Objective To evaluate the clinical outcomes ofa surgical approach for decompression of lumbar spinal stenosis, which was featured with reconstruction of posterior spinal structures and epidural space by spinous process-splitting, less osteotomy, laminar flap and keeping spinal process, lamina, outer ligmentum flavum intact. Methods From October 2001 to April 2003, 39 patients (19 males and 20 females, aging 36 to 77 years with a mean age of 49.6 years with lumbar stenosis underwent the surgical decompression procedure with reconstruction of posterior canal structures and epidural space. The involved locations were L3,4 to L5S1(5 cases),L4,5 to L5S1(18 cases), L4,5(11 cases) and L5S1(5 cases). The course of disease was 3 months to 16 years (40.4 months on average). The clinical outcomes after 1 year of operation Results All patients were followed up from 18 to 36 months. No intraoperative and postoperative complications were observed and all patients were satisfactory with the surgery. Computerized tomography showed that spinal and nerve root canal were satisfactorily enlarged 1 week postoperatively in all cases. Fusion of lamina and spinous process were detected on CT in 87.2% patients (34/39) 3 months after operation. No patients presented re-stenosis of lumbar spine and all patients presented bony fusion 1 year after surgery. Conclusion The approach of the current study was a reliable and effective method in the management of lumbar stenosis, it preserved thecontinuity of spinal process, interspinous ligaments, lamina and ligmentumn flavum and integrality of posterior spinal structures and epidural space. The integrity of the psoterior spinal structures can prevent the scar formation and improve the stability of lmbar spine postoperatively.
Objective To evaluate the short-term effectiveness of local laminectomy and interlaminar lumbar instrumented fusion (ILIF) through a small incision for lumbar spinal stenosis. Methods Between November 2009 and January 2011, 16 patients with lumbar spinal stenosis were treated by local laminectomy and ILIF through a small incision. Therewere 7 males and 9 females with an average age of 52.8 years (range, 49-67 years). Sixteen patients had lumbar degenerative stenosis with an average disease duration of 4 years and 7 months (range, 2 years-9 years and 4 months). Four cases complicated by lateral recessus stenosis, 3 by lumbar disc herniation. Involved segments included L3, 4 in 2 cases, L4, 5 in 4 cases, L5, S1 in 4 cases, L3, 4 and L4, 5 (double segments) in 2 cases, L4, 5 and L5, S1 (double segments) in 4 cases. The effectiveness was evaluated with the pre- and post-operative Visual Analogue Scale (VAS) scores, Oswestry Disabil ity Index (ODI). The cross-sectional areas of spinal canal were measured by CT scanning and were compared between pre- and post-operation. Results The average operative time was 47 minutes (range, 35-80 minutes); the average blood loss was 145 mL (range, 120-350 mL); and the average hospital ization days were 7.8 days (range, 4-15 days). Cerebrospinal fluid leakage occurred in 1 case, and healing of incisions by first intention was achieved in the others. The patients were followed up 12-22 months (mean, 14.8 months). CT scanning showed interspinous fusion in 14 cases and possible fusion in 2 cases after operation, with an average fusion time of 4.6 months(range, 3-10 months). The postoperative VAS score, ODI, and cross-sectional area were significantly improved when compared with preoperative values (P lt; 0.05). Conclusion The ILIF can promote fusion between spinous processes, provide spine stabil ization, and protect the spinal cord. The procedure has small incision, simple method of fixation and fusion.
Objective Degenerative lumbar scol iosis and spinal stenosis are more common in elderly patients. Because of many factors, treatment choices are more complex. To investigate the step treatment strategy of degenerative lumbarscol iosis and spinal stenosis. Methods Between January 2005 and December 2009, 117 patients with degenerative lumbar scol iosis and spinal stenosis were treated with step treatment methods, including conservative therapy (43 cases), posterior decompression alone (18 cases), posterior short segment fusion (1-2 segments, 41 cases), and posterior long segment fusion ( ≥ 3 segments, 15 cases). Step treatment options were made according to patient’s will, the medical compl ications, the degree of the symptoms of low back and lower extremity pain, the size of three-dimensional lumbar scol iosis kyphosis rotating deformity, lumbar spine stabil ity (lateral sl ip, degenerative spondylolysis), and the overall balance of the spine. The visual analogue scale (VAS) score of low back and lower extremity pain, Oswestry disabil ity index (ODI), lumbar lordosis angle, and scol iosis Cobb angle were measured and compared before and after treatments. Results Seventy-two cases were followed up more than 12 months, and there was no death or internal fixation failure in all patients. Of them, 19 patients underwent conservative treatment; the mean follow-up period was 19.3 months (range, 1-5 years); no symptom deterioration was observed; VAS score of low back and lower extremity and ODI were significantly decreased at last follow-up (P lt; 0.05); and lordosis angle was decreased and scol iosis Cobb angle was increased, but there was no significant difference (P gt; 0.05). Twelve cases underwentposterior decompression alone; the average follow-up was 36 months (range, 1-5 years); VAS score of lower extremity and ODI were significantly decreased at last follow-up (P lt; 0.05); and scol iosis Cobb angle was increased and lordosis angle was decreased, but there was no significant difference (P gt; 0.05). Thirty-one patients underwent posterior short segment fusion; the mean follow-up period was 21.3 months (range, 1-3 years); postoperative hematoma, poor wound heal ing, cerebrospinal fluid leakage, and superficial infection occurred in 1 case, respectively, and were cured after symptomatic treatment; VAS score of low back and lower extremity and ODI were significantly decreased (P lt; 0.05); and postoperative lumbar scol iosis Cobb angle and lordosis angle were significantly improved at last follow-up (P lt; 0.05). Ten patients underwent posterior long segment fusion; the mean follow-up period was 17.1 months (range, 1-3 years); postoperative symptoms worsened in 1 case and was cured after physical therapy and drug treatment for 3 months, and deep infection occurred in 1 case and was cured after debridement and continuous irrigation drainage; VAS score and ODI were significantly decreased (P lt; 0.05); and postoperative scol iosis Cobb angle and lordosis angle were improved significantly at last follow-up (P lt; 0.05). Conclusion The treatment of degenerative lumbar scol iosis and spinal stenosis should be individual and step. Surgery treatment should be rely on decompression while deformity correction subsidiary. Accurate judgment of the responsible segment of symptoms, scol iosis and lordosis can prevent the operation expansion and increase safety of surgery with active control bleeding.
Objective To compare the effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis. Methods Between November 2019 and May 2023, a total of 81 patients with single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis who met the selection criteria were enrolled. They were randomly divided into UBE-TLIF group (39 cases) and Endo-TLIF group (42 cases). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, body mass index, surgical segment, and preoperative visual analogue scale (VAS) scores for low back and leg pain, Oswestry Disability Index (ODI), and serum markers including creatine kinase (CK) and C reactive protein (CRP). Total blood loss (TBL), intraoperative blood loss, hidden blood loss (HBL), postoperative drainage volume, and operation time were recorded and compared between the two groups. Serum markers (CK, CRP) levels were compared between the two groups at 1 day before operation and 1, 3, and 5 days after operation. Furthermore, the VAS scores for low back and leg pain, and ODI at 1 day before operation and 1 day, 3 months, 6 months, and 12 months after operation, and intervertebral fusion rate at 12 months after operation were compared between the two groups. Results All surgeries were completed successfully without occurrence of incision infection, vascular or nerve injury, epidural hematoma, dural tear, or postoperative paraplegia. The operation time in UBE-TLIF group was significantly shorter than that in Endo-TLIF group, but the intraoperative blood loss, TBL, and HBL in UBE-TLIF group were significantly more than those in Endo-TLIF group (P<0.05). There was no significant difference in postoperative drainage volume between the two groups (P>0.05). The levels of CK at 1 day and 3 days after operation and CRP at 1, 3, and 5 days after operation in UBE-TLIF group were slightly higher than those in the Endo-TLIF group (P<0.05), while there was no significant difference in the levels of CK and CPR between the two groups at other time points (P>0.05). All patients were followed up 12 months. VAS score of low back and leg pain and ODI at each time point after operation significantly improved when compared with those before operation in the two groups (P<0.05); there was no significant difference in VAS score of low back and leg pain and ODI between the two groups at each time point after operation (P>0.05). There was no significant difference in the intervertebral fusion rate between the two groups at 12 months after operation (P>0.05). ConclusionUBE-TLIF and Endo-TLIF are both effective methods for treating degenerative lumbar spinal stenosis with lumbar spondylolisthesis. However, compared to Endo-TLIF, UBE-TLIF requires further improvement in minimally invasive techniques to reduce tissue trauma and blood loss.
ObjectiveTo evaluate early effectiveness of posterior 180-degree decompression via unilateral biportal endoscopy (UBE) in the treatment of lumbar spinal stenosis (LSS) combined with Michigan State University (MSU)-1 lumbar disc herniation (LDH). MethodsA retrospective analysis was conducted on clinical data from 33 patients with LSS combined with MSU-1 LDH, who met selection criteria and were treated between March 2022 and January 2024. All patients underwent UBE-assisted 180-degree spinal canal decompression. The cohort comprised 17 males and 16 females, aged 37-82 years (mean, 67.1 years). Preoperative presentations included bilateral lower limbs intermittent claudication and radiating pain, with disease duration ranging from 5 to 13 months (mean, 8.5 months). Affected segments included L3, 4 in 4 cases, L4, 5 in 28 cases, and L5, S1 in 1 case. LSS was rated as Schizas grade A in 4 cases, grade B in 5 cases, grade C in 13 cases, and grade D in 11 cases. LDH was categorized as MSU-1A in 24 cases, MSU-1B in 2 cases, and MSU-1AB in 7 cases. Intraoperative parameters (operation time, blood loss) and postoperative hospitalization length were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to assess the lower limb pain and functional outcomes after operation. Clinical efficacy was evaluated at last follow-up via modified MacNab criteria. Quantitative radiological assessments included dural sac cross-sectional area (DSCA) measurements and spinal stenosis grading on lumbar MRI. Morphological classification of lumbar canal stenosis was determined according to the Schizas grading, categorized into four grades. Results The operation time was 60.4-90.8 minutes (mean, 80.3 minutes) and intraoperative blood loss was 13-47 mL (mean, 29.9 mL). The postoperative hospitalization length was 3-5 days (mean, 3.8 days). All patients were followed up 12-16 months (mean, 13.8 months). The VAS score and ODI improved at immediate and 3, 6, and 12 months after operation compared to before operation, and the differences between different time points were significant (P<0.05). At last follow-up, the clinical efficacy assessed by the modified MacNab criteria were graded as excellent in 23 cases, good in 9 cases, and poor in 1 case, with an excellent and good rate of 96.97%. Postoperative lumbar MRI revealed the significant decompression of the dural sac in 32 cases, with 1 case showing inadequate dural expansion. DSCA measurements confirmed progressive enlargement and stenosis reduction over time. The differences were significant (P<0.05) before operation, immediately after operation, and at 6 months after operation. At 6 months after operation, Schizas grading of spinal stenosis improved to grade A in 27 cases and grade B in 6 cases. ConclusionPosterior 180-degree decompression via UBE is a safe and feasible strategy for treating LSS combined with MSU-1 LDH, achieving effective neural decompression while preserving intervertebral disc integrity.
Objective To assess the clinical application value of tranforaminal unilateral approach for bilateral decompression by comparing the short-term effectiveness of bilateral decompression via unilateral approach of intervertebral foramen with via small surgical incision of bilateral spinous process in lumbar interbody fusion for the treatment of lumbar spinal stenosis. Methods Between July 2014 and June 2015, 48 patients with lumbar spinal stenosis underwent decompression and internal fixation by unilateral approach in 24 cases (trial group) and by bilateral small incision approach in 24 cases (control group). There was no significant difference in gender, age, disease duration, disease type, involved segment, combined medical diseases, preoperative level of creatine phosphokinase (CPK), the visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, and the incidence of complications were recorded. The CPK levels were evaluated at 1, 3, and 7 days after operation. VAS score and ODI were used to evaluate the effectiveness, and lumbar X-ray film or CT scanning to determine the intervertebral bony fusion. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization time between 2 groups (P>0.05), but significant difference was found in postoperative drainage (t=5.547,P=0.000). At 1 day after operation, the level of CPK in the trial group was significantly lower than that in the control group (t=3.129,P=0.005), but there was no significant difference at 3 and 7 days after operation between 2 groups (P>0.05). The patients were followed up 12-24 months (mean, 17 months). All the wounds healed primarily. Heart failure occurred in 1 case of the trial group, and cerebrospinal fluid leakage and pulmonary infection, and nerve root injury occurred in 1 case of the control group respectively. There was no significant difference in the incidence of complications between 2 groups (χ2=0.273,P=0.602). The interbody fusion rate was 95.8% (23/24) in the trial group and was 91.7% (22/24) in the control group, showing no significant difference (χ2=0.356,P=0.551). No cage sink, dislocation or plate and screw loosening and breakage was found in 2 groups. No adjacent segment degeneration occurred during the follow-up, and there was no change of scoliosis and lumbar sagittal curvature. At 3, 6, and 12 months after operation, the VAS score and ODI were significantly improved when compared with the preoperative scores in 2 groups (P<0.05), and the VAS score and ODI of the trial group were significantly better than those of control group (P<0.05). Conclusion The bilateral decompression via unilateral approach of intervertebral foramen and small surgical incision of bilateral spinous process in lumbar interbody fusion have satisfactory efficacy for the treatment of lumbar spinal stenosis, but the tranforaminal unilateral approach has the advantages of less trauma, avoidance of bilateral muscle stripping and soft paraspinal muscle injury, retention of posterior spinal structure, faster postoperative recovery, shorter hospital stay and good short-term effectiveness.
To investigate the effectiveness and safety of microendoscopic decompression via unilateral approach for lumbar spinal stenosis. Methods Between May 2006 and June 2009, 79 patients with lumbar stenosis were treated and divided into 2 groups: posterior lamina fenestration decompression (group A, n=37), endoscopic decompression via unilateral approach (group B, n=42). There was no significant difference in age, sex, segment level, and disease duration between 2 groups (P gt; 0.05). The cl inical outcomes were assessed by using the visual analogue scale (VAS) score and Oswestry Disabil ity Index (ODI). The operation time, blood loss, compl ications were compared between 2 groups. Results Operations were successfully performed in all cases. The operation time, blood loss, and drainage volume were (75.0 ± 25.7) minutes, (140.3 ± 54.8) mL, and (46.5 ± 19.7) mL in group A, were (50.4 ± 18.2) minutes, (80.2 ± 35.7) mL, and (12.7 ± 5.3) mL in group B; there were significant differences between 2 groups (P lt; 0.05). All the wounds healed by first intention. All patients were followed up 12-39 months (mean, 16 months). In group A, 1 patient suffered from intervertebral space infection after operation and recovered after conservative treatment; 4 patients had lumbar instabil ity after operation and recovered after lumbar interbody fusion combined with spine system internal fixation. In group B, 2 patients suffered from spinal dural rupture during operation and recovered after corresponding treatment, and no lumbar instabil ity was found. There was no significant difference in VAS score and ODI between 2 groups at preoperation (P gt; 0.05). Both VAS score and ODI were significantly improved at early stage after operation and last follow-up when compared with preoperation in each group (P lt; 0.05). Comparing with group A, there was significant improvement in VAS score at 24 hours postoperatively and in ODI at 1 month postoperatively in group B (P lt; 0.05), but no significant difference was observed at last follow-up (P gt; 0.05). According to cl inical evaluation of ODI mprovement rate, the excellent and good rate was 89.2% in group A and 92.9% in group B, showing no significant difference (χ2=0.896, P=0.827). Conclusion Comparing with posterior decompression surgery, microendoscopic decompression via unilateral approach is one of effective method to treat lumbar stenosis, with less trauma of fenestration yield and good early outcomes.
Objective To discuss the main points of technique and the range of fusion in posterior operation of spinal stenosis associated with lumbar degenerative kyphosis (LDK). Methods The cl inical data were retrospectively analysedfrom 20 cases of spinal stenosis associated with LDK which were performed posterior operation from February 2001 to February 2008. There were 1 male and 19 females, aged 52-81 years old with an average of 64 years old. The course of disease was 6-10 years. All patients had severe low back pain. According to Frankel’s neurologic function classification, there were 18 cases of grade E and 2 cases of grade D before operation. The apex of LDK included L1 in 3 cases, L2 in 10 and L3 in 7. The operational method was decided according to different characteristics of LDK. All patients were divided into three groups. Group 1 included 6 cases of sciatica and intermittent claudication with worse physical status, the segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation were performed. Group 2 included 8 cases whose Cobb angle of LDK was less than 20°, the segmental decompression of spinal canal, posterior intervertebral fusion and one-level or multilevel lamina osteotomy were performed, instrumentation-assisted correction was used. Group 3 included 6 cases whose Cobb angle of LDK was more than 20°, the canal decompression and one-level transvertebral wedge osteotomy were performed, instrumentation-assisted correction, intervertebral fusion and posterior-lateral fusion were used. Results Incision healedby first intention in all patients. One patient suffered from superior mesenteric artery syndrome at 6 hours after operationand healed after symptomatic management. The neurologic function was improved to grade E at 2 weeks after opeartion. All patients were followed-up 24-54 months (average 26 months). At last follow-up，the Oswestry Disabil ity Index of all patients was 30.5% ± 9.6%; showing significant difference when compared with preoperation (55.9% ± 11.8%, P lt; 0.05). The back pain scoring and leg pain scoring were 2.8 ± 1.6 and 2.4 ± 1.6, respectively according to the Numeric Rating Scale score; showing significant differences when compared with preoperation (7.5 ± 0.5 and 7.3 ± 0.7, P lt; 0.05). The Numeric Rating Scale score and Oswestry Disabil ity Index in all patients were improved obviously when compared with before operation (P lt; 0.05). During the follow-up period, there was no instrumentation failure or correction loss and the fusion rate was up to 100%. Conclusion For spinal stenosis associated with LDK patients, the most important therapic purpose is to improve cl inical symptom through reconstruction lumbar stabil ization and spinal biomechanics l ine in sagittal plane. Overall estimate of the cl inical appearance and imageology character is necessary when making decision of which segments needed to be fixation and fusion. Individual ized treatment strategy may be the best choice.
Objective To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. Methods A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Results Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences (P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05). And there was no significant difference between the two groups at each time point after operation (P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months (P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group (P<0.05). ConclusionFor the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.
ObjectiveTo investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. MethodsA retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m2) in 105 cases (group A), overweight (24 kg/m2≤BMI< 28 kg/m2) in 108 cases (group B), and obese (BMI≥28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). ResultsThe operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ2=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). ConclusionPosterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.