Exploring The Significance Of Clinical Treatment On Nerve Root Sedimentation In Degenerative Lumbar Spinal Stenosis

Objective: With the increase of domestic population aging, degenerative lumbar spinal stenosis was significantly increased, becoming one of the important factors that affect the quality of life of elderly patients. Currently the clinical effect of surgical treatment for degenerative lumbar spinal stenosis has been recognized by most clinicians, but degenerative lumbar spinal stenosis patients, mostly elderly, and many patients with multiple medical conditions, increasing the risk of surgery and perioperative complication rate occurs. So in recent years, some scholars of conservative treatment of degenerative lumbar spinal stenosis patients did some research, that conservative treatment for degenerative lumbar spinal stenosis treatment is also an important selection method, but how to predict the effect has been conservative treatment of patient’s plagued clinicians. This study was designed to investigate the significance of nerve root disease settling in degenerative lumbar spinal stenosis in clinical treatment, to provide clinical basis of treatment of choice degenerative lumbar spinal stenosis patients.Methods: Degenerative lumbar spinal stenosis patients in our hospital from October 2013 to April 2014 in our hospital conducted a prospective comparative study. The study included 80 cases of patients were compared follow-up studies, the application VAS, ODI score for admission of patients and after three months, the pain and symptoms, activities of daily living six month follow-up were evaluated. All patients were routinely lumbar MRI, according to the disc level T2-weighted axial images not leave dural nerve root is sinking to the bilateral facet nerve root apex connection the following case settlement negative or positive. Patients with degenerative lumbar spinal stenosis on a voluntary basis the choice of surgical or non-surgical treatment, were randomly divided into positive operation group(A) according to the settlement nerve root disease positive and negative results and positive conservative group(B); negative surgical group(C) and negative conservative group(D); the results of 80 patients enrolled were followed up for the non-surgical group, 40 cases, 40 cases of surgical group, nerve root subsidence positive group of 40 patients, The nerve root settlement negative group of 40 patients, Up for 6 months.Surgical treatment groups: 30 minutes before surgery to give patients intravenous antibiotics, conventional indwelling catheter. Patients after general anesthesia surgery, the patient prone, chest and two iliac pad soft pillow, abdominal vacant, to take back waist midline approach, along both sides of the spinous process to transverse paraspinal muscles stripped roots, fully revealed bilateral lamina, facet, strict hemostasis. Before decompression conventional C-arm fluoroscopy, confirm intervertebral lesions, lesions adjacent to fit the size of the gap between the pedicles into the vertebral body pedicle screw up before 1/3. According spinal stenosis line PLIF or TILF or modified TLIF + PLIF surgery, intervertebral joint application CAGE particles suppress bone fusion. Surgery sterile saline flush cut, routine application of silicone drainage tube connected to suction device layer wound closure. After awake of that the patient extubation return to the ward. Pull out the drainage tube after 48 hours, orthosis ambulation. Incision stitches discharged after 10 days.Conservative Group Treatment: conservative group routine nerve root canal filling, the patient prone perspective of the surgical bed is located can make a little lumbar kyphosis, abdominal vacant, upper limbs at your sides. Preoperative imaging to determine the lumbar lateral perspective, the anteroposterior like spines located on both sides of the pedicle edge midpoint, the lateral image endplate linear, puncture segments located by X-ray fluoroscopy images Central. With 0.5% lidocaine for local anesthesia, spinal needle 18 in the X-ray monitoring after lateral approach to the disc after 1/3 puncture. After the needle into the needle point distance midline of about 10-12 cm in lateral fluoroscopy needle located in the upper part of the intervertebral foramen. After successful puncture, injecting iohexol injection line contrast, nerve root fully developed, confirm the needle position is correct to l% lidocaine 2 ml + Dexamethasone palpitated injection 2ml Nerve root blocks. Hyperbaric oxygen therapy after week and oral non-steroidal anti-inflammatory analgesic drugs was discharged three days.Results: Group A and Group B VAS and ODI scores(P<0.05), there are significant differences nerve root settlement positive effect of surgery and conservative treatment. Group C and D group VAS and ODI scores(P>0.05), nerve root settlement negative conservative treatment and surgical treatment showed no significant difference. Group A and Group C VAS and ODI scores(P>0.05), nerve root subsidence positive surgical outcomes and nerve root settlement negative surgical treatment no significant difference.Conclusion: Nerve root disease can be treated sedimentation method lumbar spinal stenosis patients choose to provide certain clinical basis. Conservative treatment of patients with positive signs of nerve root settlement is prompted conservative treatment may not work, surgery may be more effective. The nerve root settlement negative patients treated conservatively, recent surgery can achieve a similar effect. Surgical treatment of patients with nerve root disease cannot be predicted settlement outcome.