Individualized decompression strategy for lumbar spinal canal stenosis

Abstract

Objective To discuss and evaluate the clinical outcome of the personal posterior decompression strategy for patients with lumbar spinal stenosis and underwent interbody fusion. Methods From October 2009 to March 2014 , there were 57 patients with 77 vertebraes, 34 male, 24 femal, age from 47-78 years, with the average of 65.4 years. All were treated by decompression and interbody fusion via posterior approach. 26 vertebra were underwent transforaminal intervertebral retracting decompression, 45 vertebras were underwent one side laminectomy and another side undermined laminectomy, 6 vertebras were underwent modified extensive lamina decompression. Patients were followed up 3 and 12months after operation and evaluated by Japanese Orthopaedic Association Score and Oswestry disability index, and anteroposterior diameter and cross-section area of spinal canal were measured by CT scan. Results All patients were followed up from 13-45 months with an average of 25.0 months. 57 cases felt better after surgery. JOA score was from (13.52±4.48) points before surgery to (22.50±2.38) points 3 months after surgery, and (24.62±5.62) points 12 months after surgery. Oswestry score was from (31.52±4.64) points before surgery to (16.55±4.48) points 3 months after surgery, and (11.84±3.85) points 12 months after surgery. Anteroposterior diameter and cross-section area of spinal canal were from (1.08±0.38) cm and (0.36±0.12) cm2 before surgery to (2.07±0.74) cm and (2.23±0.95) cm2 after surgery. In transforaminal intervertebral retracting decompression group, anteroposterior diameter of spinal canal increased from (1.10 ± 0.41) mm before surgery to (2.10±0.84) mm after surgery, and cross-section area of spinal canal was also increased from (0.38± 0.11) mm2 to (2.33±0.82) mm2 after surgery. All of anteroposterior diameter and cross-section area of spinal canal in undermined laminectomy group and modified extensive lamina decompression group increased. Conclusion Personal posterior decompression strategy can expand lumbar canal effectively, improve symptom and protect bone and soft tissue near the canal. Key words: Lumbar vertebrae; Spinal stenosis; Spinal fusion; Decompression, surgical