Abstract
Aim: To compare between classic open surgeries and minimally invasive surgeries in Lumbar Spinal Stenosis. Methods: A comparative descriptive study, involved 117 patients suffering from lumbar canal stenosis, aged between 40 - 70 years; admitted to department of Neurosurgery from March 2011 till august 2016 in King Fahad Hospital in Saudi Arabia. Study groups are consisted of group A as patients managed with classical laminectomy, group B as patients managed with endoscopic spinal procedures and group C as patients managed with microscopic decompression facilitated by the Metrex Tubular System. SPSS was used in data entry and analysis, and ethical considerations taken into consideration and participants filled the required inform consents. Results: Age of particaoncet ranged from 45 - 63 years, Mean +/‒ 50. The degenerative canal stenosis with acute disc single level (cauda equina syndrome) was the most common type of lumbar canal stenosis encountered in group A; the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group B; while the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group C. Classic laminectomy and disectomy used mostly in group A; endoscopic unilateral decompression lamino-foraminotomy without discectomy used mostly in group B and bilateral microscopic laminectomy without discectomy followed by unilateral microscopic laminoforaminotomy without discectomy used mostly in group C. Mean of operation duration was the highest in both gender of group A, followed by group B, then group C. Unintended durotomy was the most common intra operative complications occurred in the whole study especially in group A. Mean of blood lost was the highest in both gender of group A, followed by group B, then group C. Postop complications in the patients of study groups were the highest in group A (33.3%), followed by group B (8.5%) and then group C (2%). Conclusion: Microscopic decompression facilitated by the Metrex Tubular System is the most effective technique of Surgery for Lumbar Spinal Stenosis and the least intra-operative and post-operative complications.
Highlights
Lumbar spinal stenosis (LSS) is a common and often disabling, well-recognized spinal disorder that generally occurs in the sixth or seventh decade of life, it can uncommonly occur in younger individuals
The degenerative canal stenosis with acute disc single level was the most common type of lumbar canal stenosis encountered in group A; the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group B; while the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group C
Our study showed that there was a significant improvement in patient status in the study group that underwent minimally invasive surgery, it was significant improvement in patient function of both endoscopic 97.8% and microscopic groups 100% and significant improvement of the patient self assisting score in the endoscopic group 14% in the last 3 months to 2.5 over 2 years of annual follow-up and in the microscopic group from 12% to 2.5% over the same period
Summary
Lumbar spinal stenosis (LSS) is a common and often disabling, well-recognized spinal disorder that generally occurs in the sixth or seventh decade of life, it can uncommonly occur in younger individuals. Degenerative LSS, including intervertebral disc bulge, ligamentum flavum hypertrophy/calcification, facet joint hypertrophy, causes neural compression in the vertebral canal, lateral recess, or intervertebral foramen, resulting in pain, impaired function, and decreased quality life [1]-[39]. Lumbar spinal stenosis or “loss of epidural reserve” could affect the central lumbar spinal canal ± lateral recess ± the neuro-foramen or any combination of these, causing nervous impingement and vascular structures compression [36] [40]-[75]. Lumbar canal stenosis is the disease of elderly patients which interfere with the quality of the life of those patients which cannot tolerate the pain and their function is impaired. Surgical treatment of LSS is recommended after failure of conservative medical therapy; the optimal procedure is still debated [45] [73] [74]
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