| Objectives To investigate the short-term technique and therapeutic effect of modified laminoplasty for lumbar spinal stenosis(LSS)and to explore the application value of modified laminoplasty in maintaining the stability of the spine by comparing with the conventional laminectomy.Methods This retrospective study included 90 patients with typical lumbar spinal stenosis in August 2014 to July 2015.We separated the patients into two groups.46 patients underwent modified laminoplasty in group A,and 44 patients received conventional laminectomy in group B.A total of 76 patients were followed up for 1 year at least.The 37 patients in group A(17 males and 20 females,with an average age of 52.2years)underwent modified laminoplasty.The 39 patients in group B(18 males and 21 females,with an average age of 54.1 years)received conventional laminectomy.The sex,age,narrow segment,course of disease,VAS of low back pain or leg pain,JOA score,Walking tolerance of the two groups are no significant difference in preoperative(P>0.05).postperative VAS of low back pain,leg pain,JOA score,Walking tolerance,Radiographic and CT are used to evaluate the therapeutic effect.Results 2 cases of group A and 1 case of group B occured dural tear,but all were repaired in surgery and all incision primarily healed without infection.A total of 76 patients completed at least 1 year of follow-up.The patients were followed up 12-18months(mean,14.6 months)in group A,and 12-20 months(mean,14.9 months)in group B.The bone healing time was 6-12 months(mean,9 months)in group A.CT showed healing at the junction of spinous process and vertebral plate in group A at 12 months after operation,new scar in varying degrees was observed in group B.The postoperative JOA and VAS score in both groups were improved significantly compared with the corresponding preoperative ones.There was no significant difference in VAS score of lower limb pain,JOA score and walking tolerance between the two groups,The VAS of low back pain was(0.57±0.647)in group A better than(1.69±1.280)in group B.Both sagittal and transverse diameter of lumbar vertebrae canal were increased notably in postoperative CT scanning.The change of slip distance between the two groups was statistically significant(P<0.05).The preoperative anterio-posterior canal diameter as measured on the computed tomography scan was 12.73±1.76 mm,which improved to15.17±1.90 mm postoperatively.Transverse diameter was 17.60±2.04 mm,which improved to 21.07±1.70 mm Postoperatively.The mean±SD for the preoperative claudication distance was 97.5±62.9m,which improved to 594.2±158.1m after the operation in group A and in group B the mean±SD for the preoperative claudication distance was 94.7±64.9m,which improved to 521.9±179.3m after the operation.The difference was statistically significant compared with preoperative.There were no spinal instability radiographs 1 year after the surgery in group A,but three patients were instability or spondylolisthesis in group B.We consider that the spinous process,Lamina,inter-spinus ligaments and super-spinus ligaments complex could be important for spine stability.Conclusions Our one year follow up shows that two kinds of operation methods of spinal canal stenosis patients had satisfactory effect on lumbar.But the modified decompression in the treatment of low back pain and maintaining postoperative lumbar stability is better than laminectomy decompression.The former with less trauma,complete decompression and maintaining the spinal stability is worth in clinical practice. |
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