Abstract:

BACKGROUND: Lumbar degenerative diseases are commonly found in the elderly. Thus, surgery risk is very high. To solve this problem, some scholars put forward the concept of selective decompression. However, it is hard to identify the corresponding segment or position in some patients, so selective decompression cannot obtain perfect repair effects in many previous prospective randomized controlled studies.
OBJECTIVE: To analyze the effectivity of single level decompression and fusion for multiple level lumbar disc herniation combined with lumbar spondylolisthesis.
METHODS: A total of 23 cases of multiple level lumbar disc herniation with lumbar spondylolisthesis from January 2010 to December 2013 were enrolled in this study. Repair method: single level decompression and fusion. Using conventional X-ray, lumbar MRI, , disease stage and instability interval were assessed in combination with selective nerve root closed, and dynamic X-ray measurements (over-extension, over-flexion, left and right flexion). Dynamic X-ray measurements and Posner score were used to identify stability of responsible segment. Lumbar MRI was utilized to identify obvious degeneration of intervertebral discs. Selective nerve root closed was applied to identify the major responsible interspace. Low back pain visual analog scale and the Japanese Orthopaedic Association score were employed to assess patient’s repair effects. The improvement of clinical symptoms could be used as the criteria of curative effects.
RESULTS AND CONCLUSION: All patients were followed up for 12-36 months. Low back pain visual analog scale and the Japanese Orthopaedic Association score were significantly improved during final follow-up. The improvement rate of the Japanese Orthopaedic Association score was 88%. The improvement rate of the visual analog scale was 93%. Nerve root irritation was not visible after surgery. Bone fusion was found in fusion segment of all patients. No loosening, fracture or pulling out appeared. No lumbar sagittal imbalance was detectable. Results indicated that it is necessary to give correct general diagnosis and evaluation according to symptoms, signs and radiological features before surgery. Decompression to responsible interspace, short level fixation, pedicle screw, connecting rods and interbody fusion can increase supporting force of pre-column. Stress on the screw and rod maintains dynamic equilibrium. Simultaneously, stable screw-rod fixation system is also conducive to the bone healing in anterior bone graft material. Frame structure formed by internal fixation significantly elevates the anti-rotation capability, forming strong three-dimensional fixation.

Key words: lumbar vertebrae, intervertebral disk displacement, spinal fusion, internal fixators, pain measurement