Outcomes of multisegmental transforaminal enlarged decompression plus posterior pedicle screw fixation for multilevel lumbar spinal canal stenosis associated with lumbar instability.
PURPOSE
The aim of this study was to evaluate the clinical and radiologic results of multisegmental transforaminal enlarged decompression (TED) plus posterior pedicle screw fixation in the treatment of multilevel lumbar spinal canal stenosis (LSCS) with lumbar instability (MLSCSI).


METHODS
113 patients with MLSCSI underwent surgery were recruited in this study. All patients were suffering from symptoms typical of degenerative LSCS and treated with either TED plus fusion (TEDF group) or conventional laminectomy plus fusion (CLF group). Clinical and radiologic parameters were evaluated. The clinical data, including Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), operative time, intraoperative blood loss, postoperative drainage, hospital stay, and the rate of postoperative complications, were assessed. With respect to radiologic parameters, mean disc height (MDH) and lumbar lordotic angle (LLA) were measured using plain radiographs. Patient satisfaction was evaluated according to the North American Spine Society (NASS) Outcome Questionnaire.


RESULTS
No serious complications occurred during the follow-up. The operative time was significantly shorter for TEDF group than for CLF group, and similar results were found with regard to the blood loss and postoperative drainage (p < .05). The improvements in ODI, leg and back VAS scores were observed in both groups after surgery and follow-up (P < .05). In the last follow-up, ODI and back VAS scores in TEDF group were significantly higher than those in CLF group (P < .05). Regarding radiologic variants, MDH and LLA were improved after operation for 3 months (P > .05) and were all well maintained in the final follow-up in both groups. Patients in TEDF group were more satisfied than patients in the CLF group (85.2% vs 76.9%, p = .092).


CONCLUSIONS
Satisfactory clinical and radiological outcomes can be achieved with the use of multisegmental TED plus lumbar fusion for the treatment of MLSCSI. This technique can reduce surgically induced instability and obviously improve the symptoms and signs of the patients, suggesting a safe and effective therapeutic procedure for MLSCSI.
['Sun|Chao|C|', 'Tian|Wei Ji|WJ|', 'Liu|Hui Xin|HX|', 'Guan|Ping Guo|PG|']
D019299:Decompression, Surgical D005260:Female D006801:Humans D007593:Joint Instability D007796:Laminectomy D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D061646:Operative Time D010147:Pain Measurement D017060:Patient Satisfaction D065289:Pedicle Screws D011183:Postoperative Complications D011859:Radiography D013123:Spinal Fusion D013130:Spinal Stenosis D011795:Surveys and Questionnaires D016896:Treatment Outcome
Transforaminal enlarged decompression Pedicle screw fixation Lumbar spinal canal stenosis Laminectomy