POSTOPERATIVE BONE REGROWTH IN LUMBAR SPINAL STENOSIS - A MULTIVARIATE-ANALYSIS OF 48 PATIENTS
POSTOPERATIVE BONE REGROWTH IN LUMBAR SPINAL STENOSIS - A MULTIVARIATE-ANALYSIS OF 48 PATIENTS
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DOI：
10.1097/00007632-199410000-00003
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发表时间：
1994-10-01
期刊：
影响因子：
3
通讯作者：
IMURA, S
中科院分区：
文献类型：
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作者：
CHEN, QX;BABA, H;IMURA, S
研究设计. 48例腰椎管狭窄症患者接受后路减压手术。采用多因素分析模型，探讨腰椎管狭窄症后路减压术后骨再生长对临床疗效的影响及促进骨再生长的因素。根据X线平片，评价手术部位的骨再生长占原始椎板切除部位的再生长百分比。骨再生长程度分为四组：1）无明显再生长（第I组，骨再生长率10%或更低）;轻度（第II组，11%至40%）、中度（第III组，41%至70%）和显着（第IV组，71%至100%）。随访2 ~ 7年，平均4.5年。6%的患者无明显的骨再生长，50%的患者显示轻度再生长，29%的患者显示中度再生长，15%的患者显示显著再生长。多变量分析表明，术前脊髓造影完全阻滞、随访时间超过5年、3个以上脊柱节段减压、年龄低于60岁与中度或显著骨再生相关。脊柱不稳主要在随访中期和后期加速骨再生。邻近融合的脊柱节段显示出更多的骨再生。中度和显著骨再生患者的临床结局比无显著和轻度骨再生患者差。大多数患者在后路减压后会发生手术缺损中的骨再生。中度和显著的术后骨再生长可能与随访中期和后期神经系统症状的复发有关。
Study Design. Forty-eight patients who underwent posterior decompressive surgery for lumbar spinal stenosis were studied. The effect of bone re-growth after posterior decompression in lumbar spinal stenosis on clinical outcome and the factors promoting the bone re-growth were investigated with a multivariate analysis model.Methods. Bone re-growth at the sites operated upon was evaluated as a percentage of re-growth of the original laminectomy site based upon plain radiographs. The degree of bone re-growth was classified into four groups: 1) no significant re-growth (Group I, bone regrowth rate 10% or less); mild (Group II, 11% to 40%), moderate (Group III, 41% to 70%), and marked (Group IV, 71% to 100%). The average follow-up period was 4.5 years (range, 2 to 7 years).Results. No significant bone re-growth was shown in 6% of the patients, Mild re-growth was shown in 50%, moderate re-growth in 29%, and marked re-growth in 15%. A multivariate analysis indicated that a total block in the preoperative myelogram, a follow-up period of more than 5 years, decompression at more than three spinal levels, and age under 60 years were associated with moderate or marked bone re-growth. Spinal instability accelerated the bone re-growth mainly in the mid and later follow-up intervals. Spinal levels adjacent to a fusion showed more bone re-growth. Patients with moderate and marked bone re-growth had poorer clinical outcomes than those with no significant and mild bone re-growth.Conclusion. Bone re-growth in a surgical defect will occur in most patients after posterior decompression. Moderate and marked postoperative bone re-growth are possibly related to recurrence of neurologic symptoms in the middle of and later on in follow-up periods.