Objective: To observe the curative effects of vertebral laminae reconstruction after laminectomy and pedicle screw fixation for the treatment of lumbar spinal stenosis in early (at the 3rd months after operation) and metaphase (at the more than 1 year after operation).
Methods: Twenty-two patients with lumbar spinal stenosis were treated by vertebral laminae reconstruction after laminectomy and pedicle screw fixation, there were 12 males and 10 females, the age was from 55 to 76 years with an average of 65.8 years, including single segment (6 cases), double segments (13 cases) and three segments (3 cases) of L3-S1. The follow-up period was for 1-3 years, preoperative and postoperative (at the 3rd months after operation and last follow-up) to assess the subjective symptoms, physical signs, the limit of daily activities and bladder function according to JOA scoring; and observe saggital diameter measurement and radiological changes through X-ray and CT.
Results: All the patients were followed up, the JOA scoring were respectively 5.3 +/- 1.6, 23.2 +/- 2.0, 22.9 +/- 2.4 before operation and after operation (at the 3rd after operation and last follow-up); at the 3rd months after operation, 18 cases obtain excellent results, 3 good, fair 1, and at the last follow-up, 17 cases obtain excellent results, 3 good, fair 2, there was no significant difference between two postoperative periods (u = 0.413, P < 0.05). The mean sagittal diameter of narrow segment was respectively (6.8 +/- 0.9), (17.6 +/- 2.5), (16.9 +/- 1.8) mm before operation, at the 3rd months after operation and the last follow-up. Through statistics processing, there was significant different comparing JOA scoring at 3 months after operation, last follow-up with preoperative (P < 0.05). There was significant difference of vertebral canal sagittal diameter between at the 3rd months after operation and before operation (t = 35.116, P < 0.01); there was no significant difference between at the 3rd months after operation and last follow-up (t = 1.814, P > 0.05). The CT examination of last follow-up showed the vertebral canal have no stenosis, the dural sac and nerve roots have no compression, the rebuilt vertebral laminae have fused well, the graft bone are no absorbed and the fixation have no failure.
Conclusion: Treatment of lumbar spinal stenosis with vertebral lamina reconstruction after vertebral laminectomy and pedicle screw fixation can obtain satisfactory results in early and metaphase. The method had advantages of decompression thoroughly and fixation solidly, and could prevent vertebral canal restenosis causing by nerve oppression of the postoperative scar and nerve adhesion.