The Comparsion On Clinical Effects And Adjacent Segment Degeneration Of Semi-laminectomy And Total Laminectomy Interbody Fusion In The Treatment Of Lumbar Spinal Stenosis

Objective 1. To compare the differences of clinical effects and morbidity of ASD between semi-laminectomy and total laminectomy interbody fusion; 2. To explore the factors that affecting adjacent segment degeneration after posterior lumbar interbody fusion.Methods 116 patients from January 2012 to December 2013, were included in this study. 41 patients were treated with semi-laminectomy interbody fusion(group A). And 75 patients received total laminectomy interbody fusion(group B). According to the inclusion criteria and exclusion criteria,we finally choose 116 patients for the research(Group A 41 cases:24 males, 17 females, average age 51.1±12.6years;Group B 75 cases:36 males, 39 females, average age 52.3±12.6 years).The patients were followed up for an average of 2 years. The clinical effect was evaluated by NRS and JOA. X-ray examination was used to evaluate the occurrence of postoperative ASD.Results 1、The NRS in the last follow-up interview is significantly reduced than that before the operation. The JOA in the last follow-up interview is significantly advanced than that before the operation. but no significant difference was observed between two groups(P>0.05). 2、There were 4 cases exhibiting radiographic degeneration(degeneration rate 9.8%) and 1 case exhibiting symptomatic degeneration(degeneration rate 2.4%) in the A group, however, there were 26 cases exhibiting radiographic degeneration(degeneration rate 37.4%) and 5 cases exhibiting symptomatic degeneration(degeneration rate 6.7%) in the B group.The difference is significant(P<0.05). 3、ASD was not associated with age, gender, race and fused segment, and the method of operation was one of the direct causes of ASD.Conclusion 1、The clinical effects between semi-laminectomy and total laminectomy interbody fusion is not significant.But the degeneration rate after the semi-laminectomy interbody fusion is lower. 2、ASD was not associated with age, gender, race and fused segment, but the correlation between the method of operation and ASD was found. Therefore, we speculated that the the right operation method could prevent the postoperative ASD.