Application Research Of Lumber Spinal Stenosis With Laminectomy And Spinal Process Lamina Bone Fragments And Posterolateral Fusion

Objective: The operation to lumber spinal stenosis with laminectomy and pedical screws system fixation and posterior lateral fusion (PLF) or Posterior lumbar interbody fusion (PLIF) are two kinds of operation method commonly used in clinical. This article aims to explore the value of application of spinal process lamina bone fragments in the PLF's operation.Methods: There were 51 patients in the study, including 22 males and 29 females. Their age was from 30 years to 72 years. Clinical manifestation: There were 35 cases with lower back pain and 45 cases with Intermittent Claudication. All of 51 cases with leg pain, and 30 cases with unilateral leg pain, 18 cases with hibateral leg pain, 8 cases with alternative leg pain. There were 28 cases restricted of elevation test of straight leg, 38 cases with sensory disturbance, 25 cases with muscle fell. Lumbar posterior midline incision, fully reveal the needed decompression and fusion segments of the spinous process, lamina, bilateral facet joints, transverse root, with total laminectomy, lateral recess sneak decompression. With intervertebral disk hernia the nucleus pulposus was excised, fixing the corresponding fusion segment with pedicle screw. Decompression of vertrbral joints, lumbar pedicle isthmus area lateral and transverse process bone graft to cortical bone to be treated, in addition to bite the spinous, lamina bone bite into a rice-shaped implants.All cases were followed up at least 1 year, partial 3.4 years. For the following assessment: The purpose of the present investigation was to compare the clinical outcome of posterolateral fusion based on the Japanese Orthopaedic Association(JOA) score and the Spine Study Group of Chinese Orthopaedic Association Assessment of standard methods for low back pain surgery. The stability of low lumbar was evaluated by reviewing the roentgenographic film, post-anterior, lateral, and bending views. Results: 1.Preoperative and postoperative(more than 1 year follow-up), JOA score of excellent and good rate was 83.3%, the Chinese Orthopaedic Association Spine Surgery Study Group evaluation criteria of low back pain score was 80.4%, patients satisfaction was high, the vast majority of patients clinical symptoms were alleviate obvious, 3 cases of infection were cleared and the results were satisfied, therefore the surgery is effective. 2. Postoperative radiographic examination showed a normal position of pedicle screws, all cases were not occurring internal fixators looseness and fracture, showed reliable fixation. 3. Postoperative radiographic examination showed postoperative lumbar spinal stability is good, however, the majority of grafts were absorbed, some cases no images graft, indicating less bone after bone grafting.Conclusion:Total laminectomy, posterolateral fusion in the treatment of early lumbar spinal stenosis is effective but long-term efficacy needs to be followed up. Lamina, spinous process bone fragments is a bone grafrt material that can be used, but the bone quantity is less, the quality is poorer, besides spinous process bone, lamina bone and joint Turkestan hyperplasia bone are in the low level of osteoblast bone graft, affecting the fusion results. Some of the surgical infection rate and fusion rate is not ideal, but the pressure-relief thoroughly, surgery is simple, low cost, the patient acceptable satisfaction is high, the clinical efficacy is good. So wide vertebral lamina decompression with pedicle screw fixation, spinous process, laminar bone fragments posterolateral fusion is still a good choice,?but isn't the best choice.