Clinical Diagnosis And Treatment Research On Degenerative Thoracic Spinal Stenosis Of 23 Cases

The direct pathogenesy of Thoracic Spinal Canal Stenosis (TSS) is the blood circulation, sensory and motor conduction obstacles of thoracic spinal cord caused by things to press on it. It could be seen the most in clinical is the major degenerative changes as the main pathological changes. Since 1982 domestic Shao-ting Xu scholars who had reported the first report of this disease, the clinical reports related to it is rising. But so far its etiology and pathogenesis is still not clear. At present the patient increase every year, because of surgery is very difficult and dangerous, and the treatment is not satisfactory. So, we still need to summarize its clinical characters and it is still constantly looking for better treatment methods.In this paper, we summarize the characteristics of the clinical diagnosis and surgical treatment of the degenerative Thoracic spinal stenosis, to observe and analysis the therapeutic effect of the two methods of operation, to further explore better methods of treatment and improve the treatment of the disease for the purpose. We choose 23 patients admitted our hospital and do retrospective study to those clinical data. There are 10 cases of men and women in 13 cases. The age is from 41 to 76 years old and the average age is 54 years. The course is 1 months to 10 years and the average is 29 months. Based on the clinical performance of summing up, we found that its symptoms and signs were complex and diverse and the signs of damage of upper and lower motor neuron can appear at the same time or separately. The analysis of our results of imaging examination suggests that the disease is usually onset at low of the thoracic spine and the distribution is usually more extensive and jumping. The pone pathological changes are mainly. At the same time the disease is often combined two or more of the above pathological changes.All the patients were under general anesthesia with the method of posterior midline approach. The 16 cases of them were treated by spinal canal decompression. The 7 cases of them were treated by 360°circles spinal canal decompression, transpedicle instrument fixation system and arthrodesis with bone grafting, which is innovative. For the two groups of patient who use different surgical methods, under Mann function assessment criteria, evaluate the clinical symptoms and signs as curative effect, at the time one week before and after the operation, and the last time of the follow up separately. The results of follow up show that: among the 16 cases who were treated by spinal canal decompression, 7 cases were excellent, 4 cases were good, 2 cases relieved, 1 case is poor, the rate of fineness is 78.6 percents. Among the 7 cases who were treated by 360°circles spinal canal decompression, transpedicle instrument fixation system and arthrodesis with bone grafting, 3 cases were excellent, 2 cases were good, 1 cases relieved, 1 case is poor, the rate of fineness is 71.4 percents. The time of spinal canal decompression is 100 ~ 280 min, an average of 163 min; 200 ~ 1000 ml blood loss, an average of 475 ml. The time of 360°circles spinal canal decompression, transpedicle instrument fixation system and arthrodesis with bone grafting is 180 ~ 310 min, an average of 220 min; 600 ~ 1400 ml blood loss, an average of 886 ml.In sum, we came to the conclusion: 1. The TSS clinical manifestation is complicated and diverse and need bind with the imaging examination and make comprehensive and integrated analysis is very important for clinical diagnosis and surgery programme design. 2. About the surgical treatment, the patient whose major causative agent is cataplasia should be treated by spinal canal decompression from the posterior approch; the patient whose back of thoracic cord was compressed and at the same time in front of the pathological changes there was single segment intercalated disc exerted should be treated by 360°circles spinal canal decompression, transpedicle instrument fixation system and arthrodesis with bone grafting operation,It's an effective surgical method.The surgical method of 360°circles spinal canal decompression proposed by this paper is based on the characteristics of the disease and improved on basing of the original posterior spinal canal decompression procedure and of the articular process intercalated disc removal. The research shows that the treatment is more satisfied. But the number of cases is still small and the follow-up time is short. So it still needs further observation.