Clinical and radiographic results of expansive lumbar laminoplasty in patients with spinal stenosis.
Clinical and radiographic results of expansive lumbar laminoplasty in patients with spinal stenosis.
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DOI：
10.2106/jbjs.e.00211
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发表时间：
2005-09-01
期刊：
影响因子：
--
通讯作者：
Kimura, Tomoatsu
中科院分区：
文献类型：
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作者：
Kawaguchi, Yoshiharu;Kanamori, Masahiko;Kimura, Tomoatsu
背景：1981年，我们开发了一种腰椎板扩大成形术，以缓解传统椎板切除术治疗椎管狭窄的问题。本研究的目的是评估腰椎管扩大成形术的远期疗效，并探讨术后存在的问题。方法：54例患者接受腰椎管扩大成形术治疗椎管狭窄症。男43例，女11例，平均年龄52.6岁。平均随访时间为5.5年。术前25例为退行性狭窄，13例为腰椎滑脱所致狭窄，12例为复合性狭窄(椎间盘突出和狭窄)，6例为增生性狭窄。(两组均包括2例骨质疏松症狭窄和滑脱患者。)采用日本骨科学会评分评定临床疗效，计算恢复率。根据椎管横截面积、后凸畸形、腰椎活动度和椎板间融合率对X线表现进行分析。结果：最后一次随访时，退行性狭窄患者的平均恢复率为69.2%，混合性狭窄患者为66.5%，骨质增生性狭窄患者为65.2%，滑脱患者为54.7%。导致恢复较差的因素是年龄较大和侧方狭窄减压不充分。在随访期内，7名患者的日本骨科协会评分变差，6名患者在椎板成形术邻近节段出现病变，5名患者出现腰椎滑脱。椎板间融合22例(41%)。结论：腰椎板扩大成形术的疗效平均维持在5.5年。腰椎板成形术的最佳适应证是年轻而活跃的中央性椎管狭窄症患者。
BACKGROUND: In 1981, we developed a technique of expansive lumbar laminoplasty to alleviate the problems of conventional laminectomy in the treatment of spinal stenosis. The purposes of this study were to assess the long-term outcome following expansive lumbar laminoplasty and to investigate the postoperative problems.METHODS: Fifty-four patients underwent expansive lumbar laminoplasty for the treatment of spinal stenosis. There were forty-three men and eleven women with a mean age of 52.6 years. The average length of follow-up was 5.5 years. Preoperatively, twenty-five patients had degenerative stenosis; thirteen, stenosis due to spondylolisthesis; twelve, combined stenosis (disc herniation and stenosis); and six, hyperostotic stenosis. (Two patients with hyperostotic stenosis and spondylolisthesis were included in both groups.) The clinical results were assessed with use of the Japanese Orthopaedic Association score, and the rate of recovery was calculated. Radiographic findings were analyzed on the basis of the cross-sectional area of the spinal canal, kyphosis, range of motion of the lumbar spine, and the rate of interlaminar fusion.RESULTS: The average recovery rate at the time of the last follow-up was 69.2% for patients with degenerative stenosis, 66.5% for patients with combined stenosis, 65.2% for those with hyperostotic stenosis, and 54.7% for those with spondylolisthesis. The factors resulting in a poor recovery were an older age and insufficient decompression of the lateral stenosis. During the follow-up period, the Japanese Orthopaedic Association score became worse for seven patients, six patients had lesions develop at the level adjacent to the laminoplasty, and five patients had spondylolisthesis develop. Interlaminar fusion was observed in twenty-two patients (41%).CONCLUSIONS: The satisfactory results of expansive lumbar laminoplasty were maintained at an average of 5.5 years after surgery. The best indications for the lumbar laminoplasty procedure were young and active patients with central spinal stenosis.