Efficacy Study On Percutaneous Pedicle Screw Nailing Combined With Unilateral Fenestration And Lateral Apical Decompression For Bilateral Lumbar Spinal Stenosis And Instability

Objective: The research uses orthopaedic minimally invasive technique,percutaneous pedicle screw insertion,combined with unilateral laminar fenestration and lateral apical decompression,assisted interbody fusion for the treatment of bilateral lumbar spinal recess stenosis and instability(the following is called bilateral lumbar spinal stenosis and instability),and the curative effect was observed.The purpose of this study is to find a new surgical method for bilateral lumbar spinal stenosis and instability,which can minimize tissue damage and maintain the stability of the posterior structure of spine.Methods: 90 patients with bilateral lumbar spinal stenosis and instability who had no significant improvement after systematic conservative therapy for more than 3 months,were randomly divided into 30 cases in the observation group,which treated with percutaneous minimally invasive nail combined with unilateral laminar fenestration and lateral apical decompression.60 cases in the control group was divided into two subgroups: control group 1 and control group 2(30 cases in each group).While the control group 1 was treated with open pedicle screw insertion combined with bilateral hemi laminectomy and spinal canal decompression.Group 2 underwent open pedicle screw insertion combined with bilateral fenestration and decompression.At the same time,the three groups were treated with bone graft fusion.There was no significant difference among the three groups in age,sex,lesion segment and course of disease before operation.The operation time,the amount of bleeding,times of X-ray examination in surgery,wound drainage after surgery,the time of hospitalization and complications of the three groups were recorded.The pain visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the lumbago,leg pain and function in the observation group,control group 1 and control group 2before surgery,1 day after surgery,3 days after surgery,14 days after surgery,and 3 months after surgery,and using modified Macnab efficacy evaluation criteria to evaluate the efficacy.Statistical analysis was used to determine whether the observation group was superior to the control group 1 and 2.Conclusion:(1)All three groups were followed up effectively,and were not exfoliated.Before treatment,there was no statistically significant difference among the three groups of VAS lumbago and leg pain score and ODI score(P>0.05),indicating that the three groups were comparable.(2)The operation time,the amount of bleeding,drainage after surgery and the time of hospitalization in the observation group were lower than those in the control group 1 and the control group 2(P<0.05).The times of X-ray examination in surgery in the observation group was higher than those in the control group 1and control group 2,and the difference was statistical significance(P<0.05).(3)All three groups had poor wound healing after operation,including 1 case in the observation group,3 cases in the control group 1 and 2 cases in the control group 2.One patient had neurological injury in the observation group and no one in the control group.There was no significant difference in the incidence of complications among the three groups(P>0.05).(4)There were significant differences in the VAS lumbago pain scores among the three groups at 1 day,3 days,14 days,and 3 months after operation(P<0.05).The difference of VAS lumbago pain scores at 3 days and 14 days after surgery was statistically significant(P<0.05).The observation group was superior to the control group 1 and the control group 2.However,there was no significant difference in the VAS lumbago pain score among the three groups at 1 day and 3 months after surgery(P>0.05).(5)The VAS leg pain scores of the three groups at 1 day,3 days,14 days and 3 months after operation were significantly different from those before operation(P<0.05).The VAS leg pain scores of the three groups at 3 days after operation were significantly different(P<0.05),and the observation group was superior to the control group 1 and the control group 2,but there were no significant difference in VAS leg pain scores among the three groups at 1 day,14 days after surgery and 3 months after surgery(P>0.05).(6)The ODI scores of the three groups of patients at 14 days postoperatively and 3 months postoperatively was significantly improved compared with preoperative,postoperative 1 day and postoperative 3 days(P<0.05),but there was no statistically significant difference in the ODI scores among the three groups at 1 day after surgery and 3 days after surgery(P>0.05).There was a statistically significant difference in the ODI scores among the three groups at 14 days postoperatively(P<0.05),the observation group was superior to the control group 1 and the control group 2.However,there was no significant difference in the ODI scores among the three groups at 3 months postoperatively(P>0.05).(7)The improved Mac Nab efficacy evaluation in the three groups after 3 months of follow-up had a high rate of excellent,90% in the observation group,83.33% in the control group 1 and 86.67% in the control group 2,but there was no significant difference among the three groups(P >0.05).Conclusion: There were satisfactory efficacy with percutaneous minimally invasive nail combined with unilateral laminar fenestration and lateral apical decompression,open pedicle screw insertion combined with bilateral hemi laminectomy and spinal canal decompression and open pedicle screw insertion combined with bilateral fenestration and decompression of bilateral lumbar spinal stenosis and instability.Percutaneous minimally invasive nailing combined with unilateral fenestration and lateral apical decompression is more rapid and effective in improving pain in patients.Percutaneous minimally invasive nailing combined with unilateral fenestration and lateral apical decompression for bilateral lumbar spinal stenosis and instability has the advantages of less injury,less bleeding,and minimally invasive percutaneous screw insertion.It is one of the ideal surgical methods for the treatment of bilateral lumbar spinal stenosis and instability,which is worthy of clinical application.