[Treatment of spinal stenosis associated with lumbar degenerative kyphosis through posterior approach].
摘要
OBJECTIVE: To discuss the main points of technique and the range of fusion in posterior operation of spinal stenosis associated with lumbar degenerative kyphosis (LDK). METHODS: The clinical data were retrospectively analysed from 20 cases of spinal stenosis associated with LDK which were performed posterior operation from February 2001 to February 2008. There were 1 male and 19 females, aged 52-81 years old with an average of 64 years old. The course of disease was 6-10 years. All patients had severe low back pain. According to Frankel's neurologic function classification, there were 18 cases of grade E and 2 cases of grade D before operation. The apex of LDK included L1 in 3 cases, L2 in 10 and L3 in 7. The operational method was decided according to different characteristics of LDK. All patients were divided into three groups. Group 1 included 6 cases of sciatica and intermittent claudication with worse physical status, the segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation were performed. Group 2 included 8 cases whose Cobb angle of LDK was less than 20 degrees, the segmental decompression of spinal canal, posterior intervertebral fusion and one-level or multi-level lamina osteotomy were performed, instrumentation-assisted correction was used. Group 3 included 6 cases whose Cobb angle of LDK was more than 20 degrees, the canal decompression and one-level transvertebral wedge osteotomy were performed, instrumentation-assisted correction, intervertebral fusion and posterior-lateral fusion were used. RESULTS: Incision healed by first intention in all patients. One patient suffered from superior mesenteric artery syndrome at 6 hours after operation and healed after symptomatic management. The neurologic function was improved to grade E at 2 weeks after operation. All patients were followed-up 24-54 months (average 26 months). At last follow-up, the Oswestry Disability Index of all patients was 30.5% +/