Application Of Lumbar Spinous Process And Lamina Osteotomy Replantation To Rebuild Lumbar Spinal Canal

Object: Operation is an effective and dependable way to treat Lumbar prolapsed intervertebral disc and Lumbar Spinal canal stenosis. Traditional laminectomy completely exposes the lumbar spinal canal with spinous process and lamina osteotomy , which usually causes postoperative lumbar spinal instability and scar tissue adherent. Therefore , to introduce a method in the posterior approach operation of the lumbar vertebrae for the treatment of lumbar spinal canal stenosis with vertebral canaloplasty by removing the complex of lamina and spinous process .. enlarging spinal canal and replanting the complex. Postoperatively, surgical outcomes evaluation and imaging observation in patients treated with lumbar spinous process and lamina osteotomy , replantation were carried out to evaluate its clinical effect about rebuild lumbar spinal canal.Methods: To analyze retrospectively the clinical data of 123 patients from July, 2001 to February, 2005, among all the cases, there were 63 males and 60 females ,averagely aged 48.5 years old; 83 cases were lumbar prolapsed intervertebral disc, 12 cases were Lumbar Spinal canal stenosis, and 28 cases had both diseases. All the cases accepted the operation—lumbar spinous process and lamina osteotomy replantation. Posterior central incision was used for exposure of lamina. Osteotomy wasdone at the base of the spinous process, complete exposure of the lumbar spinal canal by removing the complex of lamina and spinous process, Undermining enlargement of the central spinal canal and the neural canal were then carried out, in some cases the intervertebral disc was resected. Then we took various ways to replant the complex of lamina and spinous process to rebuild lumbar spinal canal. 107 cases were followed up from 2 months to 44 months (average 16. 5 months). Preoperative and postoperative clinical results and complication were analyzed according to surgical outcomes evaluation and results of X-ray or CT.Result: 123 cases have been treated with this operation. 107 patients were followed up. The follow-up time was from 2 months to 44 months (average 16. 5 months). The excellent and good results were seen in 96. 26%. Reviewing at CT in the 3rd months after operation, the area of the spinal canal was significantly extensive and the most of the replanted complex of Lamina and spinous process were fused to the lamina. There was no compression of vertebral canals and nerve or dura mater. Not only spinal canal can be decompressed thoroughly, but also the posterior structure of the lumbar spinal can be reconstructed. No complication occurred such as instability of lumbar vertebrae, inferior lumbar pain, so far as to the postoperative spinal slipping .This procedure enlarged lumbar spinal canal, achieved the goal of preventing postoperative lumbar spinal instability and scar tissue adherent.Conclusion: The short-term outcomes of laminectomy and vertebral canaloplasty for lumbar spinal stenosis were equally satisfactory ,but the outcomes in vertebral canaloplasty group were better than that in laminectomy group in the long-term followed up .So we can conclude the clinical application of this procedure has been proved better than the traditional laminectomy. To replant the lumbar spinous process and lamina that were resected and reconstruct the complexity and stability of thelumbar posterior structure; we can prevent the occurrence of instability of the lumbar vertebrae , decrease adherent chance of scar of spinal dura mater and obviously increase the area of the spinal canal and prevent lumbar stenosis caused by operation. Lumbar spinous process and lamina osteotomy, replantation for patients with lumbar disorders affords easy performing procedure with less complications and satisfactory surgical results. The short and long-term results are affirmative, so it is worthy of wide application.