The Results of Conventional Laminectomy for the Management of Degenerative Lumbar Canal Stenosis without Instability
DOI:
https://doi.org/10.21276/0ajptn05Keywords:
degenerative lumbar canal stenosis, neurogenic claudication, laminectomyAbstract
Introduction: The purpose of the present prospective clinical observational study is to evaluate the results of conventional laminectomy for the management of degenerative lumbar canal stenosis (DLCS) without instability.
Materials and Method: Forty eight patients who had symptomatic DLCS without instability were operated with laminectomy. The primary outcome measure was improvement in postoperative ODI and VAS score from preoperative baseline score. The secondary outcome measures were complication rate and reoperation rate.
Results: Forty eight patients, with average age of 64 years and male female ratio of 1:4, were followed up postoperatively for a minimum of 1 year. Single level stenosis was operated in 31%, two level in 50% and three level in 19% cases. The ODI significantly improved from preoperative mean score of 70.66% (SD 5.76) to postoperative mean score of 18.45% (SD 12.43) (p-value < 0.01) at 1 year. Also, the ODI significantly improved in patients having back pain. Similarly, VAS score for neurogenic claudication showed significant improvement with reduction of preoperative mean score of 8.31 (SD 1.06) to 1.7 (SD 1.32) (p-value < 0.01) at final followup. Complication rate was 14.58%. Commonest complication was dural tear (10.41%). The reoperation rate was 2.08%.
Conclusion: Our study showed significant improvement in patient reported outcome scores after decompressive laminectomy in patients with DLCS without instability. The study also observed that, in absence of instability, the outcomes of laminectomy in these patients are not adversely affected by preoperative symptom of back pain.
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References
Lee, S. Y., Kim, T. H., Oh, J. K., Lee, S. J., & Park, M. S. (2015). Lumbar Stenosis: A Recent Update by Review of Literature. Asian spine journal, 9(5), 818–828.
Machado, G. C., Ferreira, P. H., Yoo, R. I., Harris, I. A., Pinheiro, M. B., Koes, B. W., van Tulder, M. W., Rzewuska, M., Maher, C. G., & Ferreira, M. L. (2016). Surgical options for lumbar spinal stenosis. The Cochrane database of systematic reviews, 11(11), CD012421.
Grob, D., Humke, T., & Dvorak, J. (1995). Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. The Journal of bone and joint surgery. American volume, 77(7), 1036–1041.
Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A., Blood, E., Herkowitz, H., Cammisa, F., Albert, T., Boden, S. D., Hilibrand, A., Goldberg, H., Berven, S., & An, H. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14), 1329–1338.
Lee, G. Y., Lee, J. W., Choi, H. S., Oh, K. J., & Kang, H. S. (2011). A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal radiology, 40(8), 1033–1039.
Kirkaldy-Willis, W. H., Wedge, J. H., Yong-Hing, K., & Reilly, J. (1978). Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine, 3(4), 319–328.
Deyo, R. A., Ciol, M. A., Cherkin, D. C., Loeser, J. D., & Bigos, S. J. (1993). Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population. Spine, 18(11), 1463–1470.
Yong-Hing, K., & Kirkaldy-Willis, W. H. (1983). The pathophysiology of degenerative disease of the lumbar spine. The Orthopedic clinics of North America, 14(3), 491–504.
Rydevik, B., & Nordborg, C. (1980). Changes in nerve function and nerve fibre structure induced by acute, graded compression. Journal of neurology, neurosurgery, and psychiatry, 43(12), 1070–1082.
Sakamoto, Y., Nakamura, T., & Takagi, K. (2004). Functional and morphological changes of lumbar nerve roots induced by mechanical compression or the nucleus pulposus in contact with the root: analysis of fiber size-dependent vulnerability in rabbits. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 9(6), 598–604.
Rydevik, B., Brown, M. D., & Lundborg, G. (1984). Pathoanatomy and pathophysiology of nerve root compression. Spine, 9(1), 7–15.
Overdevest, G. M., Jacobs, W., Vleggeert-Lankamp, C., Thomé, C., Gunzburg, R., & Peul, W. (2015). Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. The Cochrane database of systematic reviews, (3), CD010036.
Hopp, E., & Tsou, P. M. (1988). Postdecompression lumbar instability. Clinical orthopaedics and related research, 227, 143–151.
Abumi, K., Panjabi, M. M., Kramer, K. M., Duranceau, J., Oxland, T., & Crisco, J. J. (1990). Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine, 15(11), 1142–1147.
Lorenz, M., Patwardhan, A., & Vanderby, R., Jr (1983). Load-bearing characteristics of lumbar facets in normal and surgically altered spinal segments. Spine, 8(2), 122–130.
Posner, I., White, A. A., 3rd, Edwards, W. T., & Hayes, W. C. (1982). A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine. Spine, 7(4), 374–389.
Rajasekaran, S., Thomas, A., Kanna, R. M., & Prasad Shetty, A. (2013). Lumbar spinous process splitting decompression provides equivalent outcomes to conventional midline decompression in degenerative lumbar canal stenosis: a prospective, randomized controlled study of 51 patients. Spine, 38(20), 1737–1743.
Jones, A. D., Wafai, A. M., & Easterbrook, A. L. (2014). Improvement in low back pain following spinal decompression: observational study of 119 patients. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 23(1), 135–141.
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