The Clinical Studies Of The Indications And Early Effect In The Treatment Of Degenerative Lumbar Spinal Stenosis Disease By Unilateral Approach For Bilateral Decompression

Objective:To analysis and discuss the indications and early clinical effect in the treatment of degenerative lumbar spinal stenosis(DLSS) by unilateral approach for bilateral decompression(ULBD)Methods:To analysis the clinical data, we choosed 38 patients with degenerative lumbar spinal stenosis who were treated by ULBD at China-Japan Union Hospital of Jilin University between September 2013 and September 2015.The mean age was64.6(range 51-80) and there were 17 men and 21 women. With regarding to the level treated,2 patients underwent ULBD at L2 ~ 3 level;6 at L3 ~ 4level;22 at L4 ~ 5level;4 at L5~S1level,3 at L3 ~ 4and L4 ~ 5) level;1 at(L4 ~ 5; L5~S1) level,Bilateral nerve root symptom of 17 cases, 21 cases of unilateral nerve root symptoms. The routine radiograph and CT were carried out before and after surgery.Analyze the indications in the treatment of degenerative lumbar spinal stenosis disease by ULBD.The clinical outcomes were assessed by using the Japanese Orthopaedic Association scores(JOA) score.The operation time, blood loss, complications were recorded. To analyze the early clinical effect in the treatment of degenerative lumbar spinal stenosis disease by ULBD and compared with the Meta-analysis[1]of the early efficacy of posterior decompression and internal fixation in the treatment of DLSS. The stability of the spine is assessed by facet fluid on axial T2 MR images[2-3], dynamic instability on decubitus lateral flexion-extension(DLFE) films and the clinical feature.Results : Operations were successfully performed in all cases. The mean operation time was 80±17min(range,70 to 125 min), the average blood loss was247±12 ml(range,180 to 350 ml), the average skin incision length was 5±1.2cm(4 to9 cm). All patients were followed up 2-16 months(mean, 12.7months).6 cases had dural matter tearing, which healed after filling with gelatin foam and giving timely symptomatic and supportive treatment. No cases turn into bilateral approach for bilateral decompression. The JOA score were significantly improved at early stage after operation and last follow-up when compared with pre-operation(P < 0.05).According to clinical evaluation of JOA improvement rate,the excellent and good rate was 92.11%. The clinical symptoms were improved. No nerve injury and postoperative infection occurred.Compared with the Meta-analysis[1]of the early efficacy of posterior decompression and internal fixation in treating DLSS,not lower than the results of retrospective studies of 73% and not lower than the results of the prospective studies of 54%. 2 patients suffered from motor neuron disease in the second and fifth month post-operatively. No lumbar instability was found.Conclusion : With the posterior ligaments complex almost intact,the ULBD could enlarge the lumbar spinal canal and decompress the nerve effectively.No lumbar instability was found post-operatively. The JOA score were significantly improved post-operatively, early effect is not lower than that of conventional posterior decompression and internal fixation method. Lumber spinal stability is the mean indication for treating degenerative lumbar spinal stenosis by ULBD.