Enlarged posterior column osteotomy plus intervertebral cage strutting as a exploratory surgery for lumbosacral Nerve bowstring disease: a retrospective retrospective study

Background: To explore the surgical outcome of enlarged posterior column osteotomy plus intervertebral cage strutting for patients with lumbosacral nerve bowstring disease. Methods: The clinical data of 27 patients with bowstring disease that surgically treated with Enlarged posterior column osteotomy plus intervertebral cage strutting from January 2018 to March 2021 were retrospectively reviewed. Patient demographics including age, gender, body mass index (BMI), duration, length of hospital stay, SF-36 were recorded. Surgical data including operation time, blood loss, surgical level, and complications were recorded. Inter-pedicle distance and regional lumbar lordosis was measured at lateral X-ray at both pre- and postoperative. Results: All patients underwent the operation successfully. Enlarged posterior column osteotomy plus intervertebral cage strutting was performed at L4-L5 in 9 patients, at L5-S1 in 7 patients, at L4-S1 in 6 patients, at L3-L5 in 5 patients. The mean operation time was 96.3±18.0 min, mean blood loss was 350.0±97.9 mL. Relaxation of thecal sac was noticed after pedicle screw-rod compression bilaterally. The mean decrease of inter-pedicle distance was 0.57±0.18 cm, the mean increase of regional lumbar lordosis was 17.6±6.7 degrees. Relaxation of cauda equina within the thecal sac was noticed at intra-operative after pedicle screw-rod compression bilaterally in all the patients. Most patients achieved neurological function improvement at two-year follow up. Conclusions: Enlarged posterior column osteotomy plus intervertebral cage strutting procedure is an effective surgical method for lumbosacral nerve bowstring disease through restoring the coordination between column and cord, visual relaxation of cauda equina within the thecal sac at intraoperative is the key factor in predicting the relief of neurological function at postoperative.