Outcomes Of Laminectomy With Undercutting Decompression And Replantation To Treat Lumbar Spinal Stenosis

Objectives Objective to evaluate the efficacy of laminectomy with undercutting decompression and replantation in the treatment of lumbar spinal canal stenosis by Clinical and radiographic and the the difference of two kinds of fixation materials.Methods Select between August 2014 to January 2016 by the Second Hospital of Tangshan City,Hebei Province Spine Surgery treated 73 cases prolapse of lumbar intervertebral disc with lumbar spinal stenosis and lumbar spinal stenosis symptom.47 cases lamina replantation with silk fixation,26 casea with titanium plate fixation.Evaluation of silk fixation and titanium plate fixation clinical effect by JOA and VAS score and the effect of different lamina fixation.Observation spinal decompression,lamina replantation healing and,Epidural scarring problem and lumbar stability by the anteroposterior and lateral position radiograph of lumbar spinal,CT,the fiexion and stretch position radiograph,The difference of the healing and stability of replantation lamina with different material fixation.Results Of the 73 patients,69 patients were followed up for clinical outcomes,which silk fixation of 45 people,follow-up time of 18.2 months,24 cases were fixed with titanium plate,and the follow-up time was 14.4 months.The JOA score increased and the VAS score decreased after the operation of silk fixation,compared with before operation,the difference was statistically significant(P<0.05),the good rate of the last follow-up was 88.9%,the JOA score increased and the VAS score decreased after the operation of titanium plate fixation,compared with before operation,the difference was statistically significant(P<0.05),the good rate of the last follow-up was 91.7%.Lamina replantation with silk fixation compare with titanium plate fixation at the same time,at 3 months after operation of silk fixation,JOAscare was higher than silk fixation,while VAS in 3 months and 6 months was lower than silk fixation(P<0.05).Titanium plate fixation was better than silk fixation.60 patients were followed up by videography,include 37 cases silk fixation and 23 titanium plate fixation.In the silk fixation,1 cases were not healed,6cases were incomplete healed,all the others healed normally,and the healing time was 6-12 months.In the titanium plate fixation,all of the 1 cases had normal healing because of the osteotomy of the bone,and the healing time was 3-6 months.After the healing,there was no excessive hyperplasia in the anterior part of the osteotomy,resulting in new compression and callus protruding into the vertebral canal.The anterior edge of the osteotomy was smooth,and the dural sac was filled and expanded well.Vertebral canal diameterhe and transverse diameter of spinal canal expand.repaired spinal canal effectively prevented the intraspinal scar tissue from being displaced into the spinal canal.The last follow-up showed no increase in low back pain or hyperextension or flexion.Conclusions 1laminectomy with undercutting decompression replantation laminectomy is an effective surgical treatment of lumbar spinal stenosis,can relieve the oppression to improve clinical symptoms,while repairing the posterior lumbar structure,effectively prevent the lumbar instability and epidural scar adhesion And other complications.2lamina replantation with titanium plate fixation is more reliable and helpful for the stability and healing of the implanted vertebral lamina.