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Objective:To explore the factors related to lumbar degeneration, evaluate the outcome of surgical treatment and related factorsMethods:From August 2002 to December 2008,380 patients with lumbar degenerative disorders were treated surgically in Orthopaedic department of The 88th Hospital of PL A. Of them,276 patients were followed up completely and evaluated with Japan Orthopaedic Association (JOA) Score. Data of the 276 patients, including preoperative, postoperative and at follow up quantized documentation were input into computer, statistic analysis were performed with SPSS 13.0 software. The improvement rate of JOA score between preoperation and postoperation or the latest follow up for each patient was calculated. The patients were classified into subgroups based on the time of follow up, methods of surgical operation and age. Oneway variance analysis was conducted among the subgroups on each classification or grading. Selecting preoperative X ray grade as dependent variable and the other factors as independent variable, multiple stepwise linear regression analysis was done to explore the relation among preoperative X ray grade with the other factors. Similarly, selecting improvement rate of JOA score as dependent variable and the other factors as independent variable, multiple stepwise linear regression analysis was done to explore the relation among clinical outcome with the other factors.Results:Preoperative JOA score of the 276 patients was 15.14±3.10, in contrast, JOA score at follow up was 26.72±0.97, and the improvement rate of JOA score was 82.80%. There was significant difference between preoperative and postoperative JOA scores (t=-64.968, p<0.01). According to classification of the time of follow up, there was significant difference in total (F=5.685, P<0.01). Among them, group A (8 months to 2 years follow up) was remarkably different with the other groups (P<0.05). However, there were on difference between group D (more than 6 years follow up) and group B (2-4 years follow up), or group C (4-6 years follow up) (P>0.05). Based on classification of surgical methods, there was significant difference in total (F=3.135, P=0.026< 0.05). There was different between semilaminotomy group and internal fixation group. In contrast, there was on different among the other groups (P>0.05). On classification of the age, there was no different among the groups. In this study, the data showed the clinical features of lumbar degenerative disorders as follows, herniated lumbar disc occurred most commonly in L4/5 and L5/S1, and peak age of onset of illness was from 40 to 60 years.Imaging feature in the 276 patients before operation showed that there were significant degenerative changes in 219 patients in the anteroposterior X ray account for 79.34%,224 patients in the lateral X ray account for 81.16%, and 130 patients in the oblique X ray account for 47.10%. Of the 276 patients, 245 patients took CT scanning, account for 88.77%, and 23 patients took MRI account for 9.39%before operation. Fifty seven patients underwent pedicel screws fixation, therefore, anteroposterior and lateral X rays were taken postoperativly.Multiple stepwise linear regression analysis with dependent variable of preoperative X ray grade showed that labor intensity (B=1.167, P<0.01), age (B=0.031, P<0.01), body mass index (B=0.064, P＜0.01), course of the disease before operation (B=0.104, P<0.01) entered the regression equation (R=0.857,F=83.061, p<0.01).Multiple stepwise linear regression analysis with dependent variable of the improvement rate of JOA score showed that degree of straight-leg raising (B=0.081, P<0.01), muscular strength (B=0.051, P＜0.01), gait (B=0.015, P<0.01), preoperative JOA score (B=0.004, P＜0.01) and age (B=0.001, P＜0.01) entered the regression equation (R=0.732, F=28.350, p<0.01).Conclusion:1. There are significant relation between lumbar degeneration and labor intensity, age, body mass index.2. Imagining study is important tool for selecting surgical methods and estimating the prognose.3. Improvement rate of function after operation is positive related with degree of straight-leg raising, muscular strength, gait, JOA score before operation significantly, and negative related with age.4. JOA score is benefit tool to estimate surgical outcome and prognosis. It is helpful to clinician to make treatment decision based on evaluating the patient with JOA score.
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