Abstract
BackgroundCurrently, discectomy and posterior decompression combined with lumbar circumferential fusion (CF) have been accepted as a major procedure for severe lumbar spinal stenosis (LSS). However, studies on severe LSS without protruded intervertebral disc to minimize study bias are lacking. We aimed to investigate the effectiveness of sole posterior decompression with lumbar posterolateral fusion (PLF) and the necessity of discectomy and CF in patients with severe LSS without lumbar disc protrusion or prolapse.MethodsThis retrospective cohort study included 153 severe LSS patients without lumbar disc protrusion or prolapse who were admitted in a tertiary spine center with at least a 2-year follow-up between January 2014 and August 2017. Patients were divided into the PLF (n = 77; those who underwent posterior decompression with PLF in 1–3 segments) or CF (n = 76; those who underwent posterior decompression and discectomy with CF in 1–3 segments) groups. Pedicle screw instrumentation was applied to avoid postoperative instability. Clinical outcomes were assessed by visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Score (JOA, lumbar pain score). Duration of operation, blood loss, surgical cost, and postoperative complications were analyzed. Height of intervertebral space, lumbar lordosis, and bone union were confirmed by lumbar radiography or computed tomography.ResultsBoth groups achieved significant improvement in JOA, ODI, and VAS compared with preoperative values (P < 0.001), but without significant difference between the two groups. Both groups achieved high fusion rate without difference and correction of lumbar lordosis and intervertebral space height (P < 0.001), especially in the CF group (P < 0.05). Duration of operation, blood loss, and operation cost were significantly higher in the CF group than in the PLF group (P < 0.001). Eight complications were found in both groups (1, PLF group; 7, CF group; P < 0.05).ConclusionsAfter posterior decompression, PLF successfully achieves bony fusion and symptom relief with lower complication rate, lesser surgical blood loss, shorter operative time, and lesser cost than CF. Thus, sole posterior decompression with PLF is an effective treatment for severe LSS without lumbar disc protrusion or prolapse.
Highlights
Discectomy and posterior decompression combined with lumbar circumferential fusion (CF) have been accepted as a major procedure for severe lumbar spinal stenosis (LSS)
Our findings revealed that after posterior decompression, posterolateral fusion (PLF) successfully achieves bony fusion and symptom relief with lower complication rate, lesser surgical blood loss, shorter operative time, and lesser cost than CF, indicating that sole posterior decompression with PLF is an effective treatment for severe LSS without lumbar disc protrusion or prolapse
In this study, both groups achieved satisfactory back and lower limb pain relief, without no statistical difference, which confirms that sole posterior decompression and PLF is an effective strategy for severe LSS without intervertebral disc protrusion
Summary
Discectomy and posterior decompression combined with lumbar circumferential fusion (CF) have been accepted as a major procedure for severe lumbar spinal stenosis (LSS). Lumbar spinal stenosis (LSS) is a degenerative condition in which changes in the disc, ligamentum flavum, and facet joints along with aging cause narrowing of the spinal canal, producing symptoms of pain in the legs and back, as well as impair ambulation and other disabilities, and it is a common finding in an aging or degenerative spine. Accompanying intervertebral space, height loss, stress, and mobility of the facet joints increase. These pathological processes lead to thickening of the ligamentum flavum, osteophyte formation, and hypertrophy of facet joints [1,2,3], causing central canal and lateral recess stenosis, resulting in compression of neural elements and a series of syndromes. More than 75% of unilateral or bilateral facetectomy can cause iatrogenic instability to the lumbar spine [6,7,8,9]; supplement with lumbar fusion and pedicel screw fixation is necessary for minimizing the potential risk of future instability and deformity
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