OLIF术后过长关节突移位压迫神经根再发下肢痛一例报告  

Reoccurring radicular pain related with shifting overlong articular process following oblique lumbar interbody fusion:a case report

作　　者：柳世杰 刘飞俊[1] 何登伟[1] Liu Shijie;Liu Feijun;He Dengwei(Department of Orthopaedic Surgery,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui 323000,China)

机构地区：[1]温州医科大学附属第五医院骨科,丽水323000

出　　处：《中华骨科杂志》2023年第17期1174-1177,共4页Chinese Journal of Orthopaedics

基　　金：浙江省医药卫生科技项目(2021KY412)。

摘　　要：报告1例斜外侧入路椎体融合(oblique lumbar interbody fusion,OLIF)术后过长的关节突移位压迫神经根导致再发下肢痛的病例。女,48岁,诊断为L 4椎体滑脱症。术前CT提示L5右侧上关节突过度增生,长径为10.46 mm,L5右侧上关节突与L4右侧神经根的间距仅1.34 mm。在接受OLIF术后短期内即出现右下肢放射痛复发,复查腰椎CT示融合器植入后椎间隙撑开,而L5右侧上关节突向前倾斜的角度由术前59.46°增大至65.22°;关节突至椎间孔前壁的距离由0.63 mm减小至0.25 mm,至椎间孔上壁的距离由0.31 mm增大至0.39 mm;椎间孔截面积则由0.29 mm2减小至0.18 mm2;椎间隙前凸角由0.52°增大至7.33°,均提示L4,5椎间隙不均匀撑开,且L5右侧增生的上关节突向前下倾斜压迫L4右侧神经根。再次微创手术中对增生过长的关节突进行磨除,松解受压神经根,再次手术后患者右下肢放射痛得到缓解。因此,可以认为OLIF手术中椎间隙被不均匀撑开时,异常增生或过长的关节突可导致神经根受压,进而引起术后持续不缓解的下肢根性疼痛。这也要求术者在术前应充分评估关节突增生情况对OLIF手术效果的潜在影响。The oblique lumbar interbody fusion(OLIF)procedure has yielded favorable outcomes for individuals afflicted with degenerative lumbar conditions;however,certain complications warrant attention.We present a case of a 48-year-old female experiencing recurrent radicular pain post-OLIF.This patient,who endured persistent lower back discomfort for a decade,underwent MRI scans which revealed an intervertebral disc herniation at the L 4,5 level and L 4 spondylolisthesis.The length of the right upper articular process of L 5 was 10.46 mm,and the distance between right upper articular process of L 5 and right nerve root of L4 was 1.34 mm.Subsequent to OLIF,she reported recurrent radicular pain in her right leg.Post-operative CT scans revealed that the inclination of the right upper articular process of L5 augmented from 59.46°to 65.22°.The distance from this process to the anterior foramen wall diminished from 0.63 mm to 0.25 mm,while its distance from the superior wall expanded from 0.31 mm to 0.39 mm.Furthermore,the foraminal cross-sectional area decreased from 0.29 mm2 to 0.18 mm2,and the lordotic angle of the intervertebral space amplified from 0.52°to 7.33°.Such measurements suggest that following OLIF,there was asymmetric retraction of the intervertebral space,accompanied by an anteroinferior tilt of the upper articular process,leading to persistent nerve root compression and thus necessitating immediate surgical nerve root decompression.This paper also elucidates the influence of the anatomical characteristics of the facet joint or articular process on lumbar functionality.Consequently,it could be postulated that hypertrophic or aberrantly elongated articular processes might induce nerve root compression due to intervertebral space retraction post-OLIF.Hence,spine surgeons should diligently assess and recognize the ramifications of such anomalies on OLIF surgical outcomes.

关 键 词：腰椎 脊柱融合术 手术后并发症 神经根病 关节突 

分 类 号：R687.3[医药卫生—骨科学]