Surgicaltreatmentof Complicated Lumbar Spinal Stenosis

Objective:With the population aging and the rapid development of imaging diagnostic techniques,the morbidity of degenerative lumbar spinal stenosis(LSS) was significantly increased. It is an important cause of skelalgia in aged, and common cause for lumbar spinal surgery. The surgical and non-surgical intervention were the major treatment of LSS. In this article, the application and development of surgical therapies for degenerative LSS were expatiated, such as laminectomy and decompression, fixation with fusion discectomy, and so on. To evaluate the therapetic effect of posterior trans-pedicle internal fixation and lumbar interbody fusion (PLIF) using cage and autogenus bone grafting and traditional decompression operations (vertebral windowing surgery,hemivertebral resection,holovertebral resection and trasplant) for treatment of lumbar spinal canal stenosis and investigate its technique and clinical value.Methods:From Jun,2006 to Aug,2008,85 patients accepted surgical treatments in our hospital due to lumbar spinal stenosis。Their ages were from 39 to 75, average 58. Their courses of disease were from 3 months to 40 years, average 4 years and 2 months.85 patients were followed up, traditional decompression operation (vertebral windowing surgery,hemivertebral resection,holovertebral resection and trasplant) in 38 cases (group A), posterior trans-pedicle internal fixation and lumbar interbody fusion PLIF in 47 cases (group B).All patients were followed up 16-43 months,with average 23 months.the clinical results of different operations were evaluated according to JO A method. Statistic analysis was done to evaluate the results.PLIF:Among 47 cases with lumbar spinal canal stenosis,decompression for stenosis were performed firstly,pedicle screws were conducted and intervertebral space increased,disc was removed while the anterior and lateral wall of fibrosus annulus were well preserved,the cartilage layer of end plate were gently cureted,some cancellous bone were inserted into the space firstly,then one or tow Cages were inserted.Finally,pedicle screw system with compression and locking was installed.Result:Through comparison between the above two groups the results confirmed that the PLIF had obvious advantage over traditional methods in achieving instantly stabilitation,increasing the fusion rate of bone implant and duration of recombence,madvantage in blood loss,drainage and medical cost.The patients can mobilize with brace earlier post-operativly.All the patients had excellent results,all segments were confirmed to be solidly fixed by constant X-ray exzamination.there were significant retrieve of disc space height and foraminal height,and the meaningful loss of disc height was not found in following period. there were no break of Cages and pedicle screws breakage there were no infection. According to the JOA score standard, the fineness rate was 78.94% in the patients accepted traditional decompression operations (vertebral windowing surgery,hemivertebral resection,holovertebral resection and trasplant) and 95.74% in the patients accepted posterior trans-pedicle internal fixation and lumbar interbody fusion (PLIF). According to a=0.05, xc2=4.22.P<0.05.the difference between group B and group A was statistically significant. group B higher than group A. the therapeutic effect of posterior trans-pedicle internal fixation and lumbar interbody fusion (PLIF) using cage and autogenus bone grafting is better than traditional decompression operations (vertebral windowing surgery,hemivertebral resection,holovertebral resection and trasplant) for treatment of lumbar spinal canal stenosis.Conclusion:PLIF technique meets the need of complete decompression,interbody height reconstruction,stability and sound bony fusion in the elderly lumbar disc herniation.Vertebral pedicle internal fixation can correct vertebral slip,restore the spinal physiologic curve,achieve instantly stabilization,increase the fusion rate of bone implant,ang elevate the operative effects.The effect of posterior trans-pedicle internal fixation and lumbar interbody fusion using cage and autogenus bone grafting for treatment of lumbar spinal canal stenosis is better than traditional decompression operations (vertebral windowing surgery,hemivertebral resection,holovertebral resection and trasplant).The effects of the group B were better than the group A recently,but unknown long time later.