Tranforaminal Unilateral Approach For Bilateral Decompression In Lumbar Interbody Fusion For The Treatment Of Lumbar Spinal Stenosis

ObjectiveTo compare the recent clinical results of bilateral decompression via unilateral approach of intervertebral foramen and small surgical incision of bilateral spinous process in lumbar interbody fusion for the treatment of lumbar spinal stenosis,and assess the clinical application value of tranforaminal unilateral approach for bilateral decompression.MethodsFrom July 2014 to June 2015,48 patients need decompression and internal fixation to treat lumbar spinal stenosis were randomly divided into the unilateral approach for bilateral decompression group(24 cases)and bilateral small incision approach for bilateral decompression group(24 cases),Unilateral approach for bilateral decompression group included 10 males and 14 females with an average age of 65.6 years.Small incision group included 12 males and 12 females with an average age of 60.4 years.In the perioperative period,the relevant circumstances of the operation,the incidence of surgical complications,and the intervertebral fusion rate of the two groups were compared and analyzed.Serum creatine phosphokinase levels were evaluated preoperatively and at 1,3,7 days after the opertion.All patients were followed up,and the visual analogue scale(VAS)and Oswestry disability index(ODI)of before and 3,6 and 12 months after operation were performed.ResultsCompared the two groups of patients,operation time,intraoperative blood loss,hospital stay,interbody fusion rate,the incidence of complications did not show statistically significant difference(P>0.05),but there were significant differences in the first day of postoperative the level of CPK,postoperative drainage,postoperative low back pain VAS between the two groups(P<0.05).The two groups were followed up for 12-24 months(average 17 months).The average low back pain VAS decreased from(7.1±0.8)preoperatively to(1.5±0.5)postoperatively,the average Oswestry scores decreased from(36.3±1.1)preoperatively to(2.8±0.8)postoperatively in the unilateral approach for bilateral decompression group.The outcomes of operation was satisfactory.ConclusionThe bilateral decompression via unilateral approach of intervertebral foramen and small surgical incision of bilateral spinous process in lumbar interbody fusion for the treatment of lumbar spinal stenosis were satisfied with the efficacy,but the tranforaminal unilateral approach for bilateral decompression and lumbar interbody fusion showed less trauma,avoidance of bilateral muscle stripping and soft paraspinal muscle injury,to keep the structure around the spine mostly,faster postoperative recovery,shorter hospital stay,which meant the short-term outcomes was excellent.