BACKGROUND Currently, discectomy and posterior decompression combined with lumbar circumferential fusion (CF) have been accepted as a major procedure for severe lumbar spinal stenosis (LSS). However, studies on severe LSS without protruded intervertebral disc to minimize study bias are lacking. We aimed to investigate the effectiveness of sole posterior decompression with lumbar posterolateral fusion (PLF) and the necessity of discectomy and CF in patients with severe LSS without lumbar disc protrusion or prolapse. METHODS This retrospective cohort study included 153 severe LSS patients without lumbar disc protrusion or prolapse who were admitted in a tertiary spine center with at least a 2-year follow-up between January 2014 and August 2017. Patients were divided into the PLF (n = 77; those who underwent posterior decompression with PLF in 1-3 segments) or CF (n = 76; those who underwent posterior decompression and discectomy with CF in 1-3 segments) groups. Pedicle screw instrumentation was applied to avoid postoperative instability. Clinical outcomes were assessed by visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Score (JOA, lumbar pain score). Duration of operation, blood loss, surgical cost, and postoperative complications were analyzed. Height of intervertebral space, lumbar lordosis, and bone union were confirmed by lumbar radiography or computed tomography. RESULTS Both groups achieved significant improvement in JOA, ODI, and VAS compared with preoperative values (P < 0.001), but without significant difference between the two groups. Both groups achieved high fusion rate without difference and correction of lumbar lordosis and intervertebral space height (P < 0.001), especially in the CF group (P < 0.05). Duration of operation, blood loss, and operation cost were significantly higher in the CF group than in the PLF group (P < 0.001). Eight complications were found in both groups (1, PLF group; 7, CF group; P < 0.05). CONCLUSIONS After posterior decompression, PLF successfully achieves bony fusion and symptom relief with lower complication rate, lesser surgical blood loss, shorter operative time, and lesser cost than CF. Thus, sole posterior decompression with PLF is an effective treatment for severe LSS without lumbar disc protrusion or prolapse.

中文翻译：

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回顾性队列研究显示，后外侧融合结合后路减压在治疗严重的腰椎管狭窄症（无腰椎间盘突出或脱垂）方面显示出优越性。

背景技术目前，椎间盘切除术和后路减压联合腰围融合术已被认为是严重腰椎管狭窄症（LSS）的主要手术方法。然而，缺乏对不突出椎间盘以使研究偏倚最小化的严重LSS的研究尚缺乏。我们的目的是探讨腰椎后外侧融合术（PLF）单独进行后路减压的有效性，以及在没有腰椎间盘突出或脱垂的严重LSS患者中进行椎间盘切除术和CF的必要性。方法这项回顾性队列研究纳入了2014年1月至2017年8月在三级脊椎中心接受至少2年随访的153例没有腰间盘突出或脱垂的严重LSS患者。患者分为PLF（n = 77; 接受PLF 1-3段后路减压的患者）或CF（n = 76；接受CF 1-3段后路减压和椎间盘切除术的患者）组。应用椎弓根螺钉器械以避免术后不稳定。通过视觉模拟量表（VAS），Oswestry残疾指数（ODI）和日本骨科协会评分（JOA，腰痛评分）评估临床结局。分析手术时间，失血量，手术费用和术后并发症。腰椎X线摄影或计算机体层摄影术证实了椎间隙的高度，腰椎前凸和骨连接。结果与术前相比，两组患者的JOA，ODI和VAS均有显着改善（P <0.001），但两组之间无显着差异。两组的融合率均无差异，腰椎前凸和椎间隙高度也无差异（P <0.001），尤其是CF组（P <0.05）。CF组的手术时间，失血量和手术成本均明显高于PLF组（P <0.001）。两组均发现八种并发症（1，PLF组； 7，CF组； P <0.05）。结论后路减压后，PLF成功地实现了骨融合和症状缓解，并发症发生率更低，手术失血更少，手术时间更短，成本也比CF更低。因此，PLF单独进行后路减压是治疗严重LSS而不腰椎间盘突出或脱垂的有效方法。特别是在CF组（P <0.05）。CF组的手术时间，失血量和手术成本均明显高于PLF组（P <0.001）。两组均发现八种并发症（1，PLF组； 7，CF组； P <0.05）。结论后路减压后，PLF成功地实现了骨融合和症状缓解，并发症发生率更低，手术失血更少，手术时间更短，成本也比CF更低。因此，PLF单独进行后路减压是治疗严重LSS而不腰椎间盘突出或脱垂的有效方法。特别是在CF组（P <0.05）。CF组的手术时间，失血量和手术成本均明显高于PLF组（P <0.001）。两组均发现八种并发症（1，PLF组； 7，CF组； P <0.05）。结论后路减压后，PLF成功地实现了骨融合和症状缓解，并发症发生率更低，手术失血更少，手术时间更短，成本也比CF更低。因此，PLF单独进行后路减压是治疗严重LSS而不腰椎间盘突出或脱垂的有效方法。结论后路减压后，PLF成功地实现了骨融合和症状缓解，并发症发生率更低，手术失血更少，手术时间更短，成本也比CF更低。因此，PLF单独进行后路减压是治疗严重LSS而不腰椎间盘突出或脱垂的有效方法。结论后路减压后，PLF成功地实现了骨融合和症状缓解，并发症发生率更低，手术失血更少，手术时间更短，成本也比CF更低。因此，PLF单独进行后路减压是治疗严重LSS而不腰椎间盘突出或脱垂的有效方法。