Prognostic Factors for the Management of the Lumbar Spinal Stenosis

腰椎椎管狹窄症治療的預後因素

楊榮森(Rong-Sen Yang)；陳博光(Po-Quang Chen)；游敬倫(King-Len Yu)；楊琳敏(Lin-Ming Yang)；曾永輝(Yang-Hwei Tsuang)；劉堂桂(Tang-Kue Liu)

spinal stenosis ； lumbar ； prognosis

Journal of Orthopaedic Surgery Taiwan

10卷1期（1993 / 03 / 01）

71 - 78

英文

臺大醫院自1981年1月至1990年6月間，共有232位腰椎椎管狹窄症病患接受手術治療。其中共有185例可追蹤到。這些病例中共有男性80位，女性105位；病患年齡分佈自28歲至81歲，平均60.8歲；病患接受手術前的症狀期間自5個月至20年不等，平均6.3年。經放射線學檢查發現共有77例罹患兩節腰椎椎管狹窄，57位有三節或更多節腰椎椎管狹窄，其餘為單節椎管狹窄。常見的脊椎X光變化包括脊椎退化症，椎間盤凸出，以及腰椎向前滑脫症。在這些病患中，有65例(35.1%)只接受減壓手術，23例(12.4%)接受減壓手術加上腰椎融合手術，但未接受內固定，其餘97例(52.5%)則接受減壓手術，腰椎融合手術，以及內固定手術。手術成果。有意義的預後因素如下：年紀越大，椎管狹窄部位未完全減壓的節數越多，以前手術失敗，以及手術前的延誤時間越久者，其治療成果也越差。脊椎內固定器材和脊椎融合術則可選擇合適病患施行。總之，早期檢查並施予充分的減壓手術可達成良好治療效果。

Between January 1981 and June 1990, 232 patients with lumbar spinal stenosis (LSS)received surgical management. Of them, 185 patients could be followed-up. Included were 80 male and 105 female patients. The age ranged from 28 to 81 years (mean 60.8 years). The duration of the symptoms ranged from 5 months to 20 years (mean 6.3 years). Radiographical evaluation showed that 77 cases had two-level stenosis, and 57 cses had three or more. The common associated findings of the spine were spondylosis, bulging discs and spondylolisthesis.Among them, 65 patients (35.1%) has undergone decompression alone (Group A), 23 patients (12.4%) undergoing decompression and fusion without instrumentation (Group B), and the remaining 97 patients (52.5%) receiving decompression, instrumentation and fusion (Group C). The follow-up period ranged from 12 114 months (mean 58.5 months). Totally, 153 patients (82.7%) got an excellent or good outcome. The significant adverse prognostic factors include older age, inadequate decompressed stenotic levels, previous surgery, and longer duration delay before operation. In conclusion, early detection and adequate decompression are favorable for the successful clinical out-come. The spinal instrumentation and fusion can be done in selected patients.