Selective Laminectomy Combined With Percutaneous Vertebroplasty In The Treatment Of Osteoporotic Vertebral Compression Fracture Associated With Lumbar Spinal Canal Stenosis

Objective: To explore a surgical method whose clinical curative effect，namely1period selective laminectomy and percutaneous vertebroplasty,tostudy the operation for early fracture pain relief, nerve function recovery,improvement of the waist activity, restoration of vertebra height and so on,observation of intraoperative and postoperative complications and recentlumbar degeneration. Comprehensive evaluation of1period selectivelaminectomy and percutaneous vertebroplasty of the short-term clinicalefficacy and safety.Methods: Between January2009and January2011,23cases of patientsunderwent1period selective laminectomy and percutaneousvertebroplasty.Aged68to74, an average of71.2years. All of them are8males and15females.There are21cases of one vertebral fracture and2casesof two vertebral fracture.T From L1to L5are respectively2cases,3cases,6cases,7cases and7cases. All patients only have one segmental stenosis.4cases whose narrow segment is L2/3,9cases is L3/4,5cases is L4/5and L5/S1in5cases.12patients is central canal stenosis,6patients is lateral recessstenosis,5patients is nerve root canal stenosis. Respectively in thepreoperative and1week after the operation and2year with VAS (VisualAnalogue scale) method and evaluation of fracture pain relief. The waistactivity: in the preoperative and1month after the operation,2years after theoperation to measure the waist activity with amount of square. Level0: lumbarproneness>75o; Ⅰ,45o≤Lumbar proneness <75o; Ⅱ,15o≤Lumbarproneness <45o; Ⅲ, lumbar proneness <15o. Neurologic improvement: usethe JOA score to evaluate neural function before and after operation. Vertebral fracture height recovery and recurrence: at the time of the preoperative andpostoperative follow-up on the side of X ray measuring the front and middleheight of vertebral body, understand vertebral body reduction and recurrence.Postoperative MRI contrast2years later to understand adjacent segmentdegeneration.Result: Operations are smoothly completed.All patients were followed upfor2years~2years and a half, an average of26.3months.Peration time was119.3±3.5min, bone cement injection of each vertebral body is about1.5~3.0ml, injection according to the situation.The average blood loss was301.4±20.3ml,there was no leakage of bone cementoccurredinto vertebral canaland poor wound healing. Lower limb symptoms relieved after anesthesiaawake, after5~6week stool and urine back to normal, gradually restoremuscle strength and tension, but some one with severe stenosis of preoperativestays numbness and pain temperature drops. Patients lie in bed for7~10days, and then get out of bed. Preoperative and postoperative vertebral bodyanterior height were21.3±1.2ｍｍ and24.6±1.3ｍｍ, which reflectedsignificant difference(P <0.01). Preoperative and postoperative vertebralcentral height were21.9±1.4ｍｍ and24.8±1.3ｍｍ, which reflectedsignificant difference(P <0.01); VAS score was7.3±1.0before the operation,1.4±0.5at1week after the operation,1.1±0.3at2year,anyscore after theoperationis of statistical significance（P﹤0.05) compared with before。Thescores,2years after the operation and1week，were Compared with nostatistical difference（P＞0.05）;The preoperative and postoperative JOAscore were7.9±0.8and19.9±1.4, which reflected significant difference(P <0.01). Waist activity,1month and2years later compered withpreoperative,which showed significant difference（P﹤0.05),2years latercompered with1month,which also showed singnificant difference（P﹤0.05).One patient was found to have adjacent segment degenerationat2yearsafter operation.One patient had a new vertebral compression fractureat on non-adjacent vertebral.Conclusion: Surgery has the advantage of shorter time, reducing bleeding, suitable for those elderly who can’t long time tolerance general anesthesia andhemorrhage.The surgery have obvious effect for improving pain, Lumbaractivity, nervous function, reinforcement of vertebral body. The combinationof the two operation methods, treating this kind of disease, can maximumprotect the fixation stability of the spine and explore during operation to avoidleakage. The surgicalmethod,which is an safe and effective way to cureosteoporotic compression fracture and lumbar spinal stenosis.