Degenerative Disease Of Lower Lumbar Treated With Posterior Lumbar Interbody Fusion With Interbody Fusion Cage And Posterolateral Fusion: A Comparative Study

Objective:To evaluate the clinical therapeutic effect of posterior lumbar interbody fusion with interbody fusion cage and posterolateral fusion in the treatment of the degenerative disease of lower lumbar.And to compare the treatment results and application range of them.Methods:A total of 60 patients with the degenerative disease of lower lumbar had posterior lumbar interbody fusion with interbody fusion cage or posterolateral fusion in department of orthopedies,Zhangzhou Hospital of TCM,Fujian Province from January 2006～December 2008 were seleeted.Divided into two groups,group A was treatment by reduction of posterior lumbar interbody fusion,and group B was treatment by reduction of posterolateral fusion.By reviewing the data of cases and the X-ray,hemorrhage amount, operation time,surgical complication;and relative disc space height,Boxall index,ODI score preoperatively and postoperatively as well as at follow-up;and bone fusion rate,change of JOA scoring were measured.The data were analyzed by statistics.Results:Between the two groups,there was significant diference(P＜0.05) in terms of hemorrhage amount,operation time,and there was no significant diference(P＞0.05) in terms of surgical complication.In group A,including 32 patients,relative disc space height was 0.69±0.05 preoperatively,and 1.22±0.07 postoperatively,and 1.20±0.06 at final follow-up;Boxall index was(21±7)%preoperatively,and(3±1)%postoperatively,and(4±2)%at final follow-up;ODI score was(39.52±17.38)%preoperatively,and(19.62±6.06)%postoperatively,and (10.69±3.79)%at final follow-up.In group B,including 28 patients,relative disc space height was 0.70±0.07 preoperatively,and 1.18±0.06 postoperatively,and 1.16±0.07 at final follow-up;Boxall index was(20±7)%preoperatively,and(5±2)%postoperatively,and (6±3)%at final follow-up;ODI score was(38.66±15.84)%preoperatively,and(23.10±9.03)% postoperatively,and(12.30±5.07)%at final follow-up.In each group,there was very significant difference(P＜0.01) between preoperation and postoperation and between preoperation and final follow-up in terms of relative disc space height,Boxall index and ODI score;and between postoperation and final follow-up,there was no significant differece(P＞0.05) in terms of relative disc space height and Boxall index,and the height and location of diseased intervertebral spaces after rectifying losed in varying degrees at final follow-up,but there was very significant difference(P＜0.01) in terms of ODI score.Between both groups,there was no significant difference(P＞0.05) preoperatively in terms of relative disc space height,Boxall index and ODI score,but postoperation and final follow-up,there was significant differece(P＜0.05) in terms of relative disc space height and Boxall index,and there was no significant difference(P＞0.05) in terms of ODI score.At final follow-up,group A was more than group B in the fineness rate of bone fusion rate and change of JOA scoring,and there was significant differece(P＜0.05) between both groups in terms of bone fusion rate and change of JOA scoring.Conclusion:(1) The posterior lumbar interbody fusion with interbody fusion cage and posterolateral fusion are effcetive and security for the treatment of the degenerative disease of lower lumbar,but the former is much more than the latter at the recovery rate;(2) The posterior lumbar interbody fusion with interbody fusion cage has anadvantage to posterolateral fusion in rectification of lumbar vertebrae and its maintenance,as well as bone fusion rate;and posterolateral fusion is less than posterior lumbar interbody fusion with interbody fusion cage in operation time and hemorrhage amount.