| BackgroundIn recent years,there are so many kinds of operations for the spine surgeons to treat lumbar degenerative diseases,such as posterolateral fusion(PLF),anterior lumbar interbody fusion(ALIF),posterior lumbar interbody fusion(PLIF),transforaminal lumbar interbody fusion(TLIF)and so on.Among all kinds of operations,PLIF has been proved to be effective to treat the lumbar degenerative as a more common treatment,However,as it is widely applied to clinic,many complications began to appear for the late follow-up,such as chronic low back pain,deep tissue infection,settlement of fusion,adjacent segmental degeneration and so on.Among these complications,ASD has the highest incidence.Meanwhile,many spine surgeons pay more attention and research to the ASD.According to the related report,the morbidity of ASD in the postoperative lumbar spinal fusion is from 2% to 14%,but the report and the data have so many difference.Once the ASD is formed in the postoperative,it will have a bad impact on patient daily life,even patient need a second operation which will put a burden on patients' psychological and financial burden.In recent years,our hospital improved the traditional surgery method to decompress the nerve root and enlarge the space for fusion.The improved operation need change the conventional surgical area,keep the PLC and cut off the part of the vertebral plate and facet joint on symptomatic side.However,whether it has a good effect on reducing the morbidity of ASD,we still have not the related clinical analysis.100 patients with lumbar 4/5 disc herniation who underwent PLIF surgery in our hospital from January 2012 to January 2014 were selected for retrospective analysis.The basic objective of the present study is to analyze the importance of the PLC on reducing the morbidity of ASD,which will provide the basis for clinical.ObjectiveBy comparing the difference of the clinical effect and the incidence of ASD between the improved PLIF and the traditional operation,we investigate the importance of the PLC in the prevention of the ASD after posterior lumbar spinal fusion.MethodsAccording to the inclusion criteria and exclusion criteria,eventually 100 patients with lumbar 4/5 disc herniation who underwent PLIF surgery in our hospital from January 2012 to January 2014 were selected,Divided them into two groups,Fifty patients which retained the PLC in the improved PLIF surgery were group A.Fifty patients which resected the PLC in the traditional operation were group B,in the group A,male female ratio of 23:27,age of 37 to 59 years old,average of(50.40±0.92)years old,medical history of 8 to 26 months average of(16.10 + 0.67)months,follow-up time of 18 to 42 months,average(28.80 + 0.83)months;All patients had symptoms of low back pain,29 unilateral lower limb symptoms,and 21 bilateral lower limb symptoms.While other 43 patients who suffer traditional surgery(remove the rear PLC)were regarded as group B,male female ratio of 26:24,age of 36 to 59 years old,average of(50.14±0.84)years old,medical history of 19 to 44 months,average of(30.32 + 0.89)months.All patients had symptoms of low back pain,31 unilateral lower limb symptoms,and 19 bilateral lower limb symptoms.Use pain VAS and function index ODI to score preoperative and postoperative clinical curative effect.Measure the L3/4 intervertebral height preoperatively and at the time of the last follow-up,the change of intervertebral dynamic Angle when make excessive flex,and the sliding distance of vertebral body,and evaluate adjacent segments' degeneration through the lumbar spine X-ray films.Results1.There is no statistical significance in gender,age,medical history,time and general information between these two groups(P > 0.05);2.The pain VAS score and function index of ODI score between the two groups have no statistical significance preoperatively and at the time of the last follow-up(P > 0.05),but at the time of the last follow-up,the pain VAS score and function index of ODI score between the two groups decreased.This difference is significant in statistics(P< 0.05).3.The preoperative difference between these two groups in L3 /4 intervertebral height,change of intervertebral dynamic Angle,sliding distance of vertebral body has no statistical significance(P > 0.05).But at the last postoperative follow-up,compared to the preoperative,the difference between these two groups was statistically significant(P < 0.05),differences between the two groups was also statistically significant(P < 0.05).At the last postoperative follow-up of group B,23 cases suffered L3/4 degeneration,among which 15 imaging degeneration(degeneration rate 30%),8 semeiology degeneration(degeneration rate 16%);While at the last postoperative follow-up of group A,5 cases suffered the L3/4 degeneration,among which 4 imaging degeneration(degeneration rate 8%)and 1 semeiology degeneration(degeneration rate 2%).This difference was statistically significant(P < 0.05);4.At the time of the last follow-up,the pain VAS score and function index ODI score of all the patients,there was no statistically significant difference(P > 0.05),while there was statistically significant as to the patients whit and without semeiology degeneration(P < 0.05).ConclusionPLC modified PLIF surgery and traditional surgery can achieve good clinical efficacy,but improved PLIF can significantly reduce the incidence of postoperative ASD,and only t he symptoms of degeneration can affect the clinical effect of postoperative treatment. |
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