Surgery With Traditional Chinese Medicine Treatment Of Lumbar Canal Stenosis, Clinical Observations,

Objective:To compare the clinical outcome of surgical treatment with Chinese traditional medicine treatment and a separate application with the surgical treatment f -or lumbar spinal stenosis with low degree lumbar spondylolisthesis.To discuss approach of reducing postoperative pain,promoting fusion and improving the curative effect.Methods:This article is the study of patients who were suffered from lumbar spinal stenosis with low degree lumbar spondylolisthesis,all of 60 inpatients from the Second Hospital of Shenzhen city from April 2005 to April 2007 that there were complete case information.According to random number table,all of the 60 inpatients were randomly and divided into treatment and control groups.By Wiltse classification and Meyerding indexing methods,the patients in treatment group(n=30,13 men and 17 women,average age of 55.21 years old,an average course of 5.6 years),which including 25 patients of degenerative lumba -r spondylolisthesis and 5 patients of lumbar vertebral isthmic spondylolysis.In 25 patients of degenerative lumbar spondylolisthesis,there were 8 cases of 1 d -egree and 5 cases of 2 degree of L_4～5segment spondylolisthesis;4 cases of 1 degree and 5 cases of 2 degree of L₅～S₁ segment spondylolisthesis;3 cases of 1 degree of both L_4～5and L₅～S₁ segments SpondyloIisthesis.In 5 patients of lumbar vertebral isthmic spondylolysis,there were 2 cases of 2 degree of L_4～5segment spondylolisthesis associated the fourth lumbar Pedicle bilateral isthmic spondylolysis and 3 cases of 2 degree of L₅～S₁ segment with the f -ifth lumbar Pedicle bilateral isthmic spondylolysis.In the treatment group,15 patients complained of lower back pain with both lower limb pain,4 patients pain only in leg and 11 patients only lower back pain.26 of these patients complained of intermittent claudication,with a walking distance ranging from 10 m to 1000m,11 patients had some changes in sensation,motion and reflexes of the foot.the patients in control group(n=30,15 men and 15 women,average age of 56.52 years old,an average course of 5.9 years),which including 26 patients of degenerative lumbar spondylolisthesis and 4 patients of lumbar v -ertebral isthmic spondylolysis.In 26 patients of degenerative lumbar spondylolisthesis, there were 7 cases of 1 degree and 6 cases of 2 degree of L_4～5segment spondylolisthesis;2 cases of 1 degree and 9 cases of 2 degree of L₅～S₁ segment spondylolisthesis;2 cases of 1 degree of both L_4～5and L₅～S₁ segments Spondylolisthesis.In 4 patients of lumbar vertebral isthmic spondylolysis, there were 1 cases of 2 degree of L_4～5segment spondylolisthesis associated t -he fourth lumbar Pedicle bilateral isthmic spondylolysis and 3 cases of 2 degree of L₅～S₁ segment with the fifth lumbar Pedicle bilateral isthmic spondylolysis. In the control group,14 patients complained of lower back pain with bo -th lower limb pain,3 patients pain only in leg and 13 patients only lower back pain.28 of these patients complained of intermittent claudication,with a walking distance ranging from 100m to 1000m,13 patients had some changes in sensation,motion and reflexes of the foot.All patients showed dynamic instability of the lesions section.The two groups had no significant difference in gender,age,duration,severity of patients by statistical test(P＞0.05).All the patients of two groups received treatment for lumbar decompression with lumbar posterolateral fusion and pedicle screw system fixation.While the patients in the treatment group can eat after operation,taking Chinese medicine("Fu Yuang Ke Tong" capsules).(1)The changes of pain of all the patients' at preoperation and postoperation 5,8 and 12 day were observed.In accordance with visual analogue scale to score,compare and analyse the changes.(2)The fusion rates of two groups were recorded respectively in 3,6 and 12 month after s -urgery.(3)The total score of the patients' symptoms and signs in the two groups were recorded respectively before and after operation 6 and 12 month by Japanese Orthopedic Association with low back pain score sheet.To calculate improving efficacy rate as the general evaluation standards. Results:(1)The pain score of the patients evaluated according to VAS in the two groups before surgery had no significant difference by t-test(P＞0.05),showing that there was comparison between them in pain degree.The pain score of t -he patients in the two groups were compared and tested separately at 5,8 and 12 day after operation,there were all significant difference,suggesting that t -he effect of therapy for the treatment group relieve the pain much better than it for the control group in the time period of two weeks after surgery.(2)All the patients received X-ray examination and the fusion rates of two groups were recorded respectively in 3,6 and 12 month after surgery that were performed by the same team radiology doctors.In the treatment group the fusion rate was 50%(15/30),73.33%(22/30)and 83.33%(25/30)in 3,6 and 12 month after operation;In the control group the fusion rate was 23.33%(7/30),46.67 %(14/30)and 76.67%(23/30)in 3,6 and 12 month after operation.The fusion rates of the two groups that were tested had no significant difference in 12 month after operation.But on the other hand,the statistical test showed that the two groups in 3 and 6 months after surgery had a number of significant differences(P＜0.05). The number of fusion in the treatment group was more than the control group,showed that the fusion time of treatment group was faster than the control group.(3)The rates of improvement of two groups patients in 12 month after operation had significant difference(P＜0.05),showed that the clinical effect of treatment group was better than the control group in 12 month after surgery.Conclusions:It is a better method for patients suffered lumbar spinal stenosis with low degree lumbar spondylolisthesis to add treatment of taking Chinese traditional medicine after surgical treatment,wich can reduce postoperative pain more e -ffectively,shorten the fusion of time,increase the total clinical effect and shows advantage of the combined treatment of Chinese and Western Medicine.