| Background:With the growing number of elderly people，the prealence of Degenerative lumbar SpinalStenosis disease is rising. It is become a spine of common disease, frequently-occurring disease.At the same time with the improvement of living standards, operation technology matures,operation indications also gradually broaden, currently in clinical surgery for the treatment ofone of its main method.The spine vertebra canal decompression and fusion fixation has become the maintreatment for many spinal disease means. Posterior lumbar intervertebral fusion（PLIF）isconsidered treatment degenerative lumbar spinal stenosis disease of the "gold standard". Withall kinds of new type of spinal internal fixation devices in the clinical application and operationof the success of the fusion technology improvement, especially for nearly30years, usingpedicle screws technology application, Bone fusion rate has reached about95%[1], make spinalfusion to reach unprecedented summit. In a way, fusion or not has become a judgment ofsurgery is one of the key success criteria.However this kind of surgery is not perfect, though patients receiving spinal fusionfixation and relieve pain, but also brings a series of problems, among them, Adjacent segmentdegeneration (ASD) problem is currently one of the topics attract much attention，reports in theliterature its rate of5%-45%[2.3], Because ASD can cause symptoms backleg pain of recurrenceor even worse, there are some people still need to go to surgery.More related diagnosis for ASDof literature is focused on imaging, its occurrence mechanism is not at all clear. But most scholars think, after interbody fusion the biomechanics of abnormal changes is the mainmechanism to happen ASD. Also some think of ASD may occur with age, sex, patient whetherthere are osteoporosis, the way of fusion, fusion segments surgical and position, andpreoperative waist pain condition related closely[4], but so far is still not completely clear. Thispaper will collect cases material of lumbar fusion fixation according to the clinical follow-upresults to analysis effect about PLIF is used in the treatment for DLSS and the Influence factorsof ASD.Objective:To evaluation of two different points of the nail into the lumbar spinal fusion fixationtreatment degenerative lumbar spinal narrow the clinical effect of disease, and discusses thelumbar spine fixation fusion postoperative adjacent segment degeneration factorsMethods:Collected from July2002to February2011in our hospital PLIF line of177cases ofretreat was waist spinal stenosis disease patients were divided into two groups, A group of118, is the improved of lumbar spinal pedicle into nails point group; The nail into thepoint to: on the outer rim of the vertical joints ashdod and the sudden1/4andthree-quarters of the intersections under horizontal. Group B59patients, the nail into thepoint to: on the outer rim of the vertical joints ashdod and at the intersection of thehorizontal axis on. According to two groups of patients, clinical results in its best recovery,the curative effect of time of follow-up was compared and analyzed.Results:1.Refer to Japanese Orthopaedic Association (JOA) low back pain treatment evaluationstandard[5]:Among177cases with optimal131cases (74.0%), Good33cases (18.6%), theexcellent-good rate is92.6%. A group of118patients with clinical curative effect of optimal101cases (85.56%), and13cases (11.01%), was reached96.57%; Group B59patients clinicalcurative effect optimal41cases (69.54%), and10patients (16.93%), was86.47%.2.Localization edition ODI dysfunction index(Oswestry disability index，ODI):Among177cases with optimal124cases (70.05%), Good32cases(18.07%), the excellent-good rate is 88.12%. A group of118patients with clinical curative effect of optimal97cases (82.26%), and13cases (11.01%), was93.27%; Group B59patients clinical curative effect optimal38cases(64.40%), and11patients (18.64%), was83.04%.3. Pain visual analog stick (visual analoguescale, VAS) assessment:177patients preoperative VAS score averaged6.35points,2.1pointsfor postoperative VAS.A group of118patients with preoperative VAS score5.43+/-2.19, bestrecovery VAS score of0.76+/-0.88, follow-up VAS when score for1.33+/-1.08; Group Bfifty-nine patients preoperative VAS score5.27+/-2.34, best recovery VAS score of0.97+/-0.89, follow-up VAS when score for1.79+/-1.83.4. Henderson curative standard:Among177cases with optimal126cases (71.2%); Good38cases (21.4%); But10cases; Poor3cases, theexcellent-good rate is92.6%.5. Adjacent Segment Degeneration imaging evaluation by UCLA(University of California at Los Angeles, UCLA[6]) and Pearce classification standard forevaluation the results show that the occurrence of ASD and gender no significant sexualrelationship (card square value=0.896, p=0.334>0.05); no significant sexual relationshipwith age,(card square value=1.018, p=0.293>0.05); no significant sexual relationship withthe number of fusion segments (card square value=2.453, p=0.293>0.05); But withpreexisting adjacent disc degeneration significant correlation, pre-existent adjacent segmentdisc degeneration of the incidence of ASD a preoperative does not exist nearby the discdegeneration obviously is on the high side, between the two groups of significant difference(card square value=7.418, p=0.006<0.05);5. The more fusion segments, the postoperativeASD degeneration the higher level of between groups in significant difference (card squarevalue=16.418, p=0.0001<0.05).Conclusion:Posterior lamina resection window decompression and between vertebra bone fusion andpedicle nail fixation (PLIF) is the treatment degenerative lumbar spinal stenosis diseaseeffective method for relief of symptoms backleg pain and nerve function recovery results areideal. In the clinical curative effect, we have modified the pedicle into was superior to thetraditional method into the nail collocation method. PLIF postoperative adjacent segmentdegeneration of the occurrence and age, sex, patient fusion segments no significant relationshipbetween quantity, and the adjacent intervertebral disc degeneration whether there is a significant related to the preoperative adjacent disc degeneration is ASD risk factors. |
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