Transverse decompression technique in the surgical treatment of degenerative lumbar canal stenosis

摘要

Objective: The aim of this study was to assess the outcomes of fusion technique via posterior instrumentation in combination with transverse decompression in the surgical treatment of degenerative lumbar canal stenosis. Methods: Forty-five patients–39 women (86.7%) and 6 men (13.3%)–were included. Mean age was 58.68±8.63 years with mean follow-up of 51.71±20.96 months. Preoperative and postoperative clinical evaluation was performed using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for overall pain. Preoperative and postoperative imaging studies were used to measure the degree of spondylolisthesis and the angle of scoliosis and lumbar lordosis. The presence of preoperative facet joint arthrosis and changes in the diameter of anterior, posterior, and transverse spinal canal were assessed by computed tomography (CT). Preoperative disc degeneration, disk herniation, and spondylolisthesis were examined by magnetic resonance imaging (MRI). Results: Mean preoperative ODI and VAS scores were 59.2% and 7.06, respectively, while postoperative ODI and VAS scores were 14.4% and 1.7%, respectively (p=0.001). Anteroposterior diameter of the central canal increased from 10.43±2.18 mm preoperatively to 19.63±2.01 mm postoperatively (p=0.0001). Mean preoperative and postoperative spondylolisthesis were 5.81±4.88 mm and 3.87±4.53 mm, respectively (p=0.0001). Mean preoperative and postoperative scoliosis angles were 5.84°±10.14° and 2.04°±5.08°, respectively (p=0.0002). Mean preoperative and postoperative lordosis angles were 22.47°±13.98° and 33.73°±10.89°, respectively (p=0.0001). Complications included pulmonary embolism in 1 patient (2.2%), superficial injury site infection in 1 patient (2.2%), and deep surgical site infection in 1 patient (2.2%). Two patients (4.4%) experienced dural tears. One patient (2.2%) had intraoperative radix damage. Conclusion: The results of the present study suggest that the fusion technique via posterior instrumentation, in combination with transverse decompression, offers a clinical improvement in patients with lumbar canal stenosis. DOI: 10.3944/AOTT.2015.14.0027