The Non Fusion Surgery For The Clinical Research In Lumbar Intervertebral Disc Degenerative Disease

Background and objectiveLumbar degeneration is a pathological physiological phenomenon in the processof lumbar natural degradation. Mainly includes the intervertebral disc degeneration offiber ring,the cartilage endplate degeneration,the intervertebral disc degeneration ofnucleus pulposus, Degeneration of the lumbar vertebral body, Yellow ligamentdegeneration, Lumbar vertebra small joint degeneration, Other ligament degeneration,Degeneration of spinal canal, Osteophyte formation etc. More than one or morefactors together contributed to the occurrence of lumbar degenerative disease.Theclinically main show is lumbar disc and its corresponding vertebral canal stenosis.Thus cause a series of clinical symptoms, Main symptoms for the waist pain is not,the radiating pain of lower limbs, double lower limbs numbness unwell, weakenedmuscle strength,muscle atrophy, abnormal tendon reflex, When serious the urinateand defecation appear dysfunction. Lumbar degenerative disease is a common clinicaldisease, Because people are unhealthy living habits and an ageing population, there isan upward trend in the incidence of a disease. Lumbar degenerative disease is a threatto human health of common diseases, so most experts advocate found after illness, inthe early to take active measures for treatment, can obtain better neural functionalrecovery, and the shorter the course of the corresponding recovery effect is better.At present, many methods for the treatment of lumbar degenerative disease,from the consideration on the timing and severity, divided into two kinds of surgeryand nonoperative treatment methods. The surgery depending on the intraoperativesurgical method,roughly divided into fusion surgery(Posterior Lumbar Inter bodyFusion,PLIF) and the non fusion surgery.The surgery of PLIF, as the name implies,the adjacent vertebral body fixed up by using the method of bone graft,so as to achieve permanent in the sense of stability. However,the non fusion surgery is Onlyby the effect of internal fixation stability of lumbar spine, in the stability of lumbarspine while maintaining a certain activity, so as to achieve the purpose of treatingdiseases.In recent years, Lumbar spinal fusion surgery(PLIF) has become a commonlyused method for the treatment of lumbar disease, used in the treatment of all kinds oflumbar degenerative disease such as lumbar olisthe, lumbar disc and spinal canalstenosis disease etc. Along with the increase in fusion surgery, adjacent phasedegeneration problem has become increasingly the focus of people. With thecontinuous development of technology, an emerging the non fusion surgery,also letpeople consider the two methods in adjacent phase degeneration have direct orindirect role, its clinical effect how. In this paper, lumbar pedicle screw fixationwiththe elastic rod is developed based on the fusion of philosophy. Due to itsapplication in clinical time is short, relevant research data and the literature is less.This clinical study of45cases of lumbar degenerative disease(Mainly for the singlephase of lumbar intervertebral disk, Lumbar disc and spinal canal stenosis, Lumbarspinal stenosis) patients postoperative follow-up, Analyze lumbar fusion(PLIF) withlumbar spinal non fusion (Lumbar pedicle screw fixation with the elastic rod)surgeryin the treatment of lumbar degenerative disease of the early clinical curative effect,for diagnosis and treatment of lumbar degenerative disease of the correspondingtheoretical basis and clinical evidence.MethodBy June2009to June2013in our clear diagnosis of the lumbar spine (L4/5)single stage in48patients with degenerative disease of lumbar，One line of nucleuspulposus of lumbar disc excision plus bone graft fusion and internal fixation（Thecontrol group,22cases）and Lumbar pedicle screw fixation with the elastic rod(Theexperimental group,26cases) For all surgical patients to early follow-up study,postoperative follow-up of11~33months for the cycle, an average of22months.All patients in the ODI index and JOA scores before and after operation on the earlyclinical curative effect evaluation. Respectively in the preoperative and postoperative 1month,6months,12months, and the last follow-up time line of the lumbar spineDR(Lumbar positive side, Through a bend a lumbar spine)and CT examination. Andadjacent phase measurement problem of the lumbar intervertebral motion(ROM).Andcompare two kinds of surgical methods used by the intraoperative blood loss andoperation time.ResultTwo groups of patients with postoperative ODI index compared with thepreoperative significant decline（P<0.05）, JOA score significantly higher comparedwith before the operation also appeared（P<0.05）,The results show that two kinds ofoperative methods improve patients in the early postoperative pain and othercorresponding clinical symptoms have a significant effect,two kinds of operationmethod early curative effect showed that there was no statistically significantdifference（P>0.05）; Group with1months after segmental mobility increasedcompared with the preoperative, the waist problem segmental mobility is less thanL4/5the adjacent stages, eventually with postoperative follow-up of1months is nosignificant change; Control group L4/5loss of segmental mobility problem, L3/4stage with postoperative1phases of the moon is in the final follow-up activitysignificantly increased（P<0.05）; Two kinds of intraoperative blood loss and surgeryused time difference was statistically significant（P<0.05）.ConclusionsBy comparing the two kinds of operation method, Lumbar pedicle screw fixationwith the elastic rod operating time is relatively short; Two kinds of operation methodcan obviously improve clinical symptoms of patients with ease, to obtain satisfactorycurative effect. Judging from the last follow-up data,with increase of time,Theoperation of lumbar pedicle screw fixation with the elastic rod in the lumbar spinemotion and prevent its adjacent phase degeneration, etc have a significant advantage.