Outcome of Surgical Decompression in Simple Degenerative Lumbar Canal Stenosis

Introduction: A sensory or motor deficit occurs in about half of patients with symptomatic lumbar canal stenosis. There is no study evaluating neurologically deficient patients with simple degenerative lumbar canal stenosis using validated measures and there are no consensus about outcome predictor of surgical decompression is available in literature. Only one study assessed outcome of patients with neurological deficit but it had not excluded either patients with comorbid conditions that affect outcome or those with lumbar canal stenosis secondary to spondylolisthesis and scoliosis. The aim of this study was to assess overall result and to compare the surgically treated patients of simple degenerative lumbar canal stenosis using validated outcome measures like Oswestry Disability Scale (ODS), Neurogenic Claudication Score (NCS), Visual Analogue Scale (VAS) and Satisfaction, this study also aimed to find outcome predictor of surgical decompression. Methods: This was a retrospective comparative study with homogenous cohorts with control of comorbid conditions that affect outcome. Each cohort ( Those with neurological deficit and without neurological deficit) had 11 patients who had adequate decompression with laminectomy and foraminotomies. Outcome was evaluated using validated ODS, NCS, VAS and Satisfaction in overall and also evaluated by each section of ODS, NCS with appropriate statistical analysis of both cohorts. Results: Neurologically deficient patients had more back pain, tingling, numbness, weakness and heaviness preoperatively. In neurologically deficient patients there was a trend to have poorer outcome, but overall recovery rate was higher than neurologically normal patients. Sensory deficit did not recover. The index surgery may not have effect on sitting and sleeping in both cohorts and may not have effect on lifting in neurologically normal patients and may not have effect on social life in neurological deficient patients. Additionally the index surgery may not have effect in relieving symptoms of numbness, tingling and heaviness and weakness in neurologically normal patients and may not have effect on standing in both cohorts. Recovery according to VAS was higher in neurologically normal patients. Preoperative NCS and preoperative heaviness and weakness severity contributed up to 43 % in ODS recovery rate. Conclusion: Overall there is a trend to have poorer outcome in neurologically deficient patients though recovery rate is better than neurologically normal patients. Recovery in term of VAS is better in neurologically normal patients. Preoperative NCS and preoperative heaviness and weakness severity score predict or contribute up to 43 % in ODS recovery rate. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9512 NOAJ July-December 2013, Vol 3, Issue 2, 2-9

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Acute Neurological Deficit Due to Sacral Insufficiency Fracture With Coexistent Severe Lumbar Canal Stenosis: A Case Report

HSS Journal ® ◽

10.1177/15563316211006665 ◽

2021 ◽

pp. 155633162110066

Author(s):

Bhavuk Garg ◽

Nishank Mehta

Keyword(s):

Case Report ◽

Neurological Deficit ◽

Insufficiency Fracture ◽

Sacral Insufficiency Fracture ◽

Lumbar Canal Stenosis ◽

Canal Stenosis

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Results of posterior decompression with non-instrumented lumbar fusion surgery in cases of degenerative lumbar canal stenosis presenting with neurogenic claudication in a tertiary care hospital

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213200 ◽

2021 ◽

Author(s):

Maruti Bhujangrao Lingayat ◽

Ansari Muqtadeer Abdul Aziz ◽

Gaurav Balasaheb Mate ◽

Sourabh Sahebrao Dhamale

Keyword(s):

Lumbar Fusion ◽

Tertiary Care ◽

Long Term Results ◽

Neurogenic Claudication ◽

Care Hospital ◽

Instrumented Fusion ◽

Lumbar Canal Stenosis ◽

Vas Score ◽

Canal Stenosis ◽

The Masses

Background: Degenerative lumbar canal stenosis remains an important public health problem in today’s date. With the overall average age of the world’s population rising steadily it is important to have an optimal treatment plan affordable to the masses. Non-instrumented fusion after decompression remains an important treatment option which is affordable to the masses and effectively treats the instability occurring due to degeneration process. This study aims to understand the results of such treatment in a tertiary care center catering to the masses.Methods: The study was conducted in 34 patients with diagnosed degenerative lumbar canal stenosis with neurogenic claudication who underwent decompressive laminectomy with a posterolateral strut graft posterolateral fusion from July 2018 to August 2020. Each patient was followed up for 12 months.Results: In the present study, a total of 34 patients with degenerative lumbar canal stenosis with neurogenic claudication were included. There were 18 male and 16 female patients. The pre-operative Swiss spinal stenosis Score was 61-80 (52.9%) and these scores improved to a majority of patients in the category of 21-40 (82.4%) at 1 year postoperatively. The average VAS score was 4.7±1.8 preoperatively while the average post op VAS score was 0.8±0.77.Conclusions: Non-instrumented fusion of the vertebrae with decompression has significantly improved results at 1 year follow up postoperatively and it is an excellent easy and cost-effective technique if used in a properly selected patient. Further studies are required to assess its long-term results.

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Comparative study between functional outcome of lumbar canal stenosis treated with surgical decompression by laminectomy and unilateral partial hemi laminectomy approaches

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182733 ◽

2018 ◽

Vol 4 (4) ◽

pp. 610

Author(s):

K. Ramesh ◽

G. Vimalan

Keyword(s):

Japanese Orthopaedic Association ◽

Preoperative Assessment ◽

Japanese Orthopaedic Association Score ◽

Neurogenic Claudication ◽

Excellent Outcome ◽

Lumbar Canal Stenosis ◽

Canal Stenosis ◽

Surgical Options ◽

One Year ◽

Lumbar Spinal

Background: Lumbar spinal canal stenosis may eventually cause signs of intermittent neurogenic claudication. The surgical options include procedures such as midline decompression by laminectomy and different kinds of unilateral and bilateral fenestrations and partial or full hemi laminectomies. The aim of the study is to unilateral decompressive approach provides the sufficient decompression; less invasive unilateral procedure, which preserves posterior musculoligamentous complex and bony structures reduce associated morbidity.Methods: 41 patients underwent preoperative assessment of Japanese orthopaedic association score (JOA Score), Neurogenic claudication outcome scores (NCOS), visual analogy scale for back pain and neurogenic claudication. Patients were randomized to undergo either unilateral decompression by partial hemi laminectomy or CMD (CMD) by laminectomy. 20 patients was randomized into unilateral decompression by partial hemi laminectomy group and 21 patients into CMD (CMD) by laminectomy group.Results: The mean JOA recovery rate was 50.61% for the unilateral decompression group and 52.12% for the CMD group. Notably, 62% of CMD group had good or excellent outcome while 70% of unilateral decompression group had a good or excellent outcome.Conclusions: In our study, unilateral decompression by a partial hemi laminectomy provides minimal exposure for decompression in lumbar canal stenosis while preserving musculoligamentous attachments of the posterior elements of the spine and good postoperative results after one year with favorable outcomes of at least 70%.

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Degrees of Canal Stenosis, Levels of Interleukin-6 (IL-6) And C-Reactive Protein (CRP) Preoperative as Predictors of the Output of Neurogenic Claudication Outcome Score (NCOS) 8 Weeks Post-Decompression-Stabilization-Fusion in Degenerative Lumbar Spinal Stenosis Patients

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220120 ◽

2022 ◽

Vol 12 (1) ◽

pp. 137-146

Author(s):

Nyoman Gede Bimantara ◽

I Ketut Suyasa ◽

I Gede Eka Wiratnaya

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Neurogenic Claudication ◽

C Reactive Protein ◽

Degenerative Lumbar Spinal Stenosis ◽

Lumbar Canal Stenosis ◽

Reactive Protein ◽

Canal Stenosis ◽

Magnetic Resonance Imaging Mri ◽

Lumbar Spinal

Introduction: Lumbar Spinal Stenosis (LSS) or spinal stenosis is the most common spinal disease in elderly patients. LSS is also one of the leading causes of spinal surgery in the world. The problem that is often encountered is the limited predictor of outcomes that are considered affordable and accurate, so as to provide education to patients about possible output after the surgery process is carried out. Therefore, a predictor is needed that is considered accurate and affordable such as the degree of measurable canal stenosis of Magnetic resonance imaging (MRI), serum levels of C-Reactive Protein (CRP) and Interleukin-6 (IL-6) Method: This study used a prospective cohort design conducted to compare Neurogenic Claudication Outcome Score scores among people with degenerative lumbar canal stenosis whose post-decompression-stabilization-fusion had higher degrees of canal stenosis (measured through Schizas grading of Magnetic resonance Imaging/MRI) examinations), as well as high pre-operative CRP and IL-6 levels with those with normal CRP and IL-6 levels. From the population of lumbar spinal stenosis, the selection of samples was conducted consecutively sampling. After that, statistical tests in the form of descriptor tests, normality tests, risk factor assessments with 2x2 cross tabulation, and proportion comparison analysis using the Fisher Exact test. Result: Severe lumbar canal stenosis degrees resulted in worse NCOS 8 weeks postoperative than mild degrees of lumbar canal stenosis, with statistically significant differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High CRP levels resulted in worse NCOS 8 weeks postoperative than mild lumbar degrees of canal stenosis, with statistically significantly differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High pre-operative IL-6 levels resulted in worse NCOS 8 weeks postoperative than normal pre-operative IL-6 levels with statistically significantly differences (p=0.002; p < 0.05) and RR 8 (1.24-51.50). Conclusion: Degrees of preoperative (mild) canal stenosis, high pre-operative CRP levels, and high levels of pre-operative IL-6 were predictors for better 8-week NCOS scores in patients with post-decompression-stabilizing-fusion degenerative LSS disease. Key words: Degenerative lumbar spinal stenosis, IL-6, CRP, canal degree stenosis, NCOS.

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Decompression of lumbar canal stenosis with a bilateral interlaminar versus classic laminectomy technique: a prospective randomized study

Neurosurgical FOCUS ◽

10.3171/2019.2.focus18725 ◽

2019 ◽

Vol 46 (5) ◽

pp. E3 ◽

Cited By ~ 1

Author(s):

Mohamed A. R. Soliman ◽

Ahmed Ali

Keyword(s):

Statistical Significance ◽

Patient Comfort ◽

Leg Pain ◽

Neurogenic Claudication ◽

Low Back ◽

Lumbar Canal Stenosis ◽

Canal Stenosis ◽

Estimated Blood Loss ◽

Group 2 ◽

Group 1

OBJECTIVEThe aim of this study was to compare the radiological and clinical results of bilateral interlaminar canal decompression and classic laminectomy in lumbar canal stenosis (LCS).METHODSTwo hundred eighteen patients with LCS were randomized to surgical treatment with classic laminectomy (group 1) or bilateral interlaminar canal decompression (group 2). Low-back and leg pain were evaluated according to the visual analog scale (VAS) both preoperatively and postoperatively. Disability was evaluated according to the Oswestry Disability Index (ODI) preoperatively and at 1 month, 1 year, and 3 years postoperatively. Neurogenic claudication was evaluated using the Zurich Claudication Questionnaire (ZCQ) preoperatively and 1 year postoperatively. The two treatment groups were compared in terms of neurogenic claudication, estimated blood loss (EBL), and intra- and postoperative complications.RESULTSPostoperative low-back and leg pain declined as compared to the preoperative pain. Both groups had significant improvement in VAS, ODI, and ZCQ scores, and the improvements in ODI and back pain VAS scores were significantly better in group 2. The average EBL was 140 ml in group 2 compared to 260 ml in group 1. Nine patients in the laminectomy group developed postoperative instability requiring fusion compared to only 4 cases in the interlaminar group (p = 0.15). Complications frequency did not show any statistical significance between the two groups.CONCLUSIONSBilateral interlaminar decompression is an effective method that provides sufficient canal decompression with decreased instability in cases of LCS and increases patient comfort in the postoperative period.

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Spinal Sagittal Alignment Among Patients with Degenerative Lumbar Canal Stenosis

Galen Medical Journal ◽

10.31661/gmj.v10i0.2128 ◽

2021 ◽

Vol 10 ◽

pp. e2128

Author(s):

Mehdi Khaleghi ◽

Sina Abdollahzade ◽

Sanaz Jamshidi ◽

Nafiseh Rastgoo ◽

Reza Rouhani ◽

...

Keyword(s):

Sagittal Alignment ◽

Vertical Axis ◽

Neurogenic Claudication ◽

Sacral Slope ◽

Compensatory Mechanism ◽

Healthy Individuals ◽

Sagittal Vertical Axis ◽

Lumbar Canal Stenosis ◽

Canal Stenosis ◽

Spinal Sagittal Alignment

Background: Degenerative lumbar canal stenosis (DLS) is a common spinal pathology characterized by radicular pain and neurogenic claudication. Sagittal alignment and its indices have been affected in several spinal pathologies and may play a key role in surgical planning and outcome. In this case-control study, we aimed to assess sagittal alignment among patients with DLS compared to healthy individuals. Materials and Methods: Sixty patients DLS and 60 healthy volunteers were selected. Pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), pelvic incidence (PI), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were obtained in lateral standing X-ray radiographs. Results: Mean LL was lower in DLS patients (35.3±10.2) compared to normal controls (44.78±12.95), which was statistically significant (P <0.05). In contrast, there were no significant differences in PI, SVA, and SS between the groups. In patients with DLS, TK was lower, and PT was higher when compared to healthy individuals (P<0.05). Conclusion: Patients with DLS utilize decreased lordosis of the lumbar spine as a compensatory mechanism to decompress the thecal sac and spinal roots and improve their symptoms. Consequently, these patients recruit compensatory adjustments such as thoracic hyperkyphosis and increased PT to maintain sagittal alignment. [GMJ.2021;10:e2128]

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Correlation between symptoms and sagittal alignment parameters in patients with lumbar canal stenosis: a case-control study

Coluna/Columna ◽

10.1590/s1808-18512012000400011 ◽

2012 ◽

Vol 11 (4) ◽

pp. 302-309 ◽

Cited By ~ 3

Author(s):

Paulo Tadeu Maia Cavali ◽

Wagner Pasqualini ◽

Marcelo Ítalo Risso ◽

Guilherme Rebechi Zuiani ◽

João Batista de Miranda

Keyword(s):

Back Pain ◽

Pelvic Tilt ◽

Case Control Study ◽

Case Control ◽

Neurogenic Claudication ◽

X Rays ◽

Lumbar Canal Stenosis ◽

Canal Stenosis ◽

L1 And L2 ◽

Control Study

OBJECTIVE: To examine the relationship between sagittal balance parameters and different symptoms of spinal disease in patients with lumbar canal stenosis (LCS) and controls. METHODS: In this prospective, diagnostic, case-control study, we included all patients consecutively admitted to a public teaching hospital for surgical treatment of LCS between July 2010 and October 2011, aged more than 40 years, with back pain plus radiculopathy or neurogenic claudication, and controls without LCS. Magnetic resonance and x-rays allowed the measurement of sagittal axis parameters. Clinical data, the Oswestry Disability Index and the visual analogue scale of pain were assessed. RESULTS: 23 patients were in the Stenosis group, and 17 were controls. The Stenosis group presented lower values of total lumbopelvic lordosis and regional lordosis L1, L2 and L3. In LCS patients and back pain, total lumbopelvic and regional lordosis at L1, L2 and L3 were smaller. Those with stenosis and radiculopathy had higher values of pelvic tilt and lower total lumbopelvic lordosis and regional lordosis in L1 and L2. In patients with claudication, regional lumbopelvic lordosis in L1 and L2 and the T9 sagittal offset were smaller. All patients with pain had higher values of thoracic kyphosis, regional lumbopelvic lordosis in L1, lower values for pelvic tilt, sagittal T1 offset, sacro-femoral distance and overhang compared to patients without pain. CONCLUSIONS: This study shows significant correlations between symptoms and sagittal axis parameters between patients with and without spinal canal stenosis and also in subgroups of the patients with stenosis with different complaints.

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Relief of Lumbar Canal Stenosis Using Multilevel Subarticular Fenestrations as an Alternative to Wide Laminectomy: Preliminary Report

Neurosurgery ◽

10.1227/00006123-198811000-00014 ◽

1988 ◽

Vol 23 (5) ◽

pp. 628-633 ◽

Cited By ~ 105

Author(s):

Steven Young ◽

Richard Veerapen ◽

Sean A. O'Laoire

Keyword(s):

Hospital Stay ◽

Facet Joint ◽

Neurogenic Claudication ◽

Complete Relief ◽

Early Mobility ◽

Lumbar Canal Stenosis ◽

Canal Stenosis ◽

Spinous Processes ◽

The Mean

Abstract We describe an operative approach to lumbar canal stenosis which, unlike laminectomy, takes into account the segmental pathology of the disease. At each level involved, a bilateral subarticular fenestration is performed under high magnification. The medial third of each facet joint is first removed with an air-powered drill; then the remaining two-thirds of the joint is undercut with the drill to allow a generous fenestration in the thickened ligamentum flavum and adjacent laminae. All tissue responsible for neural compression is removed, but the spinous processes, interspinous ligaments, and much of the facet joints and laminae are preserved. Spinal stability is maintained and, because tissue disruption is minimized, postoperative discomfort is usually reduced, promoting early mobility and reduced hospital stay. The operation is described in detail, and the results of operation in 32 patients are assessed. The follow-up periods now range from 17 to 58 months. Of 23 patients who presented with neurogenic claudication, 14 (61%) obtained complete relief and 7 (30%) improved significantly. The mean hospital stay was 9 days (range, 4 to 17 days).

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