Treatment Of Degenerative Lumbar Spinal Stenosis With Lumbar Vertebral Instability By Posterior Lumbar Decompression And Bone Grafting And Internal Fixation (TLIF)

OBJECTIVE Assessing the surgical results of the patients,who receive the treatment of degenerative lumbar spinal stenosis with lumbar vertebral instability by posterior lumbar decompression and bone grafting and internal fixation(TLIF),and discussing the etiology,pathology,low back pain mechanism,diagnosis,treatment options of this disease.Methods All patients were selected in strict accordance with the inclusion criteria and exclusion criteria in this article.The patients of degenerative lumbar spinal stenosis with lumbar instability with a total of 60 cases(34 males and 26 females,61±7years)were Selected from 2012 to 2014,in Tongji Hospital,Wuhan,undergoing the expected surgical approach.Back and leg pain was measured using Visual Analog Scale(VAS)and Japanese Orthopaedic Association Scores(JOA)before surgery,postoperatively at three months and twelve months.Disability was assessed using the Oswestry Disability Questionnaire(ODI)before surgery and postoperatively at three months and twelve months.Spino-pelvic Sagittal Balance(SPSB)was measured using Lumbar Lordosis(LL),Lumbar Intervertebral Height(LIH),Pelvic Tilt Angle(PT),Pelvic Incidence Angle(PI)and Sacral Tilt Angle(SS)before surgery,postoperatively at three days and twelve months.Intervertebral fusion was measur ed using X-ray and CT postoperatively at twelve months.Results The clinical symptoms and imaging parameters of all patients after surgical treatment were improved significantly,no complications occurring.At the time of follow-up,the VAS and ODI were significantly decreased in all patients,and there was significant difference between the two groups.The JOA was significantly increased,and there was significant difference between the two groups.There were significant differences in the SPSB,with LL,LIH and SS increasing,whearas,PT decreasing.There was no significant difference in the changes of these parameters after operation.Conclusion For patients of degenerative lumbar spinal stenosis with lumbar vertebrae instability,the technique of TLIF is safe and effective,which not only can significantly reduce the patient’s symptoms,shorten the course of disease,but also have a positive effect on the reconstruction of normal lumbar sequence and the restoration of lumbar vertebrae stability.