Clinical comparative study of modified versus traditional posterior lumbar interbody fusion for lumbar spinal stenosis / 中华创伤杂志

ABSTRACT

Objective To compare the clinical outcomes of modified and traditional posterior lumbar interbody fusion (PLIF) in treatment of lumbar spinal stenosis.Methods A retrospective review was made on 47 patients who sustained monosegmental L4.5 stenosis due to lumbar degenerative revise and characterized by typical intermittent claudication and single or both limb numbness and pain.The patients were randomly allocated to Group A and Group B using the lottery method.Group A (n =24) consisted of 10 males and 14 females at mean age of 52 years (range,47-66 years) and the course of disease averaged 13 months (range,9-23 months).Group B (n =23) contained 8 males and 15 females at mean age of 53 years (range,49-67 years) and the course of disease averaged 11.5 months (range,6-22months).Modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction and interbody fusion was performed in Group A.Traditional PLIF,namely posterior spinal decompression and interbody fusion,was performed in Group B.Waist function rehabilitation after surgery of the patients in the two groups was assessed using the Oswestry disability index (ODI) and postoperative results were analyzed.Results There were no significant differences between Groups A and B regarding the operation time [(1 90 ± 15.66) min vs (170 ± 11.32) min] and intraoperative blood loss [(980 ± 35.58) ml vs (879 ± 21.25) ml] (P ＞ 0.05).Mean period of follow-up was 20 months (range,12-28 months).Postoperative results in Group A were graded as excellent in 19cases,good in three,fair in two and poor in zero,with excellence rate of 88％.While in Group B,the results were excellent in 13 cases,good in four,fair in four and poor in two,with excellence rate of 74％(P ＜ 0.05).ODI score and symptom improvement rate after operation were better in Group A than in Group B (P ＜ 0.05).Conclusion The modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction is relatively an ideal surgical technique for treatment of lumbar spinal stenosis and deserves wide promotion.