Lumbar spine decompression with or without instrumentation in a limited resource setting

Abstract

Background: Lumbar degenerative spine disease is a leading cause of chronic low back pain and disability. Surgery is indicated to improve clinical condition when non operative measures fail. The objective of this study is to determine the outcome of lumbar spine decompression with or without instrumented fusion in the management of lumbar spine degenerative disease.Objectives: To determine the outcome of lumbar spine decompression with or without instrumented fusion in the management of lumbar spine degenerative disease.Patients and Methods: Study was retrospective in design and carried out at the Orthopedic Department of the National Orthopaedic Hospital, Lagos. Records of patients who had surgery for lumbar spine degenerative disease between 2007 and 2016 were retrieved. Variables of interest extracted included indication for surgery, type of surgery, complications, neurologic outcome, and length of follow-up. Descriptive and Chi-square analysis were done using SPSS version 16.0.Results: Eighty-eight patients had surgery of which sixty-five were analyzed. Duration of follow-up was 12–96 months (mean 31.7 ± 21.4 months). The age range was 32–75 years (mean 58 ± 9 years) with male:female ratio of 1:1.3. Fifty-three (81.5%) had improved pain relief, of which 7 (10.8%) had pain relapse at mean of 27.5 months post operative. Twenty-six (40%) had pre operative limb weakness of which 16/26 (61.5%) improved, 10/26 (38.5%) had no changes, while 2/26 (7.8%) had worse neurology after surgery. The complications included wound infection (7.7%), implant-related (6.2%) and dural tear (3.1%). Surgical technique (“decompression alone” vs “decompression and instrumented fusion”) and complications (none/any complication) are significantly associated with a likelihood ratio of P = 0.023. Reoperation rate was 7.7%.Conclusion: The addition of pedicle screw instrumented fusion does not seem to offer additional benefit with respect to long-term back pain and leg pain control; however, complication rate is notably higher.