[Surgical treatment of degenerative lumbar scoliosis with multi-segment lumbar spinal stenosis].

OBJECTIVE: To explore the surgical indications, decompression and fusion method, and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis.

METHODS: Between April 2000 and November 2011, 46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above). Of 46 cases, 25 were male and 21 were female, with a mean age of 70.2 years (range, 65-81 years) and with a mean disease duration of 6.4 years (range, 4 years and 6 months to 13 years). X-ray films showed that the lumbar Cobb angle was (26.7 ± 10.0) degrees, and the lumbar lordotic angle was (20.3 ± 8.8)degrees. The lumbar CT and MRI images showed three-segment stenosis in 24 cases, four-segment stenosis in 17 cases, and five-segment stenosis in 5 cases. A total of 165 stenosed segments included 12 L1,2, 34 L2,3, 43 L3,4, 45 L4,5, and 31 L5 and S1. Visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness.

RESULTS: Thirteen patients had leakage of cerebrospinal fluid during operation, and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively, who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change, adequate drainage, debridement and suture. No death, paralysis, central nervous system infection, or other complication was observed in these patients. Forty-six cases were followed up 12-72 months (mean, 36.2 months). Lumbago and backache and intermittent claudication of lower extremity were obviously improved. During follow-up, no screw incising, loosening and broken screws, or pseudarthrosis was noted under X-ray film and CT scanning. At last follow-up, the lumbar Cobb angle was reduced to (9.8 ± 3.6) degrees, while the lumbar lordotic angle was increased to (34.1 ± 9.4) degrees, which were significantly improved when compared with preoperative ones (t = 16.935, P = 0.000; t = 15.233, P = 0.000). At last follow-up, VAS, ODI, and JOA scores were 3.2 ± 1.2, 35.5% ± 14.0%, and 26.6 ± 5.7 respectively, showing significant differences when compared with preoperative scores (8.0 ± 2.2, 60.8% ± 13.3%, and 12.9 ± 3.4) (t = 19.857, P = 0.000; t = 16.642, P = 0.000; t = 15.922, P = 0.000).

CONCLUSION: Multi-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms, rebuild spinal balance, and improve the life quality of the patients. It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.