DIAGNOSIS AND LIMITED OPERATIVE TREATMENT OF MULTI-SEGMENTAL LUMBAR DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUKan ^1,2 ,  WUWenwen ² , GUOJidong ² , WANGYonggang ² , RENDongfeng ² , LILi ² , WANGHuadong ² ,  TANGJiaguang ²

1. Chinese PLA Medical College, Beijing, 100853, P. R. China;
2. Department of Orthopedics, the First Affiliated Hospital of the General Hospital of Chinese PLA;

Corresponding author：

WUWenwen, Email: wuwenwen1955@aliyun.com; TANGJiaguang, Email: tangjiaguang2013@163.com

Keywords：

Multi-segmental lumbar disease; Selective nerve root block; Responsible segment; Limited operative treatmen

DOI：

10.7507/1002-1892.20140119

Video：

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Objective To investigate the diagnosis and effectiveness of limited operative treatment for multi-segmental lumbar disease. Methods Between February 2008 and February 2011, 47 patients with multi-segmental lumbar disease were treated, including 27 males and 20 females with an average age of 60.3 years (range, 38-82 years) and a median disease duration of 21 months (range, 6 months to 7 years). Based on preoperative clinical manifestation and imaging examination results, the possibility of preliminary responsible segment was identified as two levels in 31 cases (L_{4, 5} and L₅, S₁ in 22 cases, L_{3, 4} and L_{4, 5} in 6 cases, L_{2, 3} and L_{3, 4} in 3 cases) and three levels in 16 cases (L_{3, 4}, L_{4, 5}, and L₅, S₁ in 9 cases, L_{1, 2}, L_{4, 5}, and L₅, S₁ in 4 cases, L_{2, 3}, L_{4, 5}, and L₅, S₁ in 3 cases). Selective nerve root block (SNRB) was used in all cases to identify the responsible segment. Based on the results, the patients were treated by limited operative treatment. The operation time, intra operative blood loss, postoperative drainage volume, postoperative ambulation time, and complications were recorded. The clinical outcome was evaluated according to the visual analogue scale (VAS) scores for back and leg pain, Japanese orthopaedic association (JOA) scores, and Oswestry disability index (ODI). The position of internal fixators and interbody fusion were observed through lumbar anteroposterior and lateral X-ray films. Results The responsible segment was identified as single level in 33 cases (L_{4, 5} in 18 cases, L₅, S₁ in 11 cases, and L_{3, 4} in 4 cases) and two levels in 10 cases (L_{4, 5} and L₅, S₁ in 6 cases, L_{3, 4} and L_{4, 5} in 3 cases, L_{2, 3} and L_{4, 5} in 1 case) by SNRB. After SNRB, 4 cases did not receive surgical treatment because of a low relief rate of less than 30%. The operations were performed successfully in all 43 patients. The mean operation time was 101.9 minutes; the mean intraoperative blood loss was 164.5 mL; the mean postoperative drainage volume was 238.9 mL; and the mean postoperative ambulation time was 38.2 hours. There was no complication of nerve injury or incision infection. All 43 patients were followed up 12-36 months (mean, 19.3 months). The VAS scores, JOA scores, and ODI after operation were significantly improved when compared with preoperative ones (P<0.05). The postoperative JOA recovery rates were 62.2%±12.6%, 63.4%±12.4%, and 68.6%±14.6% at 3, 6 months, and last follow-up respectively, showing no significant difference (F=2.841, P=0.062). The postoperative X-ray films showed that the internal fixators were in good position without loosening or fracture, and the interbody fusion was good. Conclusion After identifying the responsible segment by SNRB in the diagnosis, limited operative treatment is safe and reliable in the treatment of multi-segmental lumbar disease. It can relieve compression effectively, decrease the range of operation, maintain the spinal stabilization, and has a good effectiveness.

Citation： LIUKan, WUWenwen, GUOJidong, WANGYonggang, RENDongfeng, LILi, WANGHuadong, TANGJiaguang. DIAGNOSIS AND LIMITED OPERATIVE TREATMENT OF MULTI-SEGMENTAL LUMBAR DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 529-534. doi: 10.7507/1002-1892.20140119 Copy

1.	肖荣驰, 李强, 唐志宏, 等. 腰椎多节段椎间盘突出症合并腰椎管狭窄症的治疗. 中国修复重建外科杂志, 2008, 22(4):404-407.
2.	Yamagami H, Hashizume K, Sha K, et al. Evaluation of selective lumbar radiculography and radicular block. Masui, 1994, 43(2):253-257.
3.	曾述强, 葛宝丰, 文益民. 多间隙腰椎间盘突出症的有限化手术治疗. 中国骨伤, 2004, 17(3):178-179.
4.	曾述强, 葛宝丰. 有限化手术治疗多间隙腰椎间盘突出症的疗效观察. 中国骨与关节损伤杂志, 2010, 25(5):440-441.
5.	Gajraj NM. Selective nerve root block for low back pain and radiculopathy. Reg Anesth Pain Med, 2004, 29(3):243-256.
6.	Pfirrmann CW, Oberholzer PA, Zanetti M, et al. Selective nerve root blocks for the treatment of sciatica:evaluation of injection site and effectiveness-a study with patients and cadavers. Radiology, 2001, 221(3):704-711.
7.	闫伟, 王欢, 刘金榜. 选择性神经根阻滞在腰椎退变疾患责任节段定位中的应用38例分析. 中国误诊学杂志, 2012, 12(1):174-175.
8.	陈志明, 马华松, 吴继功, 等. 选择性神经根封闭术在多节段腰椎管狭窄症诊治中的应用. 实用骨科学杂志, 2012, 18(2):101-104.
9.	Deen HG. Posterolateral endoscopic excision for lumbar disc herniation:surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(18):2081-2082.
10.	Huskisson EC. Measurement of pain. J Rheumatol, 1982, 9(5):768-769.
11.	郭继东, 侯树勋, 李利, 等. 椎板开窗髓核摘除术治疗腰椎间盘突出症10年以上随访的疗效评价. 中国骨伤, 2013, 26(1):24-28.
12.	Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22):2940-2952.
13.	Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician, 2009, 12(4):699-802.
14.	Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis:an outcome study. Am J Phys Med Rehabil, 2002, 81(12):898-905.
15.	Fujiwara A, Tamai K, Yoshida H, et al. Anatomy of the iliolumbar ligament. Clin Orthop Relat Res, 2004, 15(3):167-172.
16.	Anjarwalla NK, Brown LC, McGregor AH. The outcome of spinal decompression surgery 5 years on. Eur Spine J, 2007, 16(11):1842-1847.
17.	Lawson KJ, Malychy JL, Berry LJ, et al. Lamina repair and replacement to control laminectomy membrane formation dogs. Spine (Phila Pa 1976), 1991, 16(6 Suppl):S222-226.
18.	E1-Abed K, Barakat M, Ainscow D. Multilevel lumbar spinal stenosis decompression:midterm outcome using a modified hinge osteotomy technique. J Spinal Disord Tech, 2011, 24(6):376-380.
19.	Anderberg L, Saveland H, Annertz M. Distribution patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography. Eur Spine J, 2006, 15(10):1465-1471.
20.	Sasso RC, Macadaeg K, Nordmann D, et al. Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy:Comparsion to magnetic resonance imaging. J Spinal Discord Tech, 2005, 18(6):471-478.
21.	赵景鑫, 李中实, 石东平, 等. 选择性神经根封闭在多节段腰椎管狭窄症定位诊断及手术治疗中的应用. 中国骨与关节损伤杂志, 2013, 28(7):653-654.
22.	海涌. 退行性腰椎椎管狭窄症的治疗选择. 脊柱外科杂志, 2011, 9(4):193-194.
23.	Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976), 2010, 35(14):1329-1338.

1. 肖荣驰, 李强, 唐志宏, 等. 腰椎多节段椎间盘突出症合并腰椎管狭窄症的治疗. 中国修复重建外科杂志, 2008, 22(4):404-407.
2. Yamagami H, Hashizume K, Sha K, et al. Evaluation of selective lumbar radiculography and radicular block. Masui, 1994, 43(2):253-257.
3. 曾述强, 葛宝丰, 文益民. 多间隙腰椎间盘突出症的有限化手术治疗. 中国骨伤, 2004, 17(3):178-179.
4. 曾述强, 葛宝丰. 有限化手术治疗多间隙腰椎间盘突出症的疗效观察. 中国骨与关节损伤杂志, 2010, 25(5):440-441.
5. Gajraj NM. Selective nerve root block for low back pain and radiculopathy. Reg Anesth Pain Med, 2004, 29(3):243-256.
6. Pfirrmann CW, Oberholzer PA, Zanetti M, et al. Selective nerve root blocks for the treatment of sciatica:evaluation of injection site and effectiveness-a study with patients and cadavers. Radiology, 2001, 221(3):704-711.
7. 闫伟, 王欢, 刘金榜. 选择性神经根阻滞在腰椎退变疾患责任节段定位中的应用38例分析. 中国误诊学杂志, 2012, 12(1):174-175.
8. 陈志明, 马华松, 吴继功, 等. 选择性神经根封闭术在多节段腰椎管狭窄症诊治中的应用. 实用骨科学杂志, 2012, 18(2):101-104.
9. Deen HG. Posterolateral endoscopic excision for lumbar disc herniation:surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(18):2081-2082.
10. Huskisson EC. Measurement of pain. J Rheumatol, 1982, 9(5):768-769.
11. 郭继东, 侯树勋, 李利, 等. 椎板开窗髓核摘除术治疗腰椎间盘突出症10年以上随访的疗效评价. 中国骨伤, 2013, 26(1):24-28.
12. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22):2940-2952.
13. Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician, 2009, 12(4):699-802.
14. Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis:an outcome study. Am J Phys Med Rehabil, 2002, 81(12):898-905.
15. Fujiwara A, Tamai K, Yoshida H, et al. Anatomy of the iliolumbar ligament. Clin Orthop Relat Res, 2004, 15(3):167-172.
16. Anjarwalla NK, Brown LC, McGregor AH. The outcome of spinal decompression surgery 5 years on. Eur Spine J, 2007, 16(11):1842-1847.
17. Lawson KJ, Malychy JL, Berry LJ, et al. Lamina repair and replacement to control laminectomy membrane formation dogs. Spine (Phila Pa 1976), 1991, 16(6 Suppl):S222-226.
18. E1-Abed K, Barakat M, Ainscow D. Multilevel lumbar spinal stenosis decompression:midterm outcome using a modified hinge osteotomy technique. J Spinal Disord Tech, 2011, 24(6):376-380.
19. Anderberg L, Saveland H, Annertz M. Distribution patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography. Eur Spine J, 2006, 15(10):1465-1471.
20. Sasso RC, Macadaeg K, Nordmann D, et al. Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy:Comparsion to magnetic resonance imaging. J Spinal Discord Tech, 2005, 18(6):471-478.
21. 赵景鑫, 李中实, 石东平, 等. 选择性神经根封闭在多节段腰椎管狭窄症定位诊断及手术治疗中的应用. 中国骨与关节损伤杂志, 2013, 28(7):653-654.
22. 海涌. 退行性腰椎椎管狭窄症的治疗选择. 脊柱外科杂志, 2011, 9(4):193-194.
23. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976), 2010, 35(14):1329-1338.

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EFFECTIVENESS STUDY ON MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION ASSISTED WITH MICROSCOPE IN TREATMENT OF LUMBAR SPONDYLOLISTHESIS

Chinese Journal of Reparative and Reconstructive Surgery

DIAGNOSIS AND LIMITED OPERATIVE TREATMENT OF MULTI-SEGMENTAL LUMBAR DISEASE

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