腰椎椎間孔狭窄症の診断・治療

抄録

  Introduction : Misdiagnosis and/or inadequate treatment for lumbar foraminal stenosis (LFS) are the most common causes of failed back surgery. While several surgical procedures have been reported, the best surgical treatment remains controversial. We reported use of microsurgical medial/lateral fenestration to treat patients with LFS, and describe our early results.

  Material and Methods : In our institute, 81 patients (10.7% of 752 of all patients with lumbar degenerative disease) had previously undergone LFS. Our diagnostic criteria for LFS included the following : clinical symptoms such as severe radicular symptoms (pain or paresthesia) of the affected nerve root area, a positive Kemp's sign, and radiological evidence. We followed 28 patients for a minimum of 3 years. Nineteen patients had undergone microsurgical medial fenestration, and 9 patients were treated with microsurgical lateral fenestration. The study group comprised 17 men and 11 women, with an average age at surgery of 62.3 years and a mean follow-up period of 45.5 months. Our clinical results were evaluated using the Japanese Orthopedic Association (JOA) scoring system. Pre-and postoperative plain radiographs, computed tomography, and magnetic resonance imaging were used in the evaluation of radiographic findings. We analyzed the cause of poor results with residual or recurrent symptoms.

  Results : The affected nerve root was at the L3 and L4 levels in 1 patient, and at the L5 level in 26 patients. There were no intraoperative surgical complications. The JOA scores showed significant improvement at the final follow up (p<0.05). No patients manifested postoperative spinal instability or malalignment.

  Conclusions : Microsurgical medial and lateral fenestration are less invasive surgical techniques that do not result in spinal instability or malalignment and yield excellent clinical outcomes. Coexisting diseases (excluding lumbar disease) can have a role in residual or relapsing symptoms after surgery.