The Clinical Study Focusing On Blood Loss And Effect Of Lumbar Decompression And Fusion After The Process Optimization For Lumbar Degenerative Diseases

Objective: To evaluate the safety and efficacy of lumbar decompression and fusion after the process optimization for lumbar degenerative diseases.Methods: The cases of adult patients who were in accordance with the inclusive criteria and need to undergo lumbar decompression and fusion were retrospectively analysis.According to the different operation way,the patients can be divided into process optimization(59 patients)and traditional lumbar fusion group(60 patients).Moreover,patients in two groups were classified into three subgroups based on the different fusion segmen: single segment,double sgements and beyond two segments,namely.The operative blood loss,postoperative drainage volume,transfusion volume,hematocrit value,postoperative complications(incision infection,spinal dural and nerve root injury included),VAS and JOA score before and after operation,the number of different levels according to the Macnab criterion,the number of fusion rate and adjacent segment degeneration postoperative were recorded respectively.The SPSS 17.0 statistical software was used to analyzed.Results:(1)Intra-group comparison: Among various subgroups in the same group,there were significant differences in the operative blood loss,postoperative drainage volume,hidden blood loss and transfusion volume(P<0.05).Compared with preoperative,VAS and JOA score were obviously perfect in the last follow-up(P<0.05).However,there were no significantdifferences in VAS and JOA score before and after operation(P>0.05).With the increase of fusion segment,postoperative complications and fusion rate had no significant differences among various subgroups in the same group,but the rate of adjacent segment degeneration in the beyond two fusion segments subgroup higher than the two other subgroups.(2)Comparison among groups: All cases were obtained by follow-up.In two groups,there were significant differences in the operative blood loss,postoperative drainage volume,hidden blood loss and transfusion volume among the same fusion sgement subgroups(P<0.05).There were no significant differences in VAS and JOA score before and after operation,Macnab criterion(P>0.05).In term of postoperative complications,spinal dural injury and lower nerve functional restoration on the 3rd day after operation in process optimization group were higher than traditional lumbar fusion group.Postoperative fusion rate had no significant differences between two groups,but adjacent segment degeneration in the process optimization less than traditional lumbar fusion group.Conclusion(s): Both lumbar decompression and fusion after the process optimization and traditional lumbar fusion are feasible and effective methods for lumbar degenerative diseases.However,lumbar decompression and fusion after the process optimization has lesser the soft tissue and bone structure damage,lesser hemorrhage.Not only can it be used to solve the situation of insufficient blood,but also can decrease the incidence of spinal dural or nerve root injury and slow down the speed of postoperative adjacent segment degeneration.