伴有马尾神经松弛影像学改变的腰椎椎管狭窄症患者手术疗效

摘要

目的 探讨伴马尾神经松弛影像学改变的腰椎椎管狭窄症患者的临床特征及手术效果. 方法 收集2016年9月—2017年9月接受手术治疗的16例影像学上存在马尾神经松弛改变的腰椎椎管狭窄症患者的临床及影像学资料.16例患者腰椎MRI均可见狭窄节段上方马尾神经迂曲成团,均行常规腰椎后路椎板减压椎间植骨融合内固定术治疗,其中3例患者因术中硬膜撕裂行硬膜内探查.记录所有患者术前与术后3个月的日本骨科学会(JOA)评分评估手术疗效. 结果 所有患者术后腰痛及下肢放射痛等症状均缓解,无并发症发生.3例患者硬膜内探查可见马尾神经迂曲成团,无粘连及占位.16例患者术后3个月JOA评分为9 ~ 14(12.56±0.75)分,较术前4 ~ 9(7.44±0.73)分明显改善,差异有统计学意义(P < 0.05).其中6例患者术后3个月复查腰椎MRI,显示马尾神经迂曲成团现象消失. 结论 马尾神经松弛是腰椎椎管狭窄症发展进程的一部分,椎管内马尾神经迂曲成团是导致其影像学改变的原因.治疗腰椎原发病可以获得较好的治疗效果,不需要松解马尾神经,也不必担心马尾神经松弛现象.%Objective To investigate the clinical features and the therapeutic effects of the lumbar stenosis with the redundant nerve roots of the cauda equina. Methods The clinical manifestations and imaging features of 16 patients with redundant nerve roots of the cauda equina were collected from September 2016 to September 2017. All the patients had elongated and tortuous nerve roots of the cauda equina on MRI and underwent posterior lumbar laminectomy and internal fixation. The spinal dura mater was explored for intraoperative tear in 3 patients. The Japanese Orthopaedic Association(JOA) scores were compared between pre-operation and postoperative 3 months to evaluate the surgical outcomes. Results The low back pain and lower limb radiating pain were relieved after operation without complications. The nerve roots of the 3 patients undergoing exploration of the spinal dura mater were elongated and tortuous without intradural mass and adhesion. The JOA score improved from 4 - 9(7.44±0.73) at pre-operation to 9 - 14(12.56±0.75) at postoperative 3 months. The reexamination by MRI at postoperative 3 months were performed in 6 patients,and showed that the elongated and tortuous nerve roots of the cauda equina disappeared. Conclusion The redundant nerve roots of cauda equina may be part of the natural progress of lumbar diseases. Myelographic change is the result of the lumbar spinal nerve root circuity. The treatment of the lumbar primary diseases will be effective without releasing the cauda equina nerve,and can achieve a satisfactory theraputic curative effect without worrying about redundant nerve roots of cauda equina.