背景:虽然以前有关于冗余神经根(RNRs)患者手术疗效的研究,一个持续存在的问题是,即使在手术后,一些患者仍然会出现冗余。此外,RNRs的临床意义尚不清楚.值得注意的是,在斜腰椎椎间融合术(OLIF)联合经皮内固定的背景下,缺乏关于RNR的研究.因此,本研究的主要目的是探讨OLIF联合经皮内固定后RNRs与临床结局之间的相关性.
方法:87例经单节段OLIF联合经皮内固定治疗的腰椎管狭窄症(LSS)患者分为3组。第1组包括手术前后RNR阳性的患者。第2组包括术前RNR阳性但术后RNR阴性的患者。第3组由手术前后RNR持续阴性的患者组成。收集了全面的患者数据,包括操作时间,术中失血,和任何记录的并发症。射线照相参数,术前和术后,被评估,包括狭窄段的数量,圆盘高度(DH),腰椎前凸角度,硬脑膜囊横截面积,和融合笼的放置。此外,视觉模拟量表用于测量背部和腿部疼痛,而Oswestry残疾指数被用来评估日常生活活动。在三个患者组中进行了比较分析。
结果:在这项研究中,87例LSS患者均成功接受手术治疗.其中,35例(40.2%)患者术前MRI评估显示RNRs阳性。在术后MRI评估中,这些患者中有14例保持阳性RNR状态,他们被分成第1组。其余21名患者出现了向阴性RNR状态的转变,并被纳入第2组。在52例术前MRI评估显示RNRs阴性的患者中,他们的术后RNR状态仍然为阴性,形成第3组。所有患者均接受随访,从8到18个月不等,在此期间无并发症发生。在这项研究中,所有87例患者的术后疗效和DH和硬脑膜囊CSA等参数较术前值均有显著改善.术前有RNR的患者有更多的狭窄段,较小的硬脑膜囊CSA,更严重的症状。在所有三组中,术后疗效评分较术前评分明显提高。第2组患者的融合笼放置在中间更多,而第1组患者的融合笼位于更靠前的位置。与第1组患者相比,第2组患者术后硬脑膜囊CSA恢复更大。此外,与第1组患者相比,第2组患者的ODI疗效评分更好。
结论:无论是否存在RNR,患者在接受OLIF联合经皮内固定治疗后有所改善。术前RNR似乎与多节段腰椎管狭窄有关,硬膜囊CSA减少,和症状严重程度。术后RNR阴性的患者表现出更好的治疗效果。此外,融合笼的放置对术后疗效和RNRs结局有显著影响.
BACKGROUND: While there have been previous studies on the surgical efficacy of patients with redundant nerve roots (RNRs), a persistent issue is that some patients continue to experience redundancy even after surgery. Furthermore, the clinical significance of RNRs remains unclear. Notably, there is a lack of research regarding RNRs within the context of oblique lumbar interbody fusion (OLIF) combined with percutaneous internal fixation. Therefore, the primary objective of this study is to investigate the correlation between RNRs and clinical outcomes following OLIF combined with percutaneous internal fixation.
METHODS: Eighty-seven patients diagnosed with lumbar spinal stenosis (LSS) who underwent single-segment OLIF combined with percutaneous internal fixation were categorized into three groups. Group 1 comprised patients with positive RNRs both before and after the operation. Group 2 included patients with positive RNRs preoperatively but negative RNRs postoperatively. Group 3 consisted of patients with consistently negative RNRs before and after the operation. Comprehensive patient data were collected, including operation time, intraoperative blood loss, and any recorded complications. Radiographic parameters, both pre- and post-operative, were assessed, encompassing the number of stenosis segments, disc height (DH), lumbar lordotic angle, dural sac cross-sectional area, and the placement of the fusion cage. Furthermore, the Visual Analogue Scale was applied to gauge back and leg pain, while the Oswestry Disability Index was employed to appraise daily living activities. A comparative analysis was carried out among the three patient groups.
RESULTS: In this study, all 87 LSS patients successfully underwent surgery. Among them, 35 patients (40.2%) showed preoperative MRI assessment indicating positive RNRs. In the postoperative MRI assessment, 14 of these patients maintained positive RNRs status, and they were grouped into Group 1. The remaining 21 patients saw a transition to negative RNRs status and were included in Group 2. Among the 52 patients who had preoperative MRI assessments showing negative RNRs, their postoperative RNRs status remained negative, forming Group 3. All patients received follow-up, which ranged from 8 to 18 months, and no complications occurred during this period. In this study, the postoperative efficacy and parameters such as DH and Dural Sac CSA significantly improved compared to preoperative values for all 87 patients. Patients with preoperative RNRs had more stenosis segments, smaller dural sac CSA, and more severe symptoms. In all three groups, postoperative efficacy scores significantly improved compared to preoperative scores. Group 2 patients had their fusion cages placed more in the middle, while Group 1 patients had their fusion cages more anteriorly located. Group 2 patients exhibited greater recovery in dural sac CSA postoperatively compared to Group 1 patients. Additionally, Group 2 patients had better ODI efficacy scores compared to Group 1 patients.
CONCLUSIONS: Irrespective of the presence or absence of RNRs, patients experienced improvement after undergoing OLIF combined with percutaneous internal fixation. Preoperative RNRs appear to be linked to multi-segmental lumbar spinal stenosis, a reduction in dural sac CSA, and symptom severity. Patients with negative postoperative RNRs demonstrated better treatment efficacy. Furthermore, the placement of the fusion cage appears to have a significant impact on postoperative efficacy and RNRs outcomes.