Clinical Study Of Posterior "Windows Technique" Laminoforaminotomy With Fusion By Minimal Incision For The Treatment Of Lumbar Spinal Stenosis

Objective. For patients with preoperative lumbar instability, or severe spinal stenosis that much of the bony structure and small joints need to be removed during decompression surgery, resulting in dynamic instability, simple decompression often aggravates the lumbar instability. Fusion eliminates not only instability factors within two adjacent vertebral sections, but the intervertebral activities, avoiding the developing process of spinal stenosis. The study aimed to explore the effect of posterior lumbar "windows technique" laminoforaminotomy with fusion by minimal incision for the treatment of lumbar spinal stenosis.Methods. From September 2011 to February 2012, clinical patients were divided into two groups, 40 consecutive patients were equally brought into two groups. Group A underwent posterior lumbar "windows technique" laminoforaminotomy by small incision while group B take decompressive laminectomy. Fusion and fixation were used in both groups. The patients were followed up and evaluated by surgical incision, blood loss, operation time, postoperative drainage, the relief of low-back pain, leg pain, neurological function pre-operatively and post-operatively, and complications.Results. The average follow-up was 23 months. Last follow-up showed that back pain, leg pain and neurology of patients in both groups recovered significantly compared with that before operation(P<0.05). Group A was less in incision length, blood loss, operative time, and postoperative drainage, final back pain visual analogue score(VAS) and higher in final improvement rate than Group B, with statistical difference(P<0.05).Conclusions. Posterior lumbar "windows technique" laminoforaminotomy with fusion by minimal incision may be an innovative "minimally invasive" idea. As a procedure modified from the conventional surgery, it can completely release the nerve roots and achieve interbody fusion and effectively and safely. In addition, the procedure retains the native structure with less trauma and operation time to the utmost, especially for posterior column, leading to furthermore back pain which has unique advantages compared with current minimal invasive spine surgery.