使用微创腰椎减压术（MILD）治疗腰椎滑膜囊肿引起的神经根病：病例报告

摘要(中文译文)

腰椎滑膜囊肿是起源于小关节的充满液体的病变，可导致侧隐窝狭窄和神经源性跛行。虽然手术减压是有症状囊肿的金标准，但患有严重合并症（如慢性阻塞性肺疾病（COPD）和肺气肿）的患者在全身麻醉下面临较高的围手术期风险和伤口愈合延迟。本病例报告描述了微创腰椎减压（MILD）手术作为高风险手术候选者的安全替代方案的成功应用。一名68岁男性，有高血压和严重COPD/肺气肿病史，表现为慢性、进行性下腰痛和波动的双侧神经根病，最初左侧较重，随后转移至右侧并交替出现。腰椎MRI显示一个6 mm × 5 mm的滑膜囊肿起源于左侧L4-L5小关节，导致严重的关节下狭窄和神经根压迫。为降低麻醉风险，患者在中度镇静下接受了MILD手术。使用骨性Kerrison咬骨钳和组织雕刻器，实现了椎板及肥厚黄韧带的机械减压，随后辅助硬膜外注射倍他米松。患者报告症状立即改善。在六个月随访时，其主要神经根症状维持100%缓解。随访MRI证实L4-L5侧隐窝成功减压，囊肿大小显著缩小。尽管影像学 later 注意到少量残留组织，但患者在2023年3月最终随访时维持了持续的临床改善。MILD手术为不适合开放手术的有症状滑膜囊肿患者提供了有效的替代方案。通过在中度镇静下结合机械减压和抗炎措施，临床医生可以实现持续的功能改善，同时避免与全身麻醉和侵入性手术切除相关的呼吸风险。

Abstract

Lumbar synovial cysts are fluid-filled lesions arising from the facet joints that can cause lateral recess stenosis and neurogenic claudication. While surgical decompression is the gold standard for symptomatic cysts, patients with significant comorbidities, such as chronic obstructive pulmonary disease (COPD) and emphysema, face elevated perioperative risks under general anesthesia and delayed wound healing. This case report describes the successful application of the minimally invasive lumbar decompression (MILD) procedure as a safe alternative for a high-risk surgical candidate. A 68-year-old male with a history of hypertension and severe COPD/emphysema presented with chronic, progressive lower back pain and fluctuating bilateral radiculopathy, which was initially worse on the left before migrating to the right and subsequently alternating sides. Lumbar MRI revealed a 6 mm × 5 mm synovial cyst arising from the left L4-L5 facet joint, causing severe subarticular narrowing and nerve root compression. To mitigate anesthetic risks, the patient underwent the MILD procedure under moderate sedation. Using a bone Kerrison and tissue sculptor, mechanical decompression of the lamina and hypertrophied ligamentum flavum was achieved, followed by an adjunct epidural injection of betamethasone. The patient reported immediate symptomatic improvement. At the six-month follow-up, he maintained 100% relief of his primary radicular symptoms. A follow-up MRI confirmed successful decompression of the L4-L5 lateral recess and a significant reduction in cyst size. Although imaging later noted minimal residual tissue, the patient maintained sustained clinical improvement through March 2023 at his final follow-up. The MILD procedure provides an effective alternative for symptomatic synovial cysts in patients who are poor candidates for open surgery. By combining mechanical decompression with anti-inflammatory measures under moderate sedation, clinicians can achieve sustained functional improvement while bypassing the respiratory risks associated with general anesthesia and invasive surgical excision.

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