Multilevel decompression combined with selected fusion in the treatment for multilevel lumbar stenosis

English Keywords:Lumbar stenosis  Multilevel  Decompression  Selected fusion

English Abstract:

  【Abstract】 Objective：To investigate the therapeutic effects of multilevel decompression combined with selected fusion in the treatment for multilevel lumbar stenosis.Method：27 cases of multilevel lumbar stenosis treated with long segmental decompression and selected fusion were reviewed retrospectively.The involved segments were determined by symptoms，clinical features and radiographic documents.The decompression on the stenosed nerve roots and selected fusion on the segments with preoperative instability and probably iatrogenic unstable levels were carried out.The patients were assessed clinically with the Japanese Orthopedic Association（JOA） score，visual analog scale（VAS） and Oswestry Disability Index（ODI）.The dynamic X ray and MRI were used to evaluate the lumbar stability and adjacent segment degeneration.Result：Decompression of 56 segments and fusion of 29 segments were performed on the 27 patients.The mean follow-up period was 38 months（ranges 14-84 months）.The average JOA score was 11.4±2.8 points at the initial examination and 21.1±4.4 points at the final follow-up（P<0.05）.The average ODI score for the 27 patients was 65.0%±22.1% preoperatively，and it decreased to 23.0%±10.7%（P<0.01） at follow-up.The average VAS score of low back pain and leg pain was 6.0±2.3 and 7.9±1.6 respectively before surgery，which decreased to 2.3±1.8 and 2.9±2.2 at follow-up.26 of 27 patients were satisfied with the outcome.MRI examination revealed no significant changes and disability at adjacent level.Conclusion：This investigation suggests that the clinical outcomes of multilevel decompression with selected fusion for multilevel lumbar stenosis show good results by individual surgical plan on the basis of careful evaluation of clinical and radiological features.