Abstract
Introduction
The aim of this study was to evaluate the short-term clinical outcomes of lumbar spinal canal precise decompression and Wallis interspinous dynamic stabilization for single-segmental lumbar spinal stenosis in the aged, compared with the traditional decompression and fusion operation. Method: Retrospective data review of the 46 aged patients who suffered from the degenerative spinal stenosis of L4-L5 and received the surgical treatment in the air force
Materials and Methods
A total of 25 patients received spinal canal precise decompression and Wallis interspinous dynamic stabilization operation in the General Hospital during January 2008 to December 2010, and the 21 patients received the traditional decompression and fusion operation. The height of intervertebral spaces and intervertebral foraminas of the operative segment (L4-L5) and the adjacent segment (L3-L4 and L5-S1) in the radiograph images of every patient in the precise decompression and nonfusion group were measured. The ODI and VAS scores of all patients preoperatively, at 3 days,1 month, and 6 months postoperatively were recorded; the length of incision, the duration of surgery, the intraoperative blood loss, and the time to leave a sickbed of all patients and compared between the groups were also recorded. All the intraoperative and postoperative complications were recorded.
Results
The Wallis systems were all successfully implanted after spinal canal precise decompression in total of 25 cases in the precise decompression and nonfusion group. No operation-related complications happened. Every patient got relief after the operation, with significant difference between the ODI/VAS scores preoperatively, and the data in 3 days, 1 month, and 6 months postoperatively. The difference has remarkable statistical meaning (p < 0.01). There was a similar relief rate between the two groups (p > 0.05). There was no statistical difference in the height of intervertebral spaces and intervertebral foraminas of the adjacent segment (L3-L4 and L5-S1) between the data in 3 days and the ones in 1 months and 6 months postoperatively in the precise decompression and nonfusion group (p > 0.05). Compared with the traditional general decompression and fusion operation, the precise decompression and nonfusion operation had advantages of smaller incisions, shorter surgery time, less intraoperative blood loss, less days to leave a sickbed, and less operation-related complications (p < 0.01).
Conclusion
The precise spinal canal decompression and Wallis interspinous dynamic stabilization was an effective and safe technique for degenerative segmental spinal stenosis in the aged.
None declared
Kaner T, Sasani M, Oktenoglu T, Ozer AF. Dynamic stabilization of the spine: a new classification system. Turk Neurosurg 2010;20(2):205–215
Chou WY, Hsu CJ, Chang WN, Wong CY. Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg 2002;122(1):39–43
Carreon LY, Puno RM, Dimar JR II, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 2003;85-A(11):2089–2092
Farfan HP. Mechanical Disorders of the Low Back. Philadelphia, PA: Lea and Febiger; 1973:37–401
Cinotti G, De Santis P, Nofroni I, Postacchini F. Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine 2002;27(3):223–229
Lindsey DP, Swanson KE, Fuchs P, Hsu KY, Zucherman JF, Yerby SA. The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine. Spine 2003;28(19):2192–2197
Mulholland RC, Sengupta DK. Rationale, principles and experimental evaluation of the concept of soft stabilization. Eur Spine J 2002;11(Suppl 2):S198-S205
Swanson KE, Lindsey DP, Hsu KY, Zucherman JF, Yerby SA. The effects of an interspinous implant on intervertebral disc pressures. Spine 2003;28(1):26–32