郑丰裕 医生工作室
Comparison between regular and respective bilateral procedure in posterior lumbar spinal decompressi
Objective: To investigate whether respective bilateral procedure is more advantage than regular bilateral procedure in posterior lumbar spinal decompression and segmental instrumented fusion. Methods: A retrospective chart review of 45 patients was conducted. All patients suffered from degenerative lumbar spinal disorders. They were undergone posterior lumbar spinal decompression and segmental instrumented fusion by a same surgeon from April 2005 to November 2009. Two groups were identified in terms of whose performed with regular bilateral procedure (Group A) and respective bilateral procedure (Group B). Demographics, medical history including diagnosis and comorbidity, length of incision, level involved, detail procedure, estimated intraoperative blood loss, transfusion, duration of operative time, parameters related to postoperative general reaction, and wound healing were collected based on chart review. Data were performed with SPSS statistic analysis software. Results: Twenty-two males and 23 females were involved in this study (average age 51.9, ranged 23 to 75), in which patients were diagnosed with lumbar disc prolapse in 16, degenerative stenosis in 20, degenerative scoliosis and or spondylolisthesis in 9, and secondary stenosis after previous decompression in 3. There were 20 patients in Group A, and other 25 patients in Group B, which no significant difference about the demographic, level involved and duration of operative time between two groups. A significant higher percentile of patients with DM, previous lumbar decompression, and procedure performed with interbody fusion were found in Group B. There were significant differences between two groups in terms of length of incision (P < 0.001), estimated intraoperative blood loss (P < 0.001), transfusion (P < 0.001), duration of postoperative temperature over 38oC (P < 0.05), corrective WBC count (P < 0.05) and neutrophils percentage (P < 0.01). Although wound infection was no found in both groups, there was found 3 patients in Group A with delayed wound healing, but without wound healing problem in Group B (P < 0.01). Conclusion: A limited incision, less intraoperative blood loss, no need blood transfusion, and less postoperative general reaction, the respective bilateral procedure is of absolute advantage comparing to regular procedure in posterior lumbar spinal decompression and segmental instrumented fusion. Without the help of endoscope, the respective bilateral procedure could be performed with minimal invasively by a spine surgeon who is comfortable with traditional approach.