Clinical Research On The Treatment Of Degenerative Lumbar Spinal Canal Stenosis With Lumbar Vertebral Expansion And Decompression Of Intraspinal Canal Assisted By Microendoscopic Discectomy

ObjectiveThrough comparison with the shot-time clinical results of the treatment of Spinal Canal Stenosis by lumbar vertebral expansion and decompression of intraspinal canal assisted by Microendoscopic Discectomy(MED) and decompression with posterior minimal incision, To evaluate the clinical outcomes of lumbar vertebral expansion and decompression of intraspinal canal assisted by Microendoscopic Discectomy, give instructions to further clinical practices, and make the clinical application of MED further progress by the comparison with MED and open operation.MethodFiltrated the cases of lumbar Spinal Canal Stenosis hospitalized during March 2007 to February 2008, grouped the absorbed surgical cases at random, surgery assisted by MED as group A(MED Group); decompression with posterior minimal incision as group B(Open Group). There are 23 cases in each group. The surgical duration, the intraoperative blood loss,the time of post-operative hospital stay and the time to normal activities were evaluated.The serum levels of Creatinine Kinase was measured 1 day pre-operation and 1,7d after operation as well, and compared with control group. The neurogenic intermittent clandication of each group was assessed in hospital 1 day pre-operation, 3 months and 1 year follow-up respectively. Analyse the cases in each group with the pain intensity, low-back-pain specific disability index by data statistics 1 day pre-operation,3 months and 1 year follow-up respectively. Extrally, divide the improvement rates which related to disability index to 4 grades which denoted the clinical effect(>75% is exccllent, 50%-74% is good, 25%～49% is favorable, <24% is bad). Statisticing and analyzing, synthetic appraising the differences between the two groups, as well as the differences between pre-operation and post-operation in each group.Result1. All cases were followed up. All numerical values of measurement data match to normal distribution, and all at equal variance. There was no significant stastiscal difference of age, gender, state of illness (P>0.05).2. The operation time was significantly shorter in the MED Group than in the Open Group (P<0.05). The intraoperative blood loss was significantly less in the MED Group than in the Open Group(P<0.05). The time of postoperative hospital stay and The time to normal activities in the MED Group was significantly shorter than that in the Open Group (P<0.05).3. There was no significant statistical difference of levels of CK 1 day pre-operation (P>0.05). Levels of activity peaked at 24h in both groups.MED group displayed a less significant post-operative rise in serum at 24h and at the seventh day post-operation than in open group(P<0.05).4. There was no significant stastiscal difference of levels of NIC (P>0.05). There was significant stastiscal difference of levels of NIC between the 3th month and the 1st year follow-up respectively(P<0.05). There was significant stastiscal difference of levels of NIC between the two groups at the 3th month (P<0.05),but no significant stastiscal difference at the 1st year follow-up between them(P>0.05).5. Both VAS and ODI means have no significant stastiscal difference between the two groups 1 day pre-operation (P>0.05), and there was significant stastiscal difference between them at the 3th month, the 1st year follow-up and pre-operation respectively(P<0.05). There was significant stastiscal difference of both VAS and ODI means between the two groups at the 3th month post-operation(P<0.05),but no significant stastiscal difference between them at the 1st year follow-up (P>0.05).6. There was significant statistical difference of the excellent and good rate between the two groups at the 3th month(P<0.05),but no significant statistical difference at the 1st year follow-up between them(P>0.05).Conclusion1.The effects of MED are identical with those of traditional surgery in the treatment of lumbarspinal stenosis.2. Shorter operation time, less blood loss and quicker postoperative recovery are achieved inthe treatment with lumbar vertebral expansion and decompression of intraspinal canal assistedby MED. It has broadly applicable future.3.In this subject, the longest period of time for follow-up is 1 year. We can get approximatelydirect impression about short-term clinical effects of methods that lumbar vertebral expansionand decompression of intraspinal canal. However, their effects of long-term remained to besummarized by further outcome.