[Diagnosis and limited operative treatment of multi-segmental lumbar disease].

OBJECTIVE: To investigate the diagnosis and effectiveness of limited operative treatment for multisegmental lumbar disease.

METHODS: Between February 2008 and February 2011, 47 patients with multi-segmental lumbar disease were treated, including 27 males and 20 females with an average age of 60.3 years (range, 38-82 years) and a median disease duration of 21 months (range, 6 months to 7 years). Based on preoperative clinical manifestation and imaging examination results, the possibility of preliminary responsible segment was identified as two levels in 31 cases (L4,5 and L5, S1 in 22 cases, L3,4 and L4,5 in 6 cases, L2,3 and L3,4 in 3 cases) and three levels in 16 cases (L3,4, L4,5, and L5, S1 in 9 cases, L1,2, L4,5, and L4, S1 in 4 cases, L2,3, L4,5, and L5, S1 in 3 cases). Selective nerve root block (SNRB) was used in all cases to identify the responsible segment. Based on the results, the patients were treated by limited operative treatment. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative ambulation time, and complications were recorded. The clinical outcome was evaluated according to the visual analogue scale (VAS) scores for back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry disability index (ODI). The position of internal fixators and interbody fusion were observed through lumbar anteroposterior and lateral X-ray films.

RESULTS: The responsible segment was identified as single level in 33 cases (L4,5 in 18 cases, L5, S1 in 11 cases, and L3,4 in 4 cases) and two levels in 10 cases (L4,5 and L5, S1 in 6 cases, L3,4 and L4,5 in 3 cases, L2,3 and L4,5 in 1 case) by SNRB. After SNRB, 4 cases did not receive surgical treatment because of a low relief rate of less than 30%. The operations were performed successfully in all 43 patients. The mean operation time was 101.9 minutes; the mean intraoperative blood loss was 164.5 mL; the mean postoperative drainage volume was 238.9 mL; and the mean postoperative ambulation time was 38.2 hours. There was no complication of nerve injury or incision infection. All 43 patients were followed up 12-36 months (mean, 19.3 months). The VAS scores, JOA scores, and ODI after operation were significantly improved when compared with preoperative ones (P < 0.05). The postoperative JOA recovery rates were 62.2% +/- 12.6%, 63.4% +/- 12.4%, and 68.6% +/- 14.6% at 3, 6 months, and last follow-up respectively, showing no significant difference (F = 2.841, P = 0.062). The postoperative X-ray films showed that the internal fixators were in good position without loosening or fracture, and the interbody fusion was good.

CONCLUSION: After identifying the responsible segment by SNRB in the diagnosis, limited operative treatment is safe and reliable in the treatment of multi-segmental lumbar disease. It can relieve compression effectively, decrease the range of operation, maintain the spinal stabilization, and has a good effectiveness.