手术治疗腰椎间盘突出症，这是一种非常糟糕的治疗方法，应该从Medicare支付系统中踢出去。举些病例。

一女士，62岁，自诉：一年前因腰椎间盘突出，引起左侧腰腿痛，故做手术治疗，现仍感到腰痛，左侧小腿处不舒服。手术医生讲：手术非常成功，没有留下后遗症，今后地上捡东西不要弯腰，膝关节蹲下来捡。我看了手术前的MRI报告，显示：L2/3，L3/4椎间盘膨出，L4/5椎间盘向左突出，并压迫L5神经根，L5/S1椎间盘向左侧突出，接触了L5神经根。并看了手术后的X光片，X光片显示：L4，L5与骶骨之间敲了二根钉子，把底下二个关节固定了。我叹了口气，如果不手术，经我5次针灸推拿治疗，患者也可以获得明显的腰痛减轻，腰活动改善，左侧腿痛明显减轻，根本不需要做手术。腰椎6个关节，二个关节因手术固定了，不能动了，锁死了，弯腰、后仰、左右旋转功能受很大影响，生活质量与工作能力大幅下降。左侧腿痛麻木有少许减轻，可以忽略不计，如果手术专科医生术前告诉患者：手术怎么做？希望达到什么治疗效果？这个手术完成后，将造成腰椎活动功能部份丧失，生活质量下降许多，患者会接受手术吗？必须指出，手术专科医生知道这次手术的结果，腰椎活动功能部份丧失，生活质量下降。患者还告诉我：专科医生讲，手术结果很好。做生意时，有些人是没有人性的。我建议患者去申请NDIS全国残疾保障计划。

手术前的报告如下：

In the sagittal acquisitions there is a normal appearance to the T11/12, T12/L1 and L1/2 discs. There is no focal disc protrusion or extrusion.

L2/3: neural exit foramina.

Shallow generalised disc bulge. Some mild facet joint arthrosis. No significant narrowing of the central canal or

L3/4: Generalised disc bulge. Some mild to moderate facet joint arthrosis. Mild narrowing of the lateral recess with traversing nerve roots contacted but not heavily displaced or distorted. No significant narrowing of the central canal.

Some mild narrowing of the neural exit foramina again the exiting nerve roots contacted but not displaced or distorted.

L4/5: There is reduced disc height and generalised disc bulge and small disc osteophyte complex. Superimposed left paracentral disc extrusion. The extruded disc material fills the lateral recess and extends inferiorly approximately 11mm from the superior endplate of L5. It contacts and compresses and distorts the traversing left L5 nerve roots.

Some moderate central canal stenosis. The CS and epidural fat is partially effaced. Thecal sac is distorted. Some mild narrowing of the right lateral recess and neural exit foramina.

L5/S1: There is shallow generalised disc bulge slightly eccentric to the left foraminal zone. Some mild narrowing of the

central canal or right foraminal stenosis.

exiting L5 nerve roots its contacted but not heavily displaced or distorted. There is no significant lateral recess,

Normal appearance to the sacroiliac joints. Normal marrow signal.

Conclusion: Spondylotic changes predominantly at the L4/5 level where there is a left paracentral disc extrusion contacting and compressing the traversing left L5 nerve roots.

 

我去出诊，女，将近77岁。因腰椎间盘突出，近四、五年内做了二次手术，手术疤痕从T12-S1, MRI报告显示：从L2-S1二侧都敲钉子，十个。这种手术造成这一段腰椎，不能活动，只能象电线杆一样滚动，躺在床上自己爬不起来，余生都毁掉了。女儿陪伴照顾，否则住养老院。谁碰到谁痛，这类不当治疗，不知道有多少？根据解剖学的原理，手术医生应该知道这种结果，是否手术前告诉患者。我讲：这类手术必须禁止。

 

MRI OF THE THORACIC SPINE AND LUMBAR SPINE

THORACIC SPINE

The C7-T1 to T11-12 disc levels show minimal disc bulges at T11-12, T9-10 level. There is no significant central or foraminal spinal canal narrowing. There is no cord or nerve root compression.

Thoracic cord shows normal size and shape and signal with no cord expansion or syrinx or tumour.

There is no central or foraminal spinal canal narrowing.

LUMBAR SPINE

There is evidence of previous surgery with pedicle screws on both sides at S1, L5, L4 ,L3 and L2.

Alignment of the lumbar spine shows minimal anterolisthesis at L4-5.

Significant osteophytes are seen at all levels lumbar spine indicating degenerative spondylosis.

Conus ends at L1.

No cord expansion. No syrinx or tumour in the cord.

112-L1 level: There is 0.7 cm broad based disc protrusion at the T12-L1 disc, which predominates at the left paracentral and left lateral recess location. There is cephalad displacement of the disc material. The combined vertical extent of the disc protrusion and the cephalad displaced disc material measures 2.2 cm. Severe central spinal canal narrowing is seen and there is compression on the spinal cord particularly at the central and left lateral aspects. The T12-L1 foramina are narrowed on both sides. No further nerve root compressions.

L1-2: There is 3mm broad-based disc protrusion. Gross hypertrophic change facet joints. There is severe central spinal canal narrowing with compression of thecal sac. Suspected to be mild cord compression. Foramina are narrowed on both sides and potentially further compression of bilateral L1 nerve roots. Note that at the right lateral recess region, there is cephalad displacement of disc material with cephalad displacement measuring up to 0.4 cm.

L2-3: No disc herniation. Central spinal canal is not narrowed. Foramina are narrowed but not causing nerve root compression.

L3-4: There is 3 mm broad-based disc protrusion. Central spinal canal is moderately narrowed. No cauda equina compression. Foramina are narrowed but not causing nerve root compressions L4-5: Facet joint degeneration noted. Mild spondylolisthesis. No central spinal canal narrowing. No cauda equina or cord compression. Foramina are narrowed on both sides but not causing nerve root compression.

L5-S1: No disc herniation. Facet hypertrophy noted. Central spinal canal is not narrowed. Foramina are moderately narrowed but not causing nerve root compression.

COMMENT

The thoracic region shows degenerative change. Minimal disc bulge. No cord or nerve root compression.

At T12-1 level, significant disc herniation causes severe central spinal canal narrowing.

Compression on the cord noted. Compared to March 2022, the findings and the extent of the cord compressions are similar.

Significant central spinal canal narrowing L1-2 level, possibly slightly cord compression. Bilateral L1/2 foramina are narrowed and possibly slight nerve root irritation. Compared to March 2022, the extent of the disc protrusion and extent of the cord compression is are similar.

Evidence of past surgery for the lumbar spine noted. Foraminal narrowing at multiple levels but not causing further nerve root compression.

 

一男士，84 岁，自述:80 岁因腰椎间盘突出症作了微创手术，手术后腰痛，左侧下肢疼痛 没有解决，在 83 岁时再次手术，左、右各敲了一个镙丝，手术后腰椎活动更加困难，腰椎 不能伸值，刷牙时，一个手支撑墙上，一个手刷牙，走路弧形步，左侧下肢肌肉萎缩等。 手术后，手术专科医生讲:你太老了，也只能这样了。为什么手术之前不讲呢?手术肯定 赚钱。我看患者 MRI 的片子，看不懂左右二个镙丝治疗机理是什么?病人不懂，市场缺 少监管。我告诉患者，不敲钉子容易治疗，现在治疗只能康复多少算多少。建议手术把二个镙丝拿掉，可减轻疼痛。

 

徐敏学骨伤科中医师供稿 0405186080