Regulation Of Neuro-functional Recovery And Analysis Of Relevant Factors Of Surgical Decompression For Degenerative Lumbar Spinal Stenosis

Objective To illuminate the recovery pattern of radiating pain and neuro-function(including superficial sensory and myodynamia) of lower limbs in degenerative lumbar spinal stenosis(DLSS) cases after surgical decompression of canalis spinalis, and research the related factors, including risk factors and protective factors.Methods Research objects were abstracted on criteria from 1st Jan. 2013 to 31 st Dec. 2014 from DLSS cases treated in department of orthopeadics of hospital affiliated to Jiangsu university. Mode of surgical decompression was decided on different causes of lumbar spinal stenosis in individual principle. Radiating pain and neuro-function of lower limbers were examed at each presupposed time point after surgery(exam items each day in the first week post-operation, exam items at the last day of each month in the first year post-operation). Radiating pain of lower limbers was measured with visual analogue scale/score(VAS). Superfical sensory of lower limbers was tested by measuring sense of pain and touch of th e key points from L-1 segment described in American spinal injury association(ASIA), while myodynamia of lower limbers was detected by measuring myodynamia of the key muscles from L-1 segment described in ASIA with 6 grades method for myodynamia. Trend chart was drawed according to results of VAS scales, ASIA sensory scores and ASIA motion scores on time axis. Revery patterns of radiating pain, superficial sensory, myodynimia of lower limbers were observed in the trend chart. Possible related factors which were regarded as the independent variables were determined on clinical kownledges. There are age, gender, pre-oprative instability of the spine, pre-oprative ASIA total score, pre-operative VAS score, segments involved, course of disease. Changes of post-operative ASIA score and VAS score were taken as dependent variables. Ordinal Logistic regression analysis was performed to find out risk factors and protective factors of recovery of radiating pain and neuro-function of lower limbers after surgical decompression for lumbar spinal stenosis.Results(1) Radiating pain and superficial sensory of lower limbers obtained early recovery after surgical decompression of lumbar canalis spinalis. In the first day after decompressive surgery, statistically significant recovery can be observed. However, “re-bounce period” appeared from the 2nd day to the 5th day after decompressive surgery. Radiating pain of lower limbers which had been released deteriorated again. Superfical sensory of lower limbers which had been improved worsened again. By dehydration and symptomatic treatments, radiating pain and superfical sensory of lower limbers recovered again. After 1 year follow-up, it was found that the recovery of radiating pain and superficial sensory of lower limbers occurred in the first 3 months post-operation, most recovery mainly obtained in the first month after surgical decompression. From the 4th month after surgery, the recovery of radiating pain and superficial sensory of lower limbers entered “platform period”. No significant recovery was observed till 1 year after.(2) Recovery pattern of myodynamia of lower limbers was different from that of radiating pain and superfical sensory of lower limbers. Although it came relatively later, there was no “re-bounce period” in the recovery of myodynamia of lower limbers, which was occurred continuously, and became better and better. After 1 year follow-up, it was found that the recovery of myodynamia of lower limbers also occurred in the first 3 months post-operation, most recovery mainly obtained in the first month after surgical decompression. From then on, the “platform period” of recovery came. The myodynamia of lower limbers did not improve any more.(3) Age, gender, pre-operative VAS score were relevant factors of the release of lower limber radiating pain after decompressive surgery. Those patients who were older, female, and with higher pre-operative VAS scores, obtained worse recovery of lower limber radiating pain after decompressive surgery. Age, gender, pre-operative ASIA score wererelevant factors of the recovery of superfical sensory and myodynamia of lower limbers after surgical decompression. Patients who were older, female, and with higher pre-operative ASIA scores, acchieved worse recovery of lower limber neuro-function(superfical sensory and myodynamia). Segments involved in surgery, modes of decompressive surgery, and pre-operative instablity of spine were not relevant with the recovery of lower limber radiating pain and neuro-function.Conclusion Recovery of lower limber radiating pain and neuro-function after decompressive sugery for DLSS has its pattern. Knowledge of this pattern can not only guide pateint performing better rehabilitation exercises, but also help surgeons judge the prognosis more precisely. Performing decompression surgery in time in case of insignificant results is obtained by conservative treatments can obtain significant recovery of radiating pain and neuro-function of lower limbers. The knowledge of relevant factors of recovery of lower limber radiating pain and neuro-function after surgical decompression is helpful for surgeons to identify risk groups and adopt better preventive measures, and as a result, improve effects of surgery.