Analysis Of The Efficacy Of Lumbar Spinal Stenosis After Single Or Bilateral Decompression

Objective:The incidence of contralateral radiculopathy and clinical efficacy after TLIF and TLIF combined with contralateral fenestration decompression were statistically analyzed,the risk factors and prevention measures of contralateral radiculopathy were discussed.Methods:We prospectively study 104 patient who were diagnosed as lumbar spinal stenosis of unilateral nerve root symptom at 4/5 level and randomly divided into two groups in our hospital from June 2013 to June 2017.A group has 52 patients(average age 58.2 years,range 45~83 years,sex 28 males and 24 females)who underwent TLIF and B group has 52 patients(average age 59 years,range 42~88 years,sex 22 males and30 females)who underwent TLIF combined with contralateral fenestration decompression.The causes of contralateral radiculopathy were evaluated according to the radiological data.The difference of pre-and post-operative,lumbar lordosis(LL),and segmental angle(SA),contralateral foramen area(cFA)and contralateral Intervertebral height(cIH)were compared between two groups.the clinical treatment outcomes was assessed using the visual analogue scale(VAS),the oswestry disability index(ODI),and the modified Macnab.Results:Patients were followed up for 6-28 months,average 14.3 months.Contralateral symptoms occurred in 8(15.4%)of the patients who underwent TLIF surgery,Including contralateral foraminal stenosis 1 case,contralateral disc herniation plus 1 cases,screw malposition 1 case and intraoperative stimulation 5 cases.Contralateral radiculopathy occurred in 1(1.9%)of the patients who underwent TLIF combined with contralateral fenestration decompression surgery,Including intraoperative stimulation 1 cases.3patient of A group received revision surgery because of ineffective conservative treatment.The change of preoperative and postoperative lumbar lordosis(LL)was 3.2±2.5°in group A and 2.9±1.8°in group B respectively,and there was no significant difference between the two groups(P=0.484).The change of preoperative and postoperative segmental angle(SA)was 2.6±2.1°in group A and 3.1±2.6°in group B respectively,and there was no significant difference between the two groups(P=0.283).The change of preoperative and postoperative contralateral foramen area(cFA)was 31.3±9.5 mm~2in group A and 29.5±8.8 mm~2in group B respectively,and there was no significant difference between the two groups(P=0.319).The change of preoperative and postoperative contralateral Intervertebral height(cIH)was 3.3±1.6 mm in group A and 3.6±1.1 mm in group B respectively,and there was no significant difference between the two groups(P=0.268).The preoperative VAS scores were 6.5±3.1 in group A and 7.1±2.8 in group B respectively,there was no significant difference between the two groups(P=0.303).The postoperative VAS score were 1.6±1.2 in group A and 1.8±1.1 in group B respectively,There was no significant difference between the two groups(P=0.378).However there was a significant difference in preoperative and postoperative VAS scores between A group and B group(P<0.05).The preoperative ODI scores were 68.6±22.3 in group A and 66.2±24.2 in group B respectively,there was no significant difference between the two groups(P=0.600).The postoperative ODI score were 19.1±11.3and 20.1±13.6 in group B respectively,There was no significant difference between the two groups(P=0.684).However,there was a significant difference in preoperative and postoperative ODI scores between A group and B group(P<0.05).The rate of satisfactory clinical results was 74.1%of group A and 93.8%of group B respectively,and there was significant difference between the two groups(P<0.05).Conclusion:The incidence of contralateral radiculopathy after patients who were diagnosed as lumbar spinal stenosis of unilateral nerve root symptom and underwent TLIF surgery is not likely to be small,which indicates the need of decompression of the asymptomatic side.Bilateral decompression not only has low the incidence of contralateral radiculopathy and also has better excellent to good resuIts.The risk factors of contralateral radiculopathy include intraoperative stimulation,contralateral disc herniation plus and screw malposition.