The Clinical Study Of Lumbar Spinal Stenosis Treated With Unilateral Laminotomy For Bilateral Decompression Through Interlaminar Approach With Spinal Endoscopy

Objective: To compare the clinical efficacy of spinal endoscopy interlaminar unilateral laminotomy for bilateral decompression and bilateral decompression through posterior lumbar laminectomy in the treatment of lumbar spinal stenosis,and to analyze the operation procedures,indications and advantages of spinal endoscopic technique,so as to provide certain theoretical basis for the clinical treatment of lumbar spinal stenosis in the future.Methods: From July 2018 to December 2019,56 patients with lumbar spinal stenosis who received surgical treatment in the department of orthopedics,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine and the pain department of International Zhuang Medical Hospital Affiliated to Guangxi University of Traditional Chinese Medicine were randomly divided into the observation group(28 cases)and the control group(28 cases).The observation group was treated with spinal endoscopy interlaminar unilateral laminotomy for bilateral decompression,while the control group was treated with posterior approach bilateral laminectomy and decompression.Preoperative comparison of gender,age,course of disease,stenosis classification,preoperative Visual analogue score(VAS),Japanese orthopaedic association assessment treatment(JOA)and Oswestry dysfunction index(ODI)between the two groups was conducted.The operation time,intraoperative blood loss,length of hospitalization and complications of the two groups were recorded.VAS,JOA and ODI wereused to score the observation group and the control group before surgery,7days after surgery,1 month after surgery,and 3 months after surgery respectively,the improved Mac Nab efficacy evaluation criteria were used to evaluate the efficacy.The efficacy of the two groups was statistically compared.Result:(1)The amount of blood loss and length of hospitalization in the observation group were less than those in the control group,with statistically significant differences(all P < 0.05).In terms of operation time,the average operation time in the observation group was longer than that in the control group,with no significant difference(P >0.05).(2)The VAS pain scores at 7days,1 month and 3 months follow-up after surgery of the two groups were significantly different from those at preoperative follow-up(P < 0.05).The patients in the observation group were followed up for 7 days,1 month and 3months after surgery,and the VAS pain score was significantly different from that in the control group(P < 0.05).(3)There were statistically significant differences in JOA scores between the two groups at 7 days,1 month and 3months after surgery compared with the preoperative follow-up(P <0.05).The JOA scores of the observation group at 7 days,1 month and 3months after surgery were all lower than those of the control group at the same time period,with statistically significant difference(P<0.05).(4)The ODI scores of the patients in the two groups were compared with the preoperative follow-up 7 days,1 month and 3 months after surgery,and the differences were statistically significant(P < 0.05).The ODI scores of the observation group at 7 days,1 month and 3 months after surgery were all lower than those of the control group at the same time period,with statistically significant differences(P<0.05).(5)Comparison of complications between the two groups: dural sac rupture did not occur in either group,3cases of lower limb numbness and weakness occurred in the observation group,and 2 cases of incision infection occurred in the control group.(6)Results of the improved Mac Nab efficacy evaluation 3 months after the operation in the two groups,the excellent and good rate of the observation group was 89.29%,and the excellent and good rate of the control group was82.14%,but the difference between the two groups was not statistically significant(P > 0.05).Conclusion:(1)Both spinal endoscopy interlaminar unilateral laminotomy for bilateral decompression and bilateral decompression through posterior lumbar laminectomy have achieved good clinical efficacy for lumbar spinal stenosis,which can not only alleviate the pain of patients,but also improve the lumbar function and quality of life of patients,so that patients can return to their daily life and working status.(2)Spinal endoscopy interlaminar unilateral laminotomy for bilateral decompression for the treatment of lumbar spinal stenosis has a significant early efficacy,with the advantages of small incision,less trauma,less bleeding and faster postoperative recovery.