Endoscopic Preservation Of Spinous Process Ligament Complex With Laminoplasty In The Treatment Of Lumbar Spinal Stenosis

BackgroundLumbar spinal stenosis(LSS)refers to the changes in morphology and tissue structure of lumbar vertebrae and soft tissues(vertebral body,facet joint,lamina,ligamentum flavum,intervertebral disc,etc.)caused by various causes,resulting in central spinal canal Side crypts,narrow nerve pores,the nerve roots and / or cauda equina nerves are stimulated or oppressed,causing a series of clinical symptoms of the disease.Clinically,it is divided into primary,caused by congenital abnormalities or postnatal developmental disorders,or secondary(acquired)caused by degenerative changes or local infections,trauma or surgery,Degenerative lumbar spinal stenosis(DLSS)is the most common in clinical practice,especially in the elderly population aged 60-70 years,the incidence rate is 1.7%~10%.With the development of China's economy and society and the aging of the elderly,the incidence of lumbar spinal stenosis is increasing.In lumbar degenerative disease,the incidence is second only to lumbar disc herniation.Spinal surgery has existed for more than a hundred years ago.The current science and technology and other aspects are advancing by leaps and bounds,and doctors are constantly deepening their understanding of anatomy and minimally invasive concepts,the surgical methods for the treatment of lumbar spinal stenosis are roughly divided into: lumbar spinal canal decompression,such as total laminectomy,semi-laminectomy and laminectomy;lumbar fusion and internal fixation,according to the different approaches,can be divided into a variety of surgical methods,such as traditional lumbar posterior lumbar interbody fusion(PLIF),transforaminal lumbar fusion(TLIF,MIS-TLIF)Anterior lumbar interbody fusion(ALIF),etc;lumbar non-fusion internal fixation,such as vertebral fixed dynamic stabilization system,interspinous expansion system;endoscopic minimally invasive surgery,such as discoscopy,intervertebral foramen and so on.Nowadays,with the continuous understanding of the spine anatomy and the continuous improvement of medical aids,the surgical treatment of lumbar spinal stenosis is becoming more and more invasive,diversified and intelligentt,but various surgical methods have advantages and disadvantages.There is no unified understanding of the treatment of lumbar spinal stenosis.Clinical physicians mainly choose the best treatment based on past experience and their own technical level.Undoubtedly,it has become a big problem when doctors choose the best treatment method in clinical practice,and it is also related to the ideal or not of postoperative results.PurposeTo investigate the clinical efficacy of endoscopic preservation of spinous process ligament complex with laminoplasty in the treatment of lumbar spinal stenosis.Method72 patients with lumbar spinal stenosis admitted to this medical unit from January 2017 to June 2018 were divided into the control group(36 cases)and the observation group(36)by random number table method.Patients in the control group underwent traditional Posterior Lumbar Interbody Fusion(PLIF)and patients in the observation group underwent endoscopic preservation of spinous process ligament complex with laminoplasty.The incision length,intraoperative blood loss,operation time,and bed rest time were compared after operation.The surgical outcomes of the two groups were compared using visual analog scale(VAS),Oswestry Dability Index(ODI)score and Japan Orthopedic Association(JOA)score.Resultsompared with the control group,the observation group had less blood loss,less time for surgery,shorter incision,and shorter bed rest time,and the difference was statistically significant(p<0.05).The VAS score and ODI score were lower at 1 week,3 months and 6 months after operation.The difference was statistically significant(p<0.05).There was a statistically significant difference in the excellent rate between the two groups at 1 week and 3 months after surgery(p<0.05),and there was no significant difference in the excellent rate at 6 months(P>0.05).There was no significant difference in the rate of intervertebral fusion between the two groups(P>0.05).ConclusionsEndoscopic preservation of spinous process ligament complex with laminoplasty is a new minimally invasive method for the treatment of lumbar spinal stenosis with minimal surgical trauma,rapid postoperative recovery and good clinical efficacy.