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Abstract：
Background: In the diagnosis of lumbar spinal stenosis (LSS), finding stenosis with magnetic resonance imaging (MRI) does not always correlate with symptoms such as sciatica or intermittent claudication. We perform decompression surgery only for cases where the levels diagnosed from neurological findings are symptomatic, even if multiple stenoses are observed on MRI. The objective of this study was to examine the time course of asymptomatic stenosis in patients with LSS after they underwent decompression surgery for symptomatic stenosis. Materials and Methods: The participants in this study comprised 137 LSS patients who underwent single-level L4-5 decompression surgery from 2003 to 2013. The dural sac cross-sectional area at the L3-4 disc level was calculated based on preoperative MRI. A cross-sectional area less than 50 mm2 was defined as stenosis. The patients were grouped, according to additional spinal stenosis at the L3-4 level, into a double group (16 cases) with L3-4 stenosis, and a single group (121 cases) without L3-4 stenosis. Incidences of new-onset symptoms originating from L3-4 and additional L3-4-level surgery were examined. Results: Five years after surgery, 98 cases (72%) completed follow-up. During follow-up, 2 of 12 patients in the double group (16.7%) and 9 of 86 patients in the single group (10.5%) presented with new-onset symptoms originating from L3-4, showing no significant difference between groups. Additional L3-4 surgery was performed for one patient (8.3%) in the double group and three patients (3.5%) in the single group; again, no significant difference was shown. Conclusion: Patients with asymptomatic L3-4 stenosis on preoperative MRI were not prone to develop new symptoms or need additional L3-4-level surgery within 5 years after surgery when compared to patients without preoperative L3-4 stenosis. These results indicate that prophylactic decompression for asymptomatic levels is unnecessary.
摘要：
背景：在腰椎管狭窄症（LSS）的诊断中，磁共振成像（MRI）发现狭窄并不总是与坐骨神经痛或间歇性跛行等症状相关。我们仅对从神经系统检查结果诊断出的水平有症状的情况进行减压手术，即使在MRI上观察到多个狭窄。这项研究的目的是检查LSS患者在接受有症状的狭窄减压手术后无症状狭窄的时间过程。材料和方法：这项研究的参与者包括2003年至2013年接受单级别L4-5减压手术的137例LSS患者。根据术前MRI计算L3-4椎间盘水平的硬脑膜囊横截面积。小于50mm2的横截面面积被定义为狭窄。对患者进行分组,根据L3-4级额外的椎管狭窄，分为L3-4狭窄的双组（16例），单组(121例)无L3-4狭窄。检查了源自L3-4和其他L3-4级手术的新发作症状的发生率。结果：手术后五年，98例(72%)完成随访。随访期间,双组12例患者中有2例（16.7％），单组86例患者中有9例（10.5％）出现源自L3-4的新发作症状，组间没有显着差异。双组1例(8.3%)和单组3例(3.5%)额外进行L3-4手术;没有显着差异。结论：与术前没有L3-4狭窄的患者相比，术前MRI无症状L3-4狭窄的患者在术后5年内不容易出现新症状或需要额外的L3-4级手术。这些结果表明，无症状水平的预防性减压是不必要的。
