椎间孔镜下改良环锯技术部分切除增生上关节突治疗腰神经根卡压综合征的效果

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Abstract Objective To analyze the therapeutic effect of partial excision of hyperplastic SAP by modified trephine under the transforaminal approach,and of endoscopic debridement and decompression of nerve roots in the treatment of lumbar nerve root entrapment syndrome (LNRES) caused by the hyperplastic superior articular process.Methods Ten LNRES patients with 10 intervertebral foramina were selected between April 2015 and July 2019,all of whom were L_4/5 unilateral (left 4 right 6).They were scheduled to undergo the modified percutaneous trephine for partial resection of the hyperplastic upper articular process and debridement of intervertebral foramina.Preoperatively,1 week and 12 weeks postoperatively and during the last follow-up,these patients underwent functional examination,X-ray and CT examination,respectively.The VAS pain grading method,JOA low back pain scores and MacNab criteria were adopted.Results The postoperative imaging examination showed that the intervertebral foramina were well decompressed.The VAS scores 1 week and 12 weeks after surgery and during the last follow-up became significantly lower (P<0.05),especially during the last follow-up(P<0.05),but there was no significant difference between the three groups.JOA scores 1 week and 12 weeks postoperatively and during the last follow-up also became significantly lower(P<0.05),especially during the 12-week group and the last follow-up group (P<0.05),but there was no significant difference between these two groups.In terms of MacNab criteria,10 cases were good in the 1-week group,2 cases were good and 8 cases were excellent in the 12-week group,and 10 cases were excellent in the last follow-up group.Conclusions The modified trephine combined with endoscopic discectomy is a minimally invasive,simple,effective and inexpensive approach to LNRES.

Key words： endoscopic partial resection hyperplastic superior articular process lumbar nerve root entrapment syndrome

Received: 20 August 2020

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	BAI Chunhong
	SUN Minglin
	JIN Jinzhe
	WANG Feng

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BAI Chunhong,SUN Minglin,JIN Jinzhe等. Lumbar nerve root entrapment syndrome treated with modified trephine and endoscopic partial resection of hyperplastic superior articular process[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(1): 1-5.

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2021/V32/I1/1

[1]	Cinotti G,De Santis P,Nofroni I,et al.Stenosis of lumbar intervertebral foramen:anatomic predisposing factors[J].Spine (Phila Pa 1976),2002,27(3):223-229.
[2]	Okuda T,Fujimoto Y,Tanaka N,et al.Morphological changes of the ligamentum flavum as a cause of nerve root compression[J].Eur Spine J,2005,14(3):277-286.
[3]	Arnoldi C C,Brodsky A E,Cauchoix J,et al.Lumbar spinal strmosis and nerve root entrapment syndromes.Definition and classification[J].Clin Orthop Relat Res,1976 (115):4-5.
[4]	Orita S,Inage K,Eguchi Y,et al.Lumbar foraminal stenosis,the hidden stenosis including at L5/S1[J].Eur J Orthop Surg Traumatol,2016,26(7):685-693.
[5]	Yusof M I,Hassan M N,Abdullah M S.The relationship amongst intervertebral disc vertical diameter,lateral foramen diameter and nerve root impingement in lumbar vertebra[J].Malays Orthop J,2018,12(1):21-25.
[6]	Haimoto S,Nishimura Y,Hara M,et al.Clinical and radiological outcomes of microscopic lumbar foraminal decompression:a pilot analysis of possible risk factors for restenosis[J].Neurol Med Chir (Tokyo),2018,58(1):49-58.
[7]	Gellhorn A C,Katz J N,Suri P.Osteoarthritis of the spine:the facet joints[J].Nat Rev Rheumatol,2013,9(4):216-224.
[8]	Silverstein M P,Romrell L J,Benzel E C,et al.Lumbar dorsal root ganglia location:an anatomic and MRI assessment[J].Int J Spine Surg,2015,12(9):3.
[9]	Zhong W,Driscoll S J,Tsai T Y,et al.In vivo dynamic changes of dimensions in the lumbar intervertebral foramen[J].Spine J,2015,15(7):1653-1659.
[10]	Yamada K,Aota Y,Higashi T,et al.Lumbar foraminal stenosis causes leg pain at rest[J].Eur Spine J,2014,23(3):504-507.
[11]	Suri P,Rainville J,Katz J N,et al.The accuracy of the physical examination for the diagnosis of midlumbar and low lumbar nerve root impingement[J].Spine (Phila Pa 1976),2011,36(1):63-73.
[12]	Yan S,Wang K,Zhang Y,et al.Changes in L4/5 Intervertebral foramen bony morphology with age[J].Sci Rep,2018,16,8(1):7722.
[13]	Muniz Neto F J,Kihara Filho E N,Miranda F C,et al.Demystifying MR neurography of the lumbosacral plexus:from protocols to pathologies[J].Biomed Res Int,2018:9608947.
[14]	Ergun T,Lakadamyali H.CT and MRI in the evaluation of extraspinal sciatica[J].Br J Radiol,2010,83(993):791-803.
[15]	Iwasaki M,Akiyama M,Koyanagi I,et al.Double crush of L5 spinal nerve root due to L4/5 lateral recess stenosis and bony spur formation of lumbosacral transitional vertebra pseudoarticulation:a case report and review[J].NMC Case Rep J,2017,15,4(4):121-125.
[16]	Kang K,Rodriguez-Olaverri J C,Schwab F,et al.Partial facetectomy for lumbar foraminal stenosis[J].Adv Orthop,2014,8:534658.
[17]	Nam H G W,Kim H S,Lee D K,et al.Percutaneous stenoscopic lumbar decompression with paramedian approach for foraminal/ extraforaminal lesions[J].Asian Spine J,2019,13(4):672-681.
[18]	Lewandrowski K U.Incidence,management,and cost of complications after transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis:a value proposition for outpatient ambulatory surgery[J].Int J Spine Surg,2019,13(1):53-67.
[19]	Lewandrowski K U,Ransom N A,Yeung A.Return to work and recovery time analysis after outpatient endoscopic lumbar transforaminal decompression surgery[J].J Spine Surg,2020,6(suppl 1):S100-S115.
[20]	Dowling À,Lewandrowski K U,da Silva F H P,et al.Patient selection protocols for endoscopic transforaminal,interlaminar,and translaminar decompression of lumbar spinal stenosis[J].J Spine Surg,2020,6(suppl 1):S120-S132.
[21]	Enyo Y,Yamada H,Kim J H,et al.Microendoscopic lateral decompression for lumbar foraminal stenosis:a biomechanical study[J].J Spinal Disord Tech,2014,27(5):257-262.
[22]	Wu A M,Zhang K,Li X L,et al.The compression of L5 nerve root,single or double sites? -radiographic graded signs,intra-operative detect technique and clinical outcomes[J].Quant Imaging Med Surg,2018,8(4):383-390.
[23]	Yeung A,Lewandrowski K U.Five-year clinical outcomes with endoscopic transforaminal foraminoplasty for symptomaticdegenerative conditions of umbar spine:a comparative study of inside-out versus outside-in techniques[J].J Spine Surg,2020,6(suppl 1):S66-S83.
[24]	Butler A J,Alam M,Wiley K,et al.Endoscopic lumbar surgery:the state of the art in 2019[J].Neurospine,2019,16(1):15-23.
[25]	de Carvalho P S T,Ramos M R F,da Silva Meireles A C,et al.Feasibility of using intraoperative neuromonitoring in the prophylaxis of dysesthesia in transforaminal endoscopic discectomies of the lumbar spine[J].Brain Sci,2020,10(8):522.

[1]	. [J]. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(2): 153-155.