The comparison of clinical outcomes after simultaneous decompression of the skip type noncontiguous thoracic spine stenosis versus staged operations

English Keywords:Noncontiguous thoracic spine stenosis  JOA recoveryratio  Simultaneous operation  Staged operation

English Abstract:

  【Abstract】 Objectives: To compare outcomes after one stage decompression of the skip type noncontiguous thoracic spine stenosis versus staged operations. Methods: 34 patients with skip type symptomatic noncontiguous thoracic spine stenosis who underwent surgical decompression in the author′s hospital between January 2005 and June 2016 were retrospectively reviewed. They were grouped by the general physical conditions and complexities of the lesions, and the patient′s preoperative and postoperative JOA score and the JOA improvement ratio, the surgical procedures(operation time, combined estimated blood loss, etc), and complications were evaluated. Results: 15 cases were treated with one stage operation, while 19 patients were accomplished by staged operation. The follow-up time was 11-120 months with an average of 40.0±29.7 months. Preoperative JOA scores of these two groups were 4.7±1.1 and 4.3±2.2 respectively, while 8.4±1.1 and 7.5±2.0 at final follow-up respectively, with an average recovery rate of (57.1±21.6)% and (46.0±25.8)% respectively, however, there was no statistical significance of the above-mentioned. Combined intraoperative blood loss in staged group and simultaneous group was 484.0±286.1ml and 1694.2±1532.4ml, respectively. And total operative time in these two groups was 166.8±50.3min and 326.6±121.8min and postoperative hospital stay days was 7.5±4.0 days and 19.9±8.7 days, respectively. There were statistical significances with respect of the total operation time, combined intraoperative blood loss and postoperative hospital stay days. According to the clinical outcome grading for recovery rate, the fine rate of these two groups was 60.0% and 52.6% respectively, however, there was no statistical significance. After statistical analysis, the surgical outcome of those whose operation intervals Iess than 1 year was not significantly better than those of more than 1 year. 11 cases(41.2%) were complicated with cerebrospinal fluid leakage(CSFL), including 5 cases of simultaneous group and 9 cases of staged group, while 10 cases(29.4%) were noted with other complications, including 4 cases of simultaneous group and 6 cases of staged group. However, there is no statistical significance with the respect to the complications. Conclusions： It is suggested that the single stage procedure should be for those patients with simple surgeries and good physical condition, otherwise, the staged procedure is recommended. Once the surgical options were selected, there was no difference in postoperative clinical efficacy and rate of the complications between the two groups.