选择性神经根阻滞确定多节段腰椎退变责任节段

Selective nerve root block identifying the responsible segments of multilevel lumbar degeneration

摘要:

［目的］评价超声联合透视引导下选择性神经根阻滞确定多节段腰椎退变性病变责任节段的意义。［方法］2019 年 9 月—2021 年 8 月，作者对 72 例多节段腰椎退行变患者采用超声联合 C 形臂 X 线机引导下选择性神经根阻滞 （selective nerve root block, SNRB） 明确责任节段后，明确手术节段及范围，行相应手术处理。评价 SNRB 与手术治疗相关资料。［结果］72 例中，首次穿刺定位责任神经根 30 例（41.7%），第 2 次穿刺定位 12 例（16.7%），第 3 次穿刺定位 22 例（30.6%），未能定位责任神经根 8 例 （11.1%）；总定位成功率为 88.9%。SNRB 操作时间 20~30 mim，平均 （24.5±2.6） min；透视次数 2~5 次，平均 （3.4±1.0） 次。依据影像定位与 SNRB 结果，行单节段椎管减压 12 例 （16.7%），单节段椎管减压联合椎间盘切除 17 例 （23.6%），多节段减压 10 例（13.9%），多节段减压联合椎间盘切除 15 例（20.8%），减压椎弓钉固定脊柱融合 18 例（25.0%）。所有患者均顺利完成手术，无大出血，无神经损伤，均获随访 12 个月以上。随时间推移，腰痛 VAS 评分和腿痛 VAS 评分，以及 ODI 评分显著减少（P<0.05），而 JOA 评分均显著增加（P<0.05）。［结论］选择性神经根阻滞可准确定位主要责任节段，缩小手术减压范围，提高手术治疗多节段腰椎退行性病的效率。

Abstract:

[Objective] To evaluate the significance of ultrasound-guided selective nerve root block (SNRB) in determining the responsi- ble segment of multi-level lumbar degenerative lesions. [Methods] From September 2019 to August 2021, 72 patients received SNRB to identify the responsible segments of multi-level lumbar degenerative diseases, and then corresponding surgical managements. The docu- ments regarding to SNRB and surgical procedures were evaluated. [Results] Of the 72 patients, 30 (41.7%) got the responsible nerve root lo- cated at the first puncture, 12 (16.7%) were located by the second puncture, and 22 (30.6%) were located by the third time, whereas 8 (11.1%) failed to locate the responsible nerve root, with total positioning success rate of 88.9%. The operation time of SNRB ranged from 20 min to 30 min, with an average of (24.5±2.6)min, while the fluoroscopy performed ranged from 2 times to 5 times, with an average of (3.4±1.0) times. According to the results of imaging localization and SNRB, 12 (16.7% ) underwent single- level spinal canal decompression, 17 (23.6%) received single- level decompression combined with discectomy, 10 (13.9%) were treated with muti-segment decompression, 15 (20.8%) underwent multilevel decompression combined with discectomy, and 18 (25.0%) had decompression combined instrumented fusion performed. All patients had corresponding surgical procedures performed successfully without massive bleeding or nerve injury, and were fol- lowed up for more than 12 months. The VAS scores for lumbago and leg pain, as well as ODI scores significantly decreased (P＜0.05), while the JOA scores significantly increased over time (P＜0.05). [Conclusion] The SNRB might accurately locate the main responsible segments, narrow the extent of surgical decompression, and improve the efficiency of surgical treatment for multi-level lumbar degenerative diseases.