Clinical Study On The Treatment Of Single Segment Lumbar Degenerative Disease By PLIF Lamina Osteotomy And Replantation Surgery And PLIF Laminectomy

Objective:Observe the clinical effect of PLIF lamina osteotomy and replantation surgery and PLIF laminectomy for the treatment of single segment lumbar degenerative disease.Compare the discrepancy of the incidence of postoperative complications of epidural fibrosis(EF)and adjacent segment degeneration(ASD),to investigate the best surgical treatment of single segment lumbar degenerative disease with PLIF.Method:Select cases who have the treatment of single segment lumbar degenerative disease by PLIF lamina osteotomy and replantation surgery and PLIF laminectomy and obtain complete follow-up of Shaanxi People's Hospital spinal surgery department during January 2009 to January 2014,and 167 cases were retrospectively analyzed according to the inclusion and exclusion criteria.Have all cases divided into two groups according to the different surgical methods:lamina osteotomy and replantation Group which have the PLIF lamina osteotomy and replantation surgery and include 82 patients,and laminectomy Group which have the PLIF laminectomy and include 85 patients.The two groups had the same nursing and follow up except treated with different surgical procedures.Comparative observation of visual analogue scale(VAS),low back pain score of the Japanese orthopaedic association(JOA),Oswestry disability index(ODI)and Imaging data of the two groups of patients,and analyzed the clinical efficacy,the excellent rate of lumbar interbody fusion and the difference of incidence of postoperative complications of EF and ASD of the two groups.The data were analyzed by using SPSS 18.0 statistical software.Two independent samples t test was used to compare the data between two groups,Paired samples t test was used in the in group comparison,?2 test was used to compare the count data,and the test level is set to 0.05.Result:At the last follow-up,the VAS score,JOA score,ODI index of the two groups were significantly improved compared with preoperative,the difference has statistically significant(P<0.05).At the end of the last follow-up,the three scores of lamina osteotomy and replantation Group were(2.0±1.1).(24.0±1.8).(19.8±8.2)%,the results of laminectomy Group were(2.5±1.6)?(23.3±2.0)?(22,5±8.5)%,compared within the two groups,the scores of the three items showed good statistical difference(P<0.05).Excellent rate of Macnab:lamina osteotomy and replantation Group is 96.34%,laminectomy Group is 85.88%,the difference between the two groups has statistically significant(P<0.05).Excellent rate of lumbar interbody fusion:lamina osteotomy and replantation Group is 97.56%,laminectomy Group is 92.94%.During the follow-up,16 cases of EF were found in lamina osteotomy and replantation Group,the incidence rate is 19.51%,while 30 cases of EF were found in laminectomy Group,the incidence rate is 35.29%,and the difference has statistically significant between the two groups(P<0.05);20 cases of ASD were found in lamina osteotomy and replantation Group,the incidence rate is 24.39%,while 37 cases of ASD were found in laminectomy Group,the incidence rate is 43.53%,and the difference between the two groups has statistically significant(P<0.05).At the last follow-up,the three scores of EF(+)ASD(-)patients were(2.7±1.8)?(22.0±1.9)?(24.4±9.0)%,the three scores of EF(-)ASD(+)patients were(2.9±1.5)?(21.6±2.0)?(25.7±8.7)%,they all compared with EF(-)ASD(-)patients whose scores were(1.7±1.0)?(25.6±1.6)?(16.3±7.1)0%the differences have statistically significant(P<0.05).Conclusion:This paper retrospectively analyzed the clinical data of 167 cases of the treatment of single segment lumbar degenerative disease by PLIF lamina osteotomy and replantation surgery and PLIF laminectomy,these two kinds of surgical methods both have achieved good results.PLIF lamina osteotomy and replantation surgery has better clinical efficacy and lower incidence of postoperative complications of EF and ASD compared with PLIF laminectomy.The results of this study can provide a reference for the selection of surgical methods for single segment lumbar degenerative disease in the clinical practice of spinal surgery,and have important theoretical and clinical significance in guiding the operation and reducing postoperative complications.