Clinical effect analysis of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF: a multicentre retrospective study  

Abstract Background To explore the clinical effect of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF.Methods A retrospective study was conducted on the clinical data of 142 patients with TOLF and laminectomy in the Spine surgery of the XXX Medical University from January 2003 to January 2018. According to whether the laminectomy was combined with instrumentation, the patients were divided into two groups: group A (laminectomy alone LA, n = 77) and group B (laminectomy with instrumentation LI, n = 65). Comparison possible influencing factors of demographic variables and operation-related variables between the two groups. In this study, the clinical effects of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF were discussed. Thus to explore the clinical effect of LA and LI in the treatment of TOLF.Results In terms of demographics, there was a statistically significant difference in BMI between group A and Group B (P < 0.05). The differences in Age, Sex, Smoking, Drinking, Heart disease, Hypertension and Diabetes were not statistically significant (P༞0.05). In terms of preoperative symptoms, there was significant difference in Gait disturbance, Pain in LE,Urination disorder between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). In terms of operation-related variables, there was significant difference in Preoperative duration of symptoms, Intramedullary signal change on MRI, Dural ossification, Residual rate of cross-sectional spinal canal area on CT, Shape on the sgittal MRI, Operation time, Pre-mJOA, Post-mJOA at 1 year,Leakage of cerebrospinal fluid between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). The preoperative average JOA score of group A was 6.37, and that of group B was 5.19. In group A, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.87, 8.23 and 8.26, respectively, and the average JOA score improvement rate was 32.79%, 38.32% and 38.53%, respectively. In group B, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.74, 8.15 and 8.29, respectively, and the average JOA score improvement rate was 39.15%, 46.86% and 47.12%, respectively.Conclusions Currently, there was no consensus on whether instrumentation is needed after laminectomy for TOLF. We found that for patients with long duration of Gait disturbance, Urination disorder, Preoperative duration of symptoms, Intramedullary signal change on MRI, Dural ossification, Residual rate of cross-sectional spinal canal area on CT less than 60%, Shape on the sgittal MRI as Beak and low Pre-mJOA had better clinical effect after LI than that LA, and the incidence of perioperative complications was lower.