Abstract: Objective    To investigate the effect of multi-segmental spinal decompression combined with different fusion methods on bone graft fusion and stress response in patients with multi-segment lumbar spinal stenosis (LSS) combined with lumbar disc herniation (LDH).    Methods    A total of 85 patients with multi-segment LSS and LDH in our hospital from February 2017 to February 2019 were selected and divided into group A (n=43) and group B (n=42) according to different treatment plans. Group A was treated with multi-segment spinal canal decompression combined with internal fixation with bone grafting and fusion between transverse processes, and group B was treated with multi-segment spinal canal decompression combined with intervertebral bone grafting and fusion. The conditions of related indexes of operation and related indexes of serum stress response [angiotensin II (Ang II), renin (R), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6)] levels before operation, 1 d and 3 d after operation, complications, curative effects, and bone graft fusion were compared between the two groups, as well as the visual analogue scale (VAS) score, the Japanese Orthopaedic Association (JOA) score, and the dysfunction index (ODI) scores before operation, 1 week, 12 months and 24 months after operation.  Results  The operation time and hospitalization time of group A were shorter than those of group B, and the blood loss and hospitalization expenses during operation were lower than those of group B (P<0.05). The levels of serum AngⅡ, R, hs-CRP, and IL-6 at 1 and 3 days after operation in the two groups were higher than those in the group before operation (P<0.05). The above-mentioned serum index levels in group A were lower than those in group B on the 1st and 3rd day after operation (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). There was no statistically significant difference in the excellent and good rate of surgery and the rate of bone graft fusion between the two groups (P>0.05). The VAS scores and ODI scores of low back pain at 3 months, 12 months, and 24 months after operation in the two groups were lower than those of this group before surgery, and the JOA score was higher than that of this group before operation (P<0.05), but the difference between the groups was not statistically significant (P>0.05).    Conclusions   Multi-segment spinal canal decompression combined with intertransverse process bone grafting and internal fixation or intervertebral bone grafting and fusion are both affirmative surgical procedures for the treatment of multi-level LSS combined with LDH, and the clinical effect is satisfactory. The intertransverse process bone graft fusion and internal fixation has the advantages of less trauma, less bleeding, faster recovery, and low hospitalization costs. 

Key words: Multi-segment spinal canal decompression,  ,  , Intertransverse process bone graft fusion and internal fixation,  ,  , Intervertebral bone graft fusion,  ,  , Multi-segment,  ,  , Lumbar spinal stenosis,  ,  , Lumbar disc herniation, Bone graft fusion, Stress response