Foot Drop Caused by Single-Level Disc Protrusion Between T10 and L1
Foot Drop Caused by Single-Level Disc Protrusion Between T10 and L1
复制标题
T10 和 L1 之间单层椎间盘突出导致足下垂
DOI：
10.1097/brs.0000000000000034
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发表时间：
2013-12-15
期刊：
影响因子：
3
通讯作者：
Zhou, Hui-fang
中科院分区：
文献类型：
--
作者：
Zhang, Chao;Xue, Yuan;Zhou, Hui-fang
研究设计.回顾性研究25例T10至L1区域单节段椎间盘突出症足下垂患者的手术治疗。Objective.描述T10至L1区域单节段椎间盘突出导致足下垂的病例和手术结果。背景数据总结。文献中报告了三例T12-L1椎间盘突出引起的足下垂。然而，对于T10和L1之间单节段椎间盘突出导致的足下垂或其手术结果知之甚少。方法. 1995年1月至2010年10月，共有25例患者（平均年龄：44岁;范围：21-68岁）因T10和L1之间的单节段椎间盘突出（T10-T11 6例，T11-T12 7例，T12-L1 12例）伴足下垂而就诊于我科，无颈椎或腰椎椎管狭窄或其他神经系统疾病。平均随访46.5个月。所有病例均行手术治疗，行环周减压固定。我们在术前和最终随访时评估了神经功能状态、胫骨前肌肌力、局部脊柱后凸的程度和硬膜囊受压水平的横截面积。结果术前，所有25例患者均表现出下运动神经元病变引起的足下垂和上运动神经元病变引起的病理性反射。术后，平均计算的肌力恢复率为95%。平均日本骨科协会评分从术前的5.92 ± 1.22分增加到最终随访时的9.56 ± 0.92分。磁共振成像显示横截面积从术前的36.3 ± 7.3 mm 2增加到术后的133.1 ± 6.1 mm 2。结论足下垂可由T10和L1之间的单节段椎间盘突出引起，通常与上运动神经元病变有关。在T10和L1之间发生的椎间盘突出导致的病理反射根据突出的水平而不同。环周减压并固定可能是治疗该综合征的有效治疗选择。证据等级：4级
Study Design. Retrospective investigation of surgical treatment of 25 patients with foot drop from single-level disc protrusion in the region of T10 to L1. Objective. To describe cases of foot drop from single-level disc protrusion in the region of T10 to L1 and surgical outcomes. Summary of Background Data. Three cases of foot drop from T12–L1 disc protrusion are reported in the literature. Little is known, however, about foot drop resulting from single-level disc protrusion between T10 and L1 or its surgical outcomes. Methods. Between January 1995 and October 2010, a total of 25 patients (mean age: 44 yr; range, 21–68 yr) presented to our department with single-level disc protrusion between T10 and L1 (6 at T10–T11, 7 at T11–T12, and 12 at T12–L1) with associated foot drop and without cervical or lumbar spinal stenosis or other neurological disease. The average follow-up period was 46.5 months. We treated all cases surgically with circumferential decompression with fixation. We assessed neurological status, tibialis anterior muscle strength, magnitude of local kyphosis, and cross-sectional area at the level of compression of the dural sac preoperatively and at the final follow-up. Results. Preoperatively, all 25 patients exhibited both foot drop resulting from a lower motor neuron lesion and pathological reflexes resulting from an upper motor neuron lesion. Postoperatively, the mean calculated muscle strength recovery rate was 95%. Mean Japanese Orthopaedic Association score increased from 5.92 ± 1.22 points preoperatively to 9.56 ± 0.92 points at the final follow-up. Magnetic resonance imaging indicated that the cross-sectional area increased from 36.3 ± 7.3 mm2 preoperatively to 133.1 ± 6.1 mm2 postoperatively. Conclusion. Foot drop can be caused by single-level disc protrusion between T10 and L1 and is usually associated with an upper motor neuron lesion. Pathological reflexes resulting from disc protrusion occurring between T10 and L1 differ depending on the level of the protrusion. Circumferential decompression with fixation may be an effective treatment option for this syndrome. Level of Evidence: 4