The Short-term Effect Of Selective Decompression And Fusion In The Treatment Of Lower Lumbar Degenerative Diseases With L5-S1 Spinal Stenosis

Objective:To compare the short-term effects of selective decompression and fusion fixation(L4-5 laminectomy and decompression and fusion internal fixation + L5-S1 laminectomy and selective decompression)and multi-level decompression and fusion fixation(L4-5and L5-S1 laminectomy and decompression and fusion internal fixation)in the treatment of two-level lower lumbar degenerative diseases,and evaluate the risk of adjacent segment degeneration(ASD)in both methods.Methods:The data of 95 patients with degenerative diseases of lower lumbar spine at two levels(L4-5 and L5-S1)who were operated in our department from January 2018 to November 2020 were collected retrospectively,and divided into observation group and control group according to different operation methods.In the observation group,there were 56 cases,male/female(number of cases),27/29 cases,with an average age of 59.14±7.86 years;39 cases in the control group,male/female(number of cases),22/17 cases,average age 58.15±7.08 years;Perioperative indexes(operative time,intraoperative blood loss,bed time)were compared between the two groups.The JOA Japan Orthopaedic Association’s low back pain score and improvement rate,VAS pain visual simulation score,ODI index of improvement of human dysfunction,Barthel index evaluation of daily living ability,the incidence of preoperative and postoperative complications was recorded.Lumbar radiographs were taken during follow-up to assess lumbar stability.All surgical patients informed their consent to the treatment plan,approved by our Ethics Committee.Results:(1)The operation of both groups was smooth,and there was no death during the treatment.Both surgical methods can effectively improve the clinical symptoms of patients;(2)The perioperative indexes in observation group were lower than those in control group,including operation time,intraoperative blood loss,postoperative drainage,bed time,length of hospital stay,etc.,with statistical significance(P<0.05).(3)Comparison between the two groups,preoperative JOA score,VAS score,ODI index,Barthel index The difference was not statistically significant(P > 0.05).The JOA score and Barthel index of the two groups increased after operation,and the difference was statistically significant(P<0.05),but there was no significant difference between the two groups(P> 0.05).Three months after the operation,the pain in the back and legs of the two groups were improved,the dysfunction was alleviated and the living ability was improved,with no significant difference(P > 0.05).At 6 and 12 months after operation,the VAS score and ODI index of the observation group were lower than those of the control group,and the difference was statistically significant(P < 0.05).(4)There was no significant difference in the incidence of complications between the two groups(P>0.05).(5)There was no iatrogenic instability at the decompression unfused segement in the selected group.Conclusion:When treating lower lumbar degenerative diseases in middle-aged and elderly patients,under the premise of ensuring effective decompression,selective decompression fusion and fixation can keep the integrity of the posterior bony structure and spinous ligament complex as much as possible,and retain more motion segement.with less damage to the stability of the spine,less surgical trauma,quick recovery and other advantages,and the short-term curative effect is remarkable,which is worthy of clinical promotion,but the mid-term and long-term curative effects need further follow-up results.