Effect And Safety Of Posterior Approach Decompression And Discectomy Combined With Interbody Fusion And Pecicle Screw Internal Fixation For Thoracic Spinal Stenosis

Objective: To investigate the effect and safety of the posterior approach decompression and discectomy combined with interbody fusion and pedicle screw internal fixation for thoracic spinal stenosis.Methods: From January 2010 to May 2018,a total of 14 patients with thoracic spinal stenosis in the First Affliated Hospital of Chongqing Medical University were retrospective analyzed.There were 7 males and 7females with an average age of 55.14 years(ranged from 38 to 73 years).The average time from the patient's symptoms appearing to diagnosis was(35.25±45.79)months,and the average time from symptom exacerbation to condition worsened was(10.67±14.69)months.Causes of thoracic spinal stenosis included ossification of the ligamentum flavum in 10 cases,thoracic disc herniation in 3 cases,and ossification of the ligamentum flavum combined thoracic disc herniation in one case.The operation time,intraoperative decompression and fixation segment,intraoperative bloodloss and blood transfusion volume,postoperative drainage volume and drainage time,as well as ntraoperative and postoperative complications were observed and recorded.The neurological function of the patients was evaluated by the Japan Orthopaedic Association(JOA)spinal function scale(JOA score)and the American Spinal Injury Association(ASIA)spinal cord injury classification(ASIA classification).Results: All operations were performed under electrophy siological monitoring.The average operation time was(216.21±60.40)min(110-322min).The average blood loss was(471.43±358.80)ml(50-1 200 ml).The average blood transfusion was(378.29±622.81)ml(0-2 000 ml).The average drainage volume was(440.93±396.44)ml(33-1 430 ml).The average drainage time was(3.93±1.59)d(1-7 d).Postoperative neurological complication occurred in 3 cases,included cerebrospinal fluid leakage in 2 cases and intracranial gas and low intracranial pressure syndrome in one case.Three patients recovered after appropriate treatments.At the last follow-up,one case of preoperative ASIA grade B improved to ASIA grade D,among 4 cases of ASIA grade C,3 cases improved to ASIA grade D and one case improved to ASIA grade E,among 9 patients with ASIA grade D,4 cases improved to ASIA grade D and 5 cases improved to ASIA grade E.As for JOA score,the average score changed from(6.43±2.10)at preoperation to(9.14±0.95)at last follow-up,and there were excellent in 3 cases,good in 6 cases,fair in 4 cases,poor in one case.Allcases reached bony fusion without instrument failure at the last follow-up.Conclusions: Posterior decompression and discectomy combined with interbody fusion is a safe and effective procedure for the thoracic spinal stenosis,and less postoperative complications.Electrophysiological monitoring of spinal cord and careful operation during operation can help to improve the safety of the operation.