腰椎管狭窄指在腰椎水平上椎管、神经根管和神经孔的狭窄,它主要由老年人腰椎退行性改变引起。目前在诊断和治疗腰椎管狭窄上存在很多的不确定性,比如缺乏广泛接受的、包罗万象的腰椎管狭窄分类系统,合适的影像形态学评判标准,CT和MRI影像分析规范化参数,定性和定量标准化的图像分析技术,狭窄和非狭窄之间缺乏一个可靠、明确的分隔界限以及影像学与临床特点、治疗指南之间缺乏可靠的联系等等。所有这些不确定性需要多个领域的专家共同不懈的长期努力才能最终完善。

[1] DEYO R A.Treatment of lumbar spinal stenosis:a balancing act[J].Spine J,2010,10(7):625-627.
[2] MALMIVAARA A,SLTIS P,HELIVAARA M,et al.Surgical or nonoperative treatment for lumbar spinal stenosis? a randomized controlled trial[J].Spine (Phila Pa 1976),2007,32(1):1-8.
[3] WEINSTEIN J N,TOSTESON T D,LURIE J D,et al.Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial [J].Spine (Phila Pa 1976),2010,35(14):1329-1338.
[4] OOI Y,MITA K F,SATOH Y.Myeloscopic study on lumbar spinal canal stenosis with special reference to intermittent claudication[J].Spine,1990,15:544-549.
[5] MORISHITA Y,HIDA S,NAITO M,et al.Neurogenic intermittent claudication in lumbar spinal canal stenosis[J].J Spinal Disord Tech,2009,22:130-134.
[6] FARDON D F,MILETTE P C.Combined Task Forces of the North American Spine Society,American Society of Spine Radiology,and American Society of Neuroradiology.Nomenclature and classification of lumbar disc pathology.Recommendations of the combined task forces of the North American Spine Society,American Society of Spine Radiology,and American Society of Neuroradiology[J].Spine (Phila Pa 1976),2001,26(5):E93-E113.
[7] SCHIZAS C,THEUMANN N,BURN A,et al.Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images[J].Spine (Phila Pa 1976),2010,35(21):1919-1924.
[8] LEE S,LEE J W,YEOM J S,et al.A practical MRI grading system for lumbar foraminal stenosis [J].AJR Am J Roentgenol,2010,194(4):1095-1098.
[9] MALGHEM J,WILLEMS X,VANDE-BERG B,et al.Comparison of lumbar spinal canal measurements on MRI and CT[J]. J Radiol,2009,90:493-497.
[10] LEE G Y,LEE J W,CHOI H S,et al.A new grading system of lumbar central canal stenosis on MRI:an easy and reliable method [J].Skeletal Radiol,2011,40(8):1127.
[11] SIEBERT E,PRSS H,KLINGEBIEL R,et al.Lumbar spinal stenosis:syndrome,diagnostics and treatment [J].Nat Rev Neurol,2009,5(7):392-403.
[12] KNIRSCH W,KURTZ C,HFFNER N,et al.Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI[J].Pediatr Radiol,2005,35(4):419-424.
[13] DORA C,WLCHLI B,ELFERING A,et al.The significance of spinal canal dimensions in discriminating symptomatic from asymptomatic disc herniations[J].Eur Spine J,2002,11(6):575-581.
[14] KALICHMAN L,COLE R,KIM D H,et al.Spinal stenosis prevalence and association with symptoms:the Framingham Study[J].Spine J,2009,9(7):545-550.
[15] TOMKINS C C,BATTIE M C.Validity and reproducibility of self-report measures of walking capacity in lumbar spinal stenosis:reproducibility and validity[J].Spine,2010,35:2097-2102.
[16] TOMKINS C C,BATTIE M C,ROGERS T,et al.A criterion measure of walking capacity in lumbar spinal stenosis and its comparison with a treadmill protocol[J].Spine,2009,34:2444-2449.
[17] HAIG A J,TOMKINS C.Diagnosis and treatment of lumbar spinal stenosis[J].JAMA,2010,303:71-72.
[18] 王宸,吴小涛,茅祖斌,等.腰椎短节段固定与椎间融合治疗腰椎不稳[J].东南大学学报院:医学版,2003,22(3):174-177.
[19] 张磊,王宸.单侧经椎间孔入路椎间植骨融合术对慢性下腰痛的疗效分析[J].东南大学学报:医学版,2009,28(3):225-227.
[20] HAIG A J,PARK P,HENKE P,et al.The reliability of the clinical diagnosis in persons offered surgery for lumbar spinal stenosis.Poster presented at:musculoskeletal best research presentations.American Academy of Physical Medicine and Rehabilitation,November 4-7,2010,Seattle,WA.
[21] OGIKUBO O,FORSBERG L,HANSSON T.The relationship between the cross-sectional area of the cauda equina and the preoperative symptoms in central lumbar spinal stenosis[J].Spine,2007,32:1423-1428.
[22] LOHMAN C M,TALLROTH K,KETTUNEN J A,et al.Comparison of radiologic signs and clinical symptoms of spinal stenosis[J].Spine,2006,31:1834-1840.
[23] DANIELSON B I,WILLÉN J,GAULITZ A,et al.Axial loading of the spine during CT and MR in patients with suspected lumbar spinal stenosis [J].Acta Radiol,1998,39:604-611.
[24] WILLÉN J,DANIELSON B,GAULITZ A,et al.Dynamic effects on the lumbar spinal canal:axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication[J].Spine,1997,22:2968-2976.
[25] WILLÉN J,DANIELSON B.The diagnostic effect from axial loading of the lumbar spine during computed tomography and magnetic resonance imaging in patients with degenerative disorders[J].Spine,2001,26:2607- 2614.
[26] GILBERT J W,MARTIN J C,WHEELER G R,et al.Lumbar disk protrusion rates of symptomatic patients using magnetic resonance imaging[J].J Manipulative Physiol Ther,2010,33:626-629.
[27] KANNO H,OZAWA H.Dynamic change of dural sac cross-sectional area in axial loaded magnetic resonance imaging correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis[J].Spine,2012,37:207-213.
[28] 洪有志,吴小涛,茅祖斌,等.腰椎间盘突出症手术治疗双节段椎间盘突出症的远期临床疗效随访[J].东南大学学报:医学版,2010,29(4):406-409.
[29] 于一凡,王宸.经单切口行双节段MED的可行性研究及疗效分析[J].东南大学学报院:医学版,2011,30(3):506-508.
[30] JENIS L G,AN H S,GORDIN R.Foraminal stenosis of the lumbar spine:a review of 65 surgical cases[J].Am J Orthop,2001,30:205-211.