomy has been associated with a significant incidence of postoperative degenerative spondylosis and intraneural and perineural fibrosis, complications that may be minimized, or perhaps even eliminated, with the posterolateral evacuation of the offending intervertebral disc fragment. METHODS. Each patient had: 1) not responded favorably to nonoperative treatment, 2) a persistent radiculopathy, 3) correlative imaging studies with no preoperative spondyloarthrosis and 4) minimum 2-year follow-up. Fifty patients were treated by posterior laminotomy and discectomy and fifty were treated by a posterolateral extradural discectomy. Postoperative spondylosis was graded based on the radiographic presence or absence of osteophytes, the intervertebral disc height, the vertebral body alignment and the facet joint changes. RESULTS. At an average postoperative follow-up of 65 months, the incidence of a one grade increase in degenerative spondylosis was 80% of the laminotomy and discectomy patients as compared to 39% of the posterolateral discectomy patients. CONCLUSIONS. The increased incidence of spondyloarthrosis with the posterior approach suggests that minimally invasive posterolateral extradural procedures should be considered for the decompression of a compromised lumbar nerve root.
机译：学习规划。在对100例腰椎间盘突出症患者的比较病例系列中，成功评估了受影响的神经根成功减压后的退行性脊柱发展。目标这项研究的目的是比较成功的后路椎板切开术和椎间盘切除术以及后外侧硬膜外椎间盘切除术对腰神经根减压后的退行性脊椎关节炎的相对发生率。背景数据摘要。退行性脊柱病的影像学表现与先前的手术程序之间的关系一直存在争议，有时是矛盾的。椎间盘部分切除的后路手术方法与术后退行性脊椎病，神经内和神经周纤维化的发生率显着相关，并发症的发生可以通过将有问题的椎间盘碎片从后外侧排出而最小化，甚至消除。方法。每位患者有：1）对非手术治疗没有良好的反应，2）持续性神经根病，3）相关影像学检查，无术前脊柱关节炎和4）至少两年的随访。 50例患者接受了后路椎体切开术和椎间盘切除术，而50例接受了后外侧硬膜外椎间盘切除术的治疗。根据是否存在骨赘，椎间盘高度，椎体排列和小关节变化等影像学检查对术后脊椎病进行分级。结果。在平均术后65个月的随访中，椎弓根切开术和椎间盘切除术患者退行性脊柱病发生一级增加的发生率为80％，而后外侧椎间盘切除术患者为39％。结论。后路入路引起的脊椎关节炎的发生率增加表明，应考虑采用微创后外侧硬膜外手术对腰神经根受损进行减压。

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