Comparison Of The Efficacy Of Different Decompression Procedures In The Treatment Of Lumbar Spinal Stenosis Combined With Cauda Equina Redundancy

Background:Lumbar spinal stenosis is a common clinical disease that occurs in the middle-aged and elderly and is often accompanied by cauda equina redundancy in severe cases.Patients with lumbar spinal stenosis with cauda equina redundancy account for approximately 40%of all patients with lumbar spinal stenosis.The redundant cauda equina can be found cranially and/or caudally in spinal stenosis,with the cranial side being the most common.Myelography and MRI are useful for diagnosis.Patients with lumbar spinal stenosis combined with cauda equina redundancy are usually more symptomatic,have a poor prognosis,and have poor outcomes with non-surgical treatment and should be treated with early surgery once diagnosed.Partial laminectomy or total laminectomy decompression is often used in this type of patient,which is clinically controversial due to problems such as incomplete decompression and postoperative complications.In this study,total laminectomy and interbody fusion with preservation of the spinous ligament complex was used to compare with bilateral partial laminectomy and interbody fusion to investigate the efficacy of the two procedures in patients with lumbar spinal stenosis combined with cauda equina redundancy.Objective:To compare the efficacy of total laminectomy and decompression,360° implant fusion,and internal fixation with a nail and rod system via the posterior approach with partial laminectomy and decompression,360° implant fusion,and internal fixation with a nail and rod system in the treatment of lumbar spinal stenosis with cauda equina redundancy,and to discuss the choice of procedure for the treatment of lumbar spinal stenosis with cauda equina redundancy.Methods:130 patients with lumbar spinal stenosis complicated by cauda equina redundancy admitted to our hospital from September 2020 to November 2022 were collected.The group with total laminectomy and decompression with preservation of the spinous ligament complex,360° implant fusion,and internal fixation with nail rod system was used as the treatment group,and the group with bilateral partial laminectomy and decompression,360° implant fusion and internal fixation with nail rod system was used as the control group for preoperative,intraoperative and postoperative evaluation.Inclusion criteria: patients with lumbar spinal stenosis with neurogenic intermittent claudication and cauda equina redundancy.There were 44 cases in the treatment group,20 males and 24 females,with a mean age of(68.68±6.95)years.In the control group,there were 86 cases,28 males and 58 females,with a mean age of(67.00±6.95)years.All patients were informed and free to choose their surgical procedure.The same instruments,internal fixation materials,and postoperative rehabilitation program were used at the time of surgery,with at least 5 months of follow-up.The preoperative general condition,perioperative indicators,and improvement in pain,claudication,and functional impairment at 5 months postoperatively were analyzed and compared between the two groups to evaluate the efficacy of both procedures.Results:1.The differences in age,gender,body mass index(BMI),and duration of symptoms between the two groups were not statistically significant(P > 0.05).2.There was no statistically significant difference between the two groups in terms of the number of surgical segments,intraoperative bleeding,and intraoperative blood transfusion(P > 0.05);the control group was better than the treatment group in terms of operative time(P < 0.05);and the control group was better than the treatment group in terms of self-care ability on the third day after surgery(P < 0.05).3.Follow-up at 5 months after surgery revealed that the treatment group was superior to the control group in terms of improvement in low back pain,improvement in neurogenic claudication,and ODI scores(P < 0.05).Conclusion:This study showed that in patients with lumbar spinal stenosis combined with cauda equina redundancy,total laminectomy with extensive decompression,360° implant fusion,and internal fixation with a nail bar system via the posterior approach preserving the spinous ligament complex was more complete and satisfactory than bilateral partial laminectomy decompression and could be the preferred procedure.