ABSTRACT
Objective Clinical study on the treatment of bilateral lumbar spinal stenosis with percutane-ous fixation combined with unilateral open-ended spinal canal decompression. Methods 126 patients with bilater-al lumbar spinal stenosis admitted to our hospital were randomly divided into two groups.The observation group was treated by percutaneous nail combined with unilateral laminar fenestration,and the control group was treated by open reduction combined with bilateral hemi laminectomy and spinal canal decompression.The two groups of pa-tients with general surgical complications after treatment,index,lumbago and leg pain VAS score and ODI score were compared.Results The operation time of the observation group,the amount of bleeding,the time of hospital-ization and the cost of hospitalization were less than those of the control group.There were no complications such as incision infection after operation in the two groups.The two groups were statistically significant postoperative pain and leg pain VAS score and ODI score compared with preoperative difference.The two groups had statistical signifi-cance between low back and leg pain VAS score and ODI score after 6 and 12 months and last follow-up phase dif-ference.But the two groups after 3 months of lumbago and leg pain VAS score and ODI score had no significant dif-ference.Conclusions Percutaneous minimally invasive nail combined with unilateral laminar fenestration and de-compression for bilateral lumbar spinal stenosis has the advantages of less trauma,less bleeding,shorter hospitaliza-tion time and quicker recovery.It is worthy of clinical promotion.
ABSTRACT
BACKGROUND:At present, the internal fixation and fusion surgical treatment of lumbar degenerative disease tends to diversify, but posterior lumbar interbody fusion within a single bilateral pedicle screw fixation is stil common in clinical practice; the two ways after treatment can achieve satisfactory clinical efficacy, but which way has advantages is stil controversial. OBJECTIVE:To evaluate the efficacy and safety of unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the repair of lumbar degenerative disease by a meta-analysis system. METHODS: According to the Cochrane Colaboration search strategy, we searched MEDLINE, PubMed, EMBASE, CBMdisc, CNKI, VIP and WanFang Data. Randomized controled trials concerned unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the treatment of lumbar degenerative diseases. By two reviewers, in strict accordance with inclusion and exclusion criteria, literatures were screened, data were extracted, and the methodology quality of included trials was criticaly assessed. RevMan5.1 software was used for meta-analysis. RESULTS AND CONCLUSION: Six randomized controled trials involving 507 patients were included. The results of meta-analysis showed that fixed unilateral and bilateral pedicle screw between single lumbar fusion and surgery in the treatment of lumbar degenerative diseases, significant differences were detected in surgical time [WMD=-40.29, 95% CI (-43.79, -36.79)], intraoperative blood loss [WMD=-74.13, 95%CI (-86.13,-62.13)], length of hospital stay [WMD=-1.04, 95%CI (-1.30,-0.79)], final folow-up Visual Analogue Scale score [WMD=0.33, 95% CI (0.24, 0.42)], final folow-up Oswestry dysfunction index [WMD=-1.07, 95%CI(-1.57, -0.56)]; unilateral side was better than bilateral side (P < 0.000 1). There was no significant difference in complication rate [RR=0.54, 95% CI(0.25, 1.17)] and fusion rate [RR=0.53, 95%CI (0.22, 1.28)] (P=0.12 andP=0.16). These results suggested that unilateral and bilateral pedicle screw fixation and single lumbar fusion in the treatment of lumbar degenerative disease has achieved satisfactory results. Unilateral pedicle screw fixation can reduce operation time, intraoperative blood loss and length of stay. Visual Analogue Scale score and Oswestry dysfunction index improved significantly in a short period after treatment.