Degenerative Lumbar Canal Stenosis Research Articles

To validate and correlate radiologic grading of central and foraminal stenosis post-surgical decompression on degenerative lumbar canal stenosis

Background: Lumbar canal stenosis (LCS) is characterized as a narrowing of the canal diameter with age, which can lead to degenerative bone and soft-tissue changes. Aims and Objectives: The aim of the study is to validate the radiologic grading of central and foraminal through correlation with outcome after surgical decompression in degenerative LCS. Materials and Methods: A total of 23 patients with degenerative LCS who satisfied inclusion criteria and consented to participate in the study were selected and their Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain were recorded and their magnetic resonance imaging (MRI) was graded. Results: LCS is the reduction in the dimension of the central or lateral lumbar canal that occurs most frequently as a result of chronic degenerative changes at the lumbar motion segments. In our study, ODI has comparable improvement in all groups and it does not correlate with the severity of stenosis. However, VAS for leg pain has a greater prevalence in the shorter durations group (<60 months) which had an average of 8.0. If VAS for leg pain was more preoperatively, a better outcome was seen postoperatively. Conclusion: Decompression surgery for degenerative LCS shows significant improvement in ODI and VAS for back pain and leg pain irrespective of the severity of the stenosis by MRI grading or the severity of symptoms as assessed by VAS or ODI.

Interlaminar laminectomy/discectomy techniques and outcomes

ObjectiveUnilateral Biportal Endoscopic decompression via interlaminar approach is an evolving minimally invasive technique to decompress the neural structures from either due to degenerative lumbar canal stenosis or herniated disc. The current study aims to highlight technical aspects of this procedure for safe and better clinical outcomes. FindingsUnilateral Biportal Endoscopy via interlaminar approach provides an excellent magnified and illuminated surgical field to satisfactorily decompress not only ipsilateral but contralateral side also. Dural tear and epidural hematomas are known complications; however, the incidence is low. ConclusionUnilateral Biportal Endoscopic decompression via interlaminar approach can safely and effectively decompress neural elements without destabilizing spine.

Clinical, radiological, and functional evaluation of surgical treatment in degenerative lumbar canal stenosis

Background: Low-back pain (LBP) is extremely prevalent and is the one of the most common causes for people to seek medical attention. As life expectancy continue to increase, prevalence of symptomatic spinal stenosis will increase. Although lumbar stenosis is not life-threatening, it can cause chronic and sustained pain and can limit activity severely. Early, accurate diagnosis, and treatment of lumbar stenosis is important in preserving activity in elderly population. Aims and Objectives: The study was conducted to find the incidence of degenerative lumbar canal stenosis (LCS) among patients of LBP, to evaluate clinicoradiological profile and to evaluate the outcome and complications in the surgically treated patients of degenerative LCS. Materials and Methods: This prospective study included all patients admitted with LCS under department of neurosurgery, GR medical college and associated J.A. group of Hospitals from December 2021 to December 2022 who underwent surgery. No randomization done. Results: Out of total 48 patients, 58% were males while 42% were females, 62.5% of patients were of more than 40 years of age, all patients were having LBP and 64.5% of patients were having LBP for the past 1 year. After surgical management, 87.5% of patients shows improvement in symptoms in Oswestry disability index and Visual analog scale scales. Conclusion: Overall good surgical outcome is obtained and better surgical results in degenerative LCS compared to other studies. Patients with degenerative LCS presenting with back pain and associated neurological deficit are successfully managed with surgical treatment in this study.

Surgical outcome of “Neurogenic claudication and walking limitation” due to degenerative Lumbar spinal canal stenosis

Objectives: This study aimed to evaluate the efficacy of surgical decompression of the lumbar spinal canal, a procedure involving the removal of ligamentum and other degenerated elements causing pressure on the thecal sac, nerve roots, and neurovascular structures. The procedure is considered essential for patients experiencing neurogenic claudication, low back pain, lower limb pain and paresthesia, and decreased walking performance, to effectively decompress the lumbar canal.
 Methods: A retrospective analysis was conducted on patients who underwent surgical decompression at Shar hospital between 2018 and 2020. A total of 57 eligible patients were followed up to assess the outcomes related to neurogenic claudication and walking ability after 12-24 months postoperatively.
 Results: The postoperative results for neurogenic claudication and walking ability were found to be satisfactory in nearly three-quarters of the cases. The duration of symptoms significantly influenced the results, while factors such as gender, body mass index, smoking history, the number of stenosed levels operated, and the type of stenosis did not show significant impact.
 Conclusion: Surgical decompression for degenerative lumbar canal stenosis is a relatively low-risk procedure with a very high rate of postoperative patient satisfaction regarding neurogenic claudication and improved walking distance. These positive outcomes are particularly evident when the procedure is performed promptly, by an experienced surgeon, and with appropriate patient selection.

Differences in preoperative clinical symptoms and radiological findings of degenerative lumbar spondylolisthesis and lumbar canal stenosis

ObjectiveSome reports have referred to differences in preoperative symptoms and radiological findings between lumbar degenerative spondylolisthesis (DS) and lumbar spinal canal stenosis (LCS), while others have reported no differences. We investigated the differences of preoperative clinical and radiological findings between the DS group and LCS group.Methods: We retrospectively reviewed 32 patients in the DS group and 24 patients in the LCS group with regard to preoperative clinical symptoms, dural sac area and spinopelvic parameters.Results: The mean dural sac area of the DS group (40.4 ± 18.7 mm2) was significantly narrower than that of the LCS group (56.0 ± 24.0 mm2) (p = 0.008). As for the spinopelvic parameters, the PI was significantly greater in the DS group with 56.6 ± 11.8° compared to 47.4 ± 11.4° in the LCS group (p = 0.005), and the LL was also significantly different with 45.8 ± 13.8° and 37.1 ± 14.0° respectively (p = 0.023). Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ) scores for walking ability was significantly impaired in the DS group compared to the LCS group (p = 0.025).Conclusion. The DS group had a significantly smaller dural sac area than the LCS group, while PI and LL were significantly larger and walking ability was significantly impaired.

Surgical outcome of lower limbs radiculopathy “due to degenerative lumbar canal stenosis” 12-24 months after decompression

Objectives: Interlaminar decompression is a surgical procedure that decompresses the lumbar spinal canal in order to release neuro-vascular components that have been compromised by degenerative stenosis. It can significantly improve patient quality of life and reduce morbidity and the effects of lumbar canal stenosis.
 Methods: A retrospective study of 57 patients, surgically operated for degenerative lumbar canal stenosis, at the Sulaymaniyah teaching hospital between Mar. 2018 and Mar. 2020.
 Diagnosis was achieved via history and clinical examination and radiological imaging (Lumbo-sacral spine MRI). Surgical procedure was standardized for all patients that was interlaminar decompression of the lumbar spinal canal, the postoperative follow up was after 12-24 months.
 Results: In total, 57 patients with degenerative lumbar canal stenosis (due to ligamentum flavum hypertrophy) were included, male (26%) and female (74%), age of the cases were between 34 – 85 years, mean 57.39 and median 57 and standard deviation 10.96, there were no deference in the outcome of different ages and genders.
 chief complain of patients were back pain and both lower limbs radiculopathy in the majority of the cases, associated with paresthesia and numbness of the lower limbs, which were improved modestly after surgical decompression.
 Conclusion: Interlaminar decompression of the stenosed lumbar spinal canal is an effective and generally safe surgical procedure with high patient satisfaction and good functional outcomes expected.

Comparative study between microscopic bilateral decompression via unilateral approach and standard total laminectomy for treatment of degenerative lumbar canal stenosis

Comparative study between microscopic bilateral decompression via unilateral approach and standard total laminectomy for treatment of degenerative lumbar canal stenosis

Comparative study between microscopic bilateral decompression via unilateral approach and classic laminectomy for treatment of degenerative lumbar canal stenosis

Comparative study between microscopic bilateral decompression via unilateral approach and classic laminectomy for treatment of degenerative lumbar canal stenosis

Full Endoscopic Lumbar Stenosis Decompression: A Future Gold Standard in Managing Degenerative Lumbar Canal Stenosis.

Until recently, open decompression was considered the gold standard for the management of spinal stenosis, but the evolution of minimally invasive spine instruments has brought a new dimension to the management of spinal stenosis. Full endoscopic surgery has a lot of advantages in terms of minimal soft tissue damage, less bleeding, shorter hospital length of stay, and earlier return to work. Our aim was to evaluate the efficacy of full endoscopic lumbar decompression for degenerative lumbar canal stenosis compared with classic open decompression surgery. This is a retrospective cohort study of degenerative lumbar spinal stenosis without instability, consisting of 132 open decompression and 163 full endoscopic decompression patients. We evaluated the clinical result of the pre- and postoperative visual analog scale (VAS) of leg pain, back pain, and Oswestry Disability Index (ODI). We observed the patients until 1 year after the operation. The postoperative ODI scores and VAS scores for back pain and leg pain were better than the preoperative scores. The ODI scores and VAS scores for leg pain were significantly better in both groups (P = 0.033 and 0.04, respectively). The main difference between open and full endoscopic decompression was the VAS back pain and amount of bleeding. In the full endoscopic group, the mean VAS back pain was 1.6 and the amount of bleeding was minimal. In the open decompression surgery, the mean VAS back pain was 3.5 and the amount of bleeding was around 84 mL. The length of hospital stay was shorter in the full endoscopic group, which was 1.5 days compared with 3.4 days in open decompression (P = 0.034). Full endoscopic decompression showed better early results compared with the conventional group, but a long-term study is still needed for further evaluation of the clinical results. The use of the full endoscopic technique is very promising in the management of spinal stenosis. This study provides a comparison of the efficacy of open decompression and full endoscopic decompression in degenerative lumbar canal stenosis.

Effects of Expression of Matrix Metalloproteinases and Discoidin Domain Receptors in Ligamentum Flavum Fibrosis in Patients with Degenerative Lumbar Canal Stenosis.

This is a retrospective cohort study. This study aimed to clarify the role of crosstalk between discoidin domain receptors (DDRs) and matrix metalloproteinases (MMPs) in the ligamentum flavum (LF) fibrosis obtained from patients with degenerative lumbar canal stenosis (DLCS). The DDRs, DDR1 and DDR2, are cell surface receptors and have an essential role in collagen fiber accumulation in several fibrotic diseases. MMPs are one of the critical factors in extracellular matrix remodeling and elastic fiber degradation in LF tissues. However, the crosstalk between DDRs and MMPs and the role of this molecular signal in LF fibrosis remain unclear. A total of 35 patients were divided into two groups in this study. Spinal surgery was performed in 23 of these patients with the diagnosis of DLCS. Twelve patients with lumbar disk herniation (LDH) were included in the control group. On axial T2-weighted magnetic resonance imaging, LF thickness was measured bilaterally at the level of the facet joint. Histology, quantitative real-time polymerase chain reaction (qRT-PCR), and Western blot analyses were performed on LF tissue samples. LF tissues were stained with hematoxylin and eosin. In addition, the grade of fibrosis was histologically assessed using Masson trichrome triple staining. DDR1 and DDR2 Western blot analyses were performed. DDR1, DDR2, MMP2, MMP3, MMP9, and MMP13 expression levels were measured using qRT-PCR analysis. The grade of fibrosis and LF thickness were significantly higher in the DLCS patients than in the LDH patients. DDR1 and DDR2 gene expression and protein levels in LF tissues are significantly greater in DLCS samples than in control samples, according to both qRT-PCR and Western blot analyses. In addition, we detected a significant expression of the MMP3, MMP9, and MMP13, which are known to have important roles in extracellular matrix remodeling in DLCS. Furthermore, we discovered a link between DDR protein levels and LF thickness, fibrosis, and MMP3/MMP9. Our results indicate that DDR1, DDR2, and MMP3 and MMP9 signals can be correlated with each other in LF tissues and be promoted LF fibrosis leading to spinal canal narrowing in patients with DLCS.

Histological difference in ligament flavum between degenerative lumbar canal stenosis and non-stenotic group: A prospective, comparative study.

BACKGROUNDLigament flavum (LF) hypertropy is the main etiopathogenesis of lumbar canal stenosis (LCS). The purely elastic LF undergoes a morphological adaptation including a reduction in the elastic fibers and a consequent increase in the collagen content, fibrosis, cicatrization, and calcification. However, the morphometric analysis can delineate the LF in patients with LCS from those without LCS, which would help in better understanding LCS pathogenesis.AIMTo compare the histopathological changes in LF between the degenerative LCS and non-stenotic (non-LCS) group.METHODSThe present prospective study was conducted in 82 patients who were divided into two groups, namely LCS and non-LCS. Demographic details of the patients such as duration of symptoms, level of involvement, and number of segments were recorded. The LF obtained from both groups was histopathologically examined for the fibrosis score, elastic fiber degeneration, calcification, and chondroid metaplasia. Morphometrical details included a change in elastin and collagen percentages, elastin/collagen ratio, elastic fiber fragmentation, and ligamentocyte numbers. All parameters were compared between the two groups by using the independent t test, Chi-square test, and Pearson’s correlation test.RESULTSOut of 82 cases, 74 were analysed, 34 in LCS and 40 in non-LCS group. The mean ± SD age of presentation in LCS and non- LCS group was 49.2 ± 8.9 and 43.1 ± 14.3 respectively. The LCS group (n = 34) exhibited significant differences in fibrosis (P = 0.002), elastic fiber degeneration (P = 0.01), % elastic fragmentation (66.5 ± 16.3 vs 29.5 ± 16.9), % elastic, content (26.9 ± 6.7 vs 34.7 ± 8.4), % collagen content (63.6 ± 10.4 vs 54.9 ± 6.4), reduction of elastic/collagen (0.4 ± 0.1 vs 0.6 ± 0.1), and ligamentocyte number (39.1 ± 19.1 vs 53.5 ± 26.9) as compared to non-LCS group (n = 40). The calcification (P = 0.08) and Pearson’s correlation between duration and loss of elastin was not significant. The difference in LF morphology is consistent in patient’s ≥ 40 years of age among the groups as found in subgroup analysis. Similarly in the patents < 40 and > 40 in the non-LCS group.CONCLUSIONLF is vital in the pathogenesis of LCS. The purely elastic LF undergoes a morphological adaptation that includes a reduction in the elastic fibers with a consequent increase in the collagen content, fibrosis, cicatrization, and calcification. The present study provides a detailed morphometric analysis to semiquantitatively delineate the LF changes in patients with LCS from those in patients without LCS.

Outcome of Decompression with Transpedicular Screw Fixation and posterolateral fusion in Stable Degenerative Lower Lumbar Canal Stenosis

Outcome of Decompression with Transpedicular Screw Fixation and posterolateral fusion in Stable Degenerative Lower Lumbar Canal Stenosis

Intraoperative CT-guided navigation versus fluoroscopy for percutaneous pedicle screw placement in 192 patients: a comparative analysis

BackgroundPercutaneous pedicle screw (PPS) placement is a key step in several minimally invasive spinal surgery (MISS) procedures. Traditional technique for PPS makes use of C-arm fluoroscopy assistance (FA). More recently, newer intraoperative imaging techniques have been developed for PPS, including CT-guided navigation (CTNav). The aim of this study was to compare FA and CTNav techniques for PPS with regard to accuracy, complications, and radiation dosage.Materials and methodsA total of 192 patients with degenerative lumbar spondylolisthesis and canal stenosis who underwent MISS posterior fusion ± interbody fusion through transforaminal approach (TLIF) were retrospectively reviewed. Pedicle screws were placed percutaneously using either standard C-arm fluoroscopy guidance (FA group) or CT navigation (CTNav group). Intraoperative effective dose (ED, mSv) was measured. Screw placement accuracy was assessed postoperatively on a CT scan using Gertzbein and Robbins classification (grades A–E). Oswestry disability index (ODI) and visual analog scale (VAS) scores were compared in both groups before and after surgery.ResultsA total of 101 and 91 procedures were performed with FA (FA group) and CTNav approach (CTNav group), respectively. Median age was 61 years in both groups, and the most commonly treated level was L4–L5. Median ED received from patients was 1.504 mSv (0.494–4.406) in FA technique and 21.130 mSv (10.840–30.390) in CTNav approach (p < 0.001). Percentage of grade A and B screws was significantly higher for the CTNav group (96.4% versus 92%, p < 0.001), whereas there were 16 grade E screws in the FA group and 0 grade E screws in the CTNav group (p < 0.001). A total of seven and five complications were reported in the FA and CTNav group, respectively (p = 0.771).ConclusionsCTNav technique increases accuracy of pedicle screw placement compared with FA technique without affecting operative time. Nevertheless, no significant difference was noted in terms of reoperation rate due to screw malpositioning between CTNav and FA techniques. Radiation exposure of patients was significantly higher with CTNav technique.Level of Evidence: Level 3.

35. Effect of surgical intervention on gait function in patients with symptomatic lumbar canal stenosis

<h3>BACKGROUND CONTEXT</h3> Gait impairment is one of the primary symptoms of degenerative lumbar canal stenosis (LCS), yet it is poorly understood due to a lack of quantitative data on kinematics and kinetics during the gait. Gait analysis is a well-established tool for the quantitative assessment of gait disturbances, providing a functional diagnosis, assessing treatment plan and monitoring of disease progress. <h3>PURPOSE</h3> To analyze the effect of decompression surgery on gait characteristics in patients with LCS. <h3>STUDY DESIGN/SETTING</h3> Prospective non-randomized comparative study at a teaching hospital. <h3>PATIENT SAMPLE</h3> Eighteen patients with symptomatic LCS and 18 healthy volunteers. <h3>OUTCOME MEASURES</h3> Gait quality: spatiotemporal, kinetic and kinematic parameters functional outcome: ODI, VAS. <h3>METHODS</h3> Eighteen patients with single-level LCS and 18 healthy volunteers were prospectively recruited. All the patients with symptomatic LCS underwent TLIF (transforaminal lumbar interbody fusion) surgery. Gait analysis was perfomed preoperatively and six months postoperatively as per standard protocol. The spatiotemporal, kinematic and kinetic parameters were analyzed. The Kolmogorov-Smirnov test and coefficient of skewness and kurtosis was used to assess the normality of distribution. Pre- and postoperative clinical outcomes, spatial-temporal, kinetic and kinematic data were compared with the paired t-test or Wilcoxon signed-rank test according to the normality of the distribution. Unpaired t-test was used to compare the two groups. Stepwise linear regression models were used to detect significant relationships between changes in ODI and VAS score, and parameters describing gait function. <h3>RESULTS</h3> Significant improvement was noted in ODI (p < 0.05) and VAS scores (p < 0.05) six months post-surgery. Spatiotemporal (Stride time [p=0.01], Swing phase % [p=0.01], Double support phase % [p=0.02], Mean velocity [p < 0.01], Cadence [p < 0.01], Stride length [p < 0.01], Step length [p < 0.01] and step width [p < 0.01])and kinetic parameters (peak hip [p < 0.01], knee [p < 0.01] and ankle power [p < 0.01], vertical GRF [p=0.01]) were significantly better following surgery, reaching normal levels when compared to healthy individuals. The kinematic parameters (trunk tilt [p=0.02], peak hip extension [p < 0.01], peak knee flexion in stance [p=0.01] and swing phase [p < 0.01], peak ankle dorsiflexion in stance [p < 0.01] and swing phase [p=0.04], GPS [p < 0.01] and GDI [p < 0.01]) were significantly improved following surgery but did not reach normal levels when compared to controls. A significant correlation was found between change in ODI and VAS score with change in certain kinematic parameters (knee power, stance time, ankle plantarflexion, peak ankle dorsiflexion moment, GDI, swing time, peak ankle dorsiflexion in swing, peak hip and knee flexor moment). <h3>CONCLUSIONS</h3> Decompression surgery in LCS produces improvement in gait parameters, pain scores, and functional outcome that significantly improves walking tolerance and speed. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The Effect of Topical Tranexamic Acid on Intraoperative Blood Loss in Patients Undergoing Posterior Lumbar Laminectomy and Discectomy: A Randomized, Double-Blind, Controlled Trial Study.

Randomized, double-blind, controlled trial study. This study aimed to evaluate the safety and efficacy of topical tranexamic acid (TXA) on intraoperative blood loss (IBL) in patients that have degenerative lumbar canal stenosis and undergo posterior lumbar laminectomy and discectomy. The volume of IBL is directly proportional to potential surgical complications. Recent reports have shown that the topical use of antifibrinolytic drugs, such as TXA, during surgery might decrease IBL and improve patient outcomes. A total of 104 patients with lumbar canal stenosis were enrolled in this randomized, double blinded clinical trial. Participants were randomized and divided into two groups: TXA (54 cases) and control (50 cases). In the TXA group, a TXA solution was used for washing and soaking, whereas, in the control group, irrigation of wound was with normal saline. IBL, pre- and postoperative coagulative studies, operation time, conventional hemostatic agent usage, systemic complications, and length of hospitalization were consecutively recorded. All participants were followed for an additional two months to gather data on their recovery status and time to return to work (RTW). At baseline, there was no difference in clinical or lab findings, between the groups. IBL and use of hemostatic agents were significantly decreased in TXA group, as compared to the control group (p=0.001 and p=0.011, respectively). Systemic complications, length of hospitalization, and RTW were not significantly different between groups (p=0.47, p=0.38, and p=0.08, respectively). This study showed that topical use of TXA during surgery may decrease IBL and minimize the use of hemostatic materials during posterior midline-approach laminectomy and discectomy, without increasing the potential for complications seen with intravenous TXA usage.

Operative outcomes of decompression in degenerative lumbar canal stenosis

Background: Spinal canal stenosis is a condition in which the spinal cord and the nerve roots are compressed by a number of pathologic factors, leading to symptoms such as pain, numbness, and weakness. This study was undertaken to evaluate clinical, functional and radiological outcomes of surgical decompression in spinal canal stenosis. Material and Method: We have included 26 adult patients with lumbar spinal canal stenosis in this prospective study who have not improved after conservative management for minimum of 6 weeks. All the patients underwent standard open decompression using a posterior midline approach. Patients were followed up at 6 weeks, 3 months, 6 months, and 1 year, they were assessed clinically and functionally using the VAS score and ODI score. Results: In this study total of 26 patients, out of which, 14(54%) were females and 12(46%) were males, with an average age of 58.08 years. VAS of back pain improved from 2.85 on admission to 1.08 on final follow-up and leg pain form 8.00 on admission to 1.73 on final follow-up and ODI from 63.69 on admission to 14.54 on final follow-up. Conclusion: Decompression surgery is the gold standard treatment for central or lateral recess lumbar stenosis when conservative treatment fails as it provides significant clinical as well as functional improvement in terms of VAS score and Oswestry Disability Index.

A Review of Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Canal Stenosis.

The unilateral biportal endoscopic (UBE) technique provides minimally invasive decompression for degenerative lumbar canal stenosis (DLCS). With appropriate control of the hydrostatic pressure of normal saline irrigation, the surgery can be performed in a clear and magnified surgical field through 2 small surgical wounds. A review of published literature in PubMed was performed to identify studies of UBE decompression for DLCS. The outcome measures include operation time, length of hospital stay, estimated blood loss, visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and the Macnab criteria. A total of 76 relevant studies were retrieved through the PubMed search. After screening, 15 studies comprising 6 case series, 6 comparative studies, and 3 randomized controlled trials were included in this review. Significant improvements in pain and neurological symptoms were obtained in all studies. In the 6 case series studies, the outcome measures were extracted from each study and summarized. The follow-up periods ranged from 8.6 to 29 months. The operation time was 72.0 min. The VAS score for leg pain was reduced from 7.8 to 1.7, and the VAS score for back pain was reduced from 5.8 to 1.7. The ODI was reduced from 63.0 to 20.7, and 87.3% of patients reported good to excellent outcomes according to the Macnab criteria. The complication rates ranged from 5.5% to 13.8%, with dural tear having the highest incidence rate. In the comparative studies and randomized controlled trials examining the UBE, microscopic, microendoscopic, and uniportal endoscopic techniques, the UBE technique showed treatment results that were comparable with the others. Compared with the microscopic technique, the UBE technique resulted in significantly less tissue trauma and quicker recovery with less wound pain, lower serum creatine kinase and C-reactive protein levels, and lower ODI in the very early postoperative period. The UBE technique also provided adequate decompression with less facet joint destruction than all the other decompression techniques. The UBE technique is safe and effective for decompression of DLCS. Along with its efficacy in decompression, this technique is capable of preserving segmental stability. However, a long-term comparative study is required to verify this hypothesis.

A PROSPECTIVE STUDY TO EVALUATE THE FUNCTIONAL OUTCOME OF NON- INSTRUMENTED LUMBAR DECOMPRERSSION IN ADULT DEGENERATIVE LUMBAR CANAL STENOSIS [LCS] AND DETERMINE PREDICTIVE FACTORS OF FAVOURABLE OUTCOME

AIM AND OBJECTIVES: A prospective study to evaluate the functional outcome of non- instrumented lumbar decompression in adult degenerative lumbar canal stenosis [LCS] and determine predictive factors of favourable outcome. Study details: Patients attending Orthopedic OPD at BARC Hospital, Mumbai, who were operated for adult degerative LCS from June 2017 to May 2019. CONCLUSION: The VAS and Beaujon score were stasistically significant when compared to preoperative and 3 months post operatively

Spinal Sagittal Alignment Among Patients with Degenerative Lumbar Canal Stenosis

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 &lt;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&lt;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]

Spinal Sagittal Alignment Among Patients with Degenerative Lumbar Canal Stenosis

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 &lt;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&lt;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]