Observation of the clinical effect of the limited spinal canal decompression in elderly patients with lumbar spinal stenosis

English Keywords:Unilateral approach  Bilateral decompression  Lumbar spinal stenosis  Elderly

English Abstract:

  【Abstract】 Objectives: To explore the clinical effect of unilateral approach for bilateral decompression in the treatment of elderly patients with lumbar spinal stenosis. Methods: Data of 35 patients who were elder than 75 years old with lumbar spinal stenosis treated in our hospital from March 2017 to September 2019 were retrospectively reviewed. According to the operation methods, all the patients were divided into group A, in which 17 patients were treated with bilateral lamina fenestration decompression(group A, n=17, 7 males and 10 females with an average age of 80.1±3.8 years), and group B, in which 18 patients were treated with unilateral approach for bilateral decompression(group B, n=18, 10 males and 8 females with an average age of 79.9±3.7 years). The operation time and blood loss were compared between both groups. VAS pain score and JOA score were used to evaluate the efficacy． Results: There was no statistically significant difference of the basic conditions of patients between both groups. Both groups successfully completed the operation. Compared with those in group A, patients in group B had shorter operation time(61.9±17.6min vs 50.4±14.3min) and less intraoperative blood loss(62.6±24.7ml vs 45.4±20.3ml), and the difference was statistically significant(P<0.05). Compared with that preoperatively, the VAS score of leg pain was significantly decreased and the JOA score was significantly increased at 12 months after operation for both groups. The difference was statistically significant(P<0.05) within each group, while that was not statistically significant between groups(P>0.05). The VAS score of low back pain at 12 months after operation did not improve significantly comparing with that before operation(P>0.05). No spinal instability occurred in all patients after surgery. Conclusions: Unilateral approach and bilateral decompression in the treatment of elderly lumbar spinal stenosis can achieve the same curative effect as open surgery, which has the advantages of short time, less intraoperative bleeding, less trauma, and no damage to the stability of the lumbar spine.