| Objective:To observe and compare with posterior lumbar interbody fusion with autologous bone or Cage for treatment of degenerative lumbar spinal stenosis with lumbar instability based on pedicle screw fixation. To choice more safety, satisfactory efficacy, acceptanted easily operational methods.Methods:Retrospective Analysis of people diagnosed degenerative lumbar spinal stenosis with lumbar instability had operated with monosegmental posterior lumbar interbody fusion 52 cases from January 2006 to December 2013 in Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine. These cases divided into two groups of A and B. Group A with 25 cases(male 15 cases, female 10 cases) pure autogenous bone fusion; Group B with 27 cases(male 11 cases, female 16 cases) pure Cage fusion. To compare with operation time, blood loss in operation, length of stay in hospital and incidence rate of operative complication. To compare with the variety of intervertebral height of two groups before operation,1 month,3 months,6 months,12 months after operation and last follow up. To compare with the variety of lumbosacral angle of two groups before operation,1 month,12 months after operation and last follow up. To compare with visual analog scale(VAS) of lumbago and lower limb pain, oswestry disability index(ODI) of two groups before operation,1 month,6 months,12 months after operation and last follow up. To compare with lameness distance of two groups before operation and last follow up. Using SUK standard to compare with the rate of bone graft fusion of two groups 6 months,12 months after operation and last follow up. Using Fischgrund standard to compare with excellent rate on clinical efficacy last follow up. All data were analyzed by SPSS 19.0. P<0.05 has statistical significance.Results:1. There is nosignificant difference on basic data, symptoms and signs of two groups(P> 0.05).2.The operation time and blood loss in operation of group A are more than group B(P <0.01).There is nosignificant difference on length of stay in hospital and incidence rate of operative complication for two groups (P>0.05).3.The intervertebral height of two groups of 1 month after operation increased significantly than before operation (P<0.01). The intervertebral height of group A of 3 months after operation lossed significantly than 1 month after operation (P<0.05). There is nosignificant difference on change of intervertebral height from 3 months to 12 months after operation (P>0.05). There is nosignificant difference on change of intervertebral height from before operation to 3 months after operation of group B(P >0.05). The intervertebral height of group B of 6 months after operation lossed significantly than 3 months after operation(P<0.05). There is nosignificant difference on change of intervertebral height from 6 months after operation to 12 months after operation of group B(P>0.05). There is significant difference on intervertebral height 3 months after operation between two groups(P<0.01). There is nosignificant difference on intervertebral height 6 months,12 months after operation between two groups(P>0.05).The lumbosacral angle of two groups of 1 month after operation reduced significantly than before operation(P<0.05). Comparing with two groups, there is nosignificant difference on changes of lumbosacral angle on before operation, 1 month,12 months after operation and last follow up(P>0.05).4.1t is obvious that visual analog scale(VAS) of lumbago and lower limb pain of 1 month after operation reduced significantly than before operation of two groups(P< 0.01). Visual analog scale(VAS) of lumbago and lower limb pain of 6 months after operation reduced significantly than 1 month after operation of two groups(P<0.01). There is nosignificant difference on changes of visual analog scale(VAS) of lumbago and lower limb pain on 6 months after operation,12 months after operation and last follow up of two groups (P>0.05). There is nosignificant difference on changes of visual analog scale(VAS) of lumbago and lower limb pain on before operation,1 month after operation,6 months after operation,12 months after operation and last follow up between two groups(P> 0.05). It is obvious that oswestry disability index(ODI) of 1 month after operation reduced significantly than before operation of two groups(P<0.01). Oswestry disability index(ODI) of 6 months after operation reduced significantly than 1 month after operation of two groups(P<0.01).There is nosignificant difference on changes of oswestry disability index(ODI) of 6 months after operation,12 months after operation and last follow up of two groups (P>0.05). There is nosignificant difference on changes of oswestry disability index(ODI) on before operation,1 month after operation,6 months after operation,12 months after operation and last follow up between two groups (P>0.05).5. It is obvious that lameness distance of two groups last follow up increased significantly than before operation(P<0.01). There is nosignificant difference on lameness distance between two groups(P>0.05).6. There is nosignificant difference on rate of bone graft fusion for 6 months,12 months after operation and last follow up between two groups(P>0.05). There is nosignificant difference on excellent rate on clinical efficacy last follow up(P>0.05).Conclusion:The operation time and blood loss in operation of autogenous bone fusion are more than Cage fusion. There is no nosignificant difference of autogenous bone fusion or Cage fusion on length of stay in hospital, incidence rate of operative complication, symptoms improvement, excellent rate on clinical efficacy, rate of bone graft fusion mid-short term and changes of lumbosacral angle. Choice autogenous bone fusion could get lower medical expenses than Cage fusion. It could obtain the same satisfactory efficacy either autogenous bone fusion or Cage fusion. But aspect of ability on maintain intervertebral height 3 months after operation, autogenous bone fusion is worse than Cage fusion. Autogenous bone fusion will add bedridden time after operation. It will occurrence complication of fetch autogenous bone possibility. So it should be choiced based on operation proficiency of surgeon and patients’ practice. Cage fusion could reduce risks of infection after operation. Cage fusion could reduce bedridden time early stage and less wound should be acceptant easily. It should be popularizated and used in clinical. |
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