Lumbar Canal Stenosis Research Articles

Clinical and Radiological Outcome following MIS-TLIF and Open-TLIF between Asian and African Population- A Comparative Retrospective Analysis in 104 Patients

Purpose: This study aimed to evaluate pre-operative and post-operative sagittal parameters using pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis (SL) between Asian and African population who underwent minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) and open-TLIF surgeries. Study compares blood loss, operative time, and hospital stay; and evaluates disability and pain by Oswestry disability index (ODI) and visual analog scale (VAS) score, respectively, in both groups. Methods: This retrospective study included 104 patients with an average age of 52.1 ± 12.9 years. All were operated for open-TLIF and MIS-TLIF for one- or two-level lumbar canal stenosis or spondylolisthesis. Patients were divided into two groups according to race: Asian and African. Clinical improvements were evaluated using VAS and ODI scores. Modified MacNab’s criteria were used to evaluate outcome. Estimated blood loss, hospital stay, operative time, perioperative morbidity, and complications were reviewed. On radiological parameters, patients’ LL, PI, and SL were compared between two groups. Results: Average follow-up was 40.6 ± 13.9 months. Both groups showed significant post-operative improvement in their VAS and ODI scores in both open- and MIS-TLIF (P < 0.0001); however, comparing clinical improvement between Asian and African groups, it did not show significant difference in VAS (P = 0.103) and ODI (P = 0.077). Both groups showed significant improvement in LL and SL in both open- and MIS-TLIF (P < 0.0001); however, there was no change in PI. It did not show any significant difference in improvement in LL (P = 0.156), PI (P = 0.798), and SL (P = 0.179) between Asian and African groups. Regarding post-operative complications, there were 4 (6.9%) and 3 (6.5%) complications occurred in Asian and African population, respectively. There were no difference in complication rates in both groups (P = 0.939). Discussion: TLIF (MIS and open) gives similar clinical outcome between Asian and African population. Sagittal parameters were higher in African population than the Asian population. Attention should be paid to predetermine the value of LL to achieve during surgery. Keywords: Transforaminal lumbar interbody fusion, Asian versus African, Sagittal parameters, Clinical outcome.

MRI Study of Lumbar Canal Stenosis by Morphological Grading and Thecal Sac Measurement- A Cross-sectional Study

Introduction: Lumbar Spinal Stenosis (LSS) is a condition in which the spinal canal narrows to the point at which it can exert pressure on the nerves that travel through the spine. Aetiology is categorised into congenital, developmental and acquired (degenerative) causes. Magnetic Resonance Imaging (MRI) is investigation of choice in the evaluation of patients with symptoms related to lumbar central canal stenosis. Aim: To assess the morphologically grade of thecal sac in lumbar central canal stenosis on MRI. Materials and Methods: This cross-sectional observational study was conducted from November 2017 to October 2019 at Department of Radiology of Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, Andhra Pradesh, India. Study included 100 patients who were referred with symptoms of lumbar stenosis and outcome was to determine the correlation between the morphological grade and thecal sac axial antero-posterior diameter grade. Correlation was assessed by Fischer-exact test and Spearman's rank correlation coefficient test. A p-value <0.0001 was considered highly significant. Results: Morphological Grade II corresponded to maximum number of cases, amounting to 46% with mean anteroposterior thecal sac diameter of 6.21 mm, followed by 36% of Grade III with mean thecal sac diameter of 4.57 mm. Grade I corresponded to 14% of cases mean thecal sac diameter of 8.35 mm and Grade IV corresponded to 4% of cases with mean thecal sac diameter of 1.1 mm. Morphological grade had shown significant correlation of r value=0.78 with significant p-value <0.0001 with thecal sac measurement. Conclusion: Morphological grade of the thecal sac has significant correlation with the canal measurements and it helps in quick assessment of the severity of the lumbar canal stenosis.

Surgical outcomes of the thoracic ossification of ligamentum flavum: A high incidence of combined spinal stenosis

The term “tandem spinal stenosis (TSS)” has been used to describe combined cervical and lumbar canal stenosis. We identified in our large series of cases that approximately 58% of cases with cervical canal stenosis were considered to be TSS, and 15% needed surgery for concurrent lumbar spinal canal stenosis (LCS)

Analysis of cell-free circulating DNA fragment size and level in patients with lumbar canal stenosis.

Cell‐free circulating DNA (cfDNA), extracted by liquid biopsy, has been studied as a noninvasive biomarker for various diseases. The potential of cfDNA fragment size and level as a marker in lumbar canal stenosis (LCS) patients has never been studied. We investigated whether cfDNA is a biomarker of low back pain, leg pain, leg numbness severity in patients with an LCS. Blood samples were obtained from patients with LCS (n = 22) before and immediately after spinal surgery. Plasma DNA was isolated and examined for cfDNA fragment size and concentration. A cohort of healthy volunteers (n = 5) constituted the control group. The cfDNA fragment size tended to be shorter in patients than in healthy controls, but this difference was not significant (P = .186). cfDNA level was significantly higher in LCS patients (mean 0.614 ± 0.198 ng/μL, range 0.302‐1.150 ng/μL) than in healthy controls (mean 0.429 ± 0.064 ng/μL, range 0.366‐0.506 ng/μL) (P = .008). cfDNA level correlated positively with average pain (r = .435, P = .026) and leg numbness (r = .451, P = .018). cfDNA fragment size did not differ from before to after surgery, but cfDNA level increased postoperatively in patients with LCS. This was the first study investigating whether cfDNA fragment size and level are associated with pain in patients with LCS. Our findings suggest that cfDNA level may be an objective indicator of pain and surgical invasiveness in patients with LCS.

Comparison of decompression, decompression plus fusion, and decompression plus stabilization: a long-term follow-up of a prospective, randomized study

BACKGROUND CONTEXTLumbar canal stenosis due to degenerative lumbar spondylolisthesis is one of the most common indications for lumbar spinal surgery. However, from a long-term perspective, it is still unclear which of these procedures should be performed: decompression, decompression plus fusion, or decompression plus stabilization. PURPOSEThis study aimed to present the long-term results of a randomized controlled trial of surgery for degenerative spondylolisthesis. STUDY DESIGN/SETTINGThis is a long-term follow-up of a previously reported randomized controlled trial. PATIENT SAMPLEPatients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative lumbar spondylolisthesis were enrolled at two hospitals from May 1, 2003, to April 30, 2012; the final follow-up was on May 20, 2021. OUTCOME MEASURESThe following data were collected: modified Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score for lower back pain, leg pain, and numbness, and scores from eight Short-Form 36 (SF-36) subscales preoperatively, 1 year postoperatively, 5 years postoperatively, and at the final follow-up. METHODSPatients were randomized to undergo decompression alone, decompression plus fusion, or decompression plus stabilization. The primary outcome measure was the change in VAS for lower back pain with secondary outcomes including the modified JOA score, VAS for leg pain, VAS for leg numbness, eight SF-36 subscale scores, and occurrence of reoperation at the last follow-up. RESULTSAmong 85 patients who were randomized, 66 responded to the current survey. The mean follow-up period was 12.3 years. The VAS score for low back pain improvement was not significantly different between the decompression and fusion groups at the mean follow-up of 12.3 years. Of the 12 secondary outcomes, 8 showed no significant difference between decompression and fusion, 12 showed no significant difference between decompression and stabilization, and 10 showed no significant difference between fusion and stabilization. CONCLUSIONSAlthough additional instrumentation surgery did not significantly improve low back pain at the mean follow-up of 12.3 years compared with decompression alone, fusion surgery provided clinically meaningful improvements in patient-reported vitality, social functioning, role limitations due to personal or emotional problems, and mental health compared with decompression alone. TRIAL REGISTRATIONUMIN000028114

Long-Term Follow-Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study.

ObjectiveTo examine the postoperative progression of multilevel thoracic posterior longitudinal ligament (OPLL) at circumferential decompression (CD) levels and evaluate the long‐term results after CD via the posterior approach.MethodsClinical data from 16 patients with thoracic myelopathy secondary to OPLL who underwent CD at a single center were evaluated retrospectively from 2007 to 2014 and were followed up for more than 60 months. Patients of all sexes and ages were included in the study. Thin‐slice computed tomography scans obtained at the time of surgery and the most recent follow‐up were analyzed. The ossified area was measured on the axial reconstructed scan of the most obvious protrusion of ossification at the CD level. The neurological outcomes were evaluated using modified Japanese Orthopaedic Association (JOA) scores and Hirabayashi recovery rates (HRRs). Continuous variables were presented as the mean ± standard deviation and were analyzed using the Student's t‐test, while categorical variables were tested using Fisher's exact test.ResultsAmong all patients, the most predominant type was the mixed type (9/16, 56.3%), while the circumscribed type was only found in two patients (12.5%), and the continuous type was found in five patients (31.2%). Six cases were associated with ossification of the ligamentum flavum, and two cases were combined with cervical OPLL. The OPLL area at the CD level increased in all patients. The mean follow‐up period was 5.5 ± 0.92 years (range 5–8 years). The mean area of ossification increased from 35.63 ± 39.23 mm2 at the time of surgery to 99.94 ± 65.39 mm2 at the last follow‐up visit (P < 0.01). There was no internal fixation disorder on any computed tomography scan after the operation. The average JOA score of all patients improved from 4.2 ± 2.2 points before surgery to 8.4 ± 2.6 points at the final follow‐up (P < 0.01). The overall HRR was 61.8%. None of the patients exhibited any neurological deterioration due to OPLL progression. One patient developed a severe gait disturbance due to worsening lumbar canal stenosis, an unrelated cause, but the other 15 experienced gait disturbance improvements.ConclusionsAccording to the long‐term follow‐up results, although OPLL progression did not decrease or stop after removing the OPLL mass, CD is a safe and effective procedure that can provide adequate reserve ventral space to cope with postoperative OPLL progression.

Comparison of Applied Anatomy at L4-L5 and L5-S1 in Context of Tubular Decompression for Lumbar Canal Stenosis.

Tubular over-the-top decompression is getting popular in the management of lumbar canal stenosis (LCS). While L4-L5 is the most common level affected and operated for LCS, it is not uncommon to encounter patients with stenosis at L5-S1. No previous study has described the technical challenges of tubular decompression at the L5-S1 level as compared to at the L4-L5 level. This observational study was done on 40 consecutive patients older than 45 years who underwent magnetic resonance imaging (MRI) for back-related issues. The following radiological parameters: interlaminar angle, tube angle, laminar thickness ratio at the isthmus, and the laminar length ratio were evaluated at the L4-L5 level (group A) and the L5-S1 level (group B). The hypothesis behind the study was that if these patients were subjected to tubular decompression, then there will be technical differences between doing the surgery at the L4-L5 and L5-S1 levels. The mean age of the patients was 56.8 years (46-72) and the male to female ratio was 3:2. The mean interlaminar angle in group A was 71° and in group B was 102°. The tube angle in group A and group B was 36.8° and 49.7°, respectively. The laminar thickness ratio (L4:L5) was 1.34:1 and the laminar length ratio (L4:L5) was 1:1.42 in group A and B, respectively. Tubular decompression at the L5-S1 level has its own challenges because of the different anatomy of the L5 lamina compared to that of the L4 lamina. The wide interlaminar angle of L5 as compared to L4 dictates more oblique tube docking (tube angle) and more extensive table tilting to reach the contralateral lateral recess, thus making it challenging. The authors recommend that surgeons be conscious of this fact while performing tubular decompression at the L5-S1 level. This article provides information regarding technical challenges of doing surgery at L5-S1 level as compared to L4-L5 level. 3.

Outcome of back pain in patients with lumbar canal stenosis, after decompression without fusion or instrumentation

Outcome of back pain in patients with lumbar canal stenosis, after decompression without fusion or instrumentation

Functional outcome in operated patients of multilevel lumbar canal stenosis and use of HRQoL role in depicting the anxiety and its correlation with the pain

BackgroundLumbar canal stenosis (LCS) is a degenerative spinal disease of elderly people, and it not only impairs the mechanical activity but also alters the economic and mental status of the patients indirectly.This is single-center observational prospective study conducted for 2 years and included 30 consecutive operated patients of multilevel LCS patients and excluded the patients with single-level LCS, with primary LCS or with grade II subluxation. We analyzed the various measurement indices used for the surgical outcome assessment as ED-5D 5L and OLBPDI (Oswestry low back pain disability index). Statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 21.0 statistical Analysis Software. The independent t test, post hoc analysis, Wilcoxon signed rank statistic test and RM-ANOVA test were also applied.ResultMost patients have improvement in pain and all the components of HRQoL (health-related quality of life) after surgery, which was further improved in mean follow-up of 1 year. Our study also suggested that the patients with higher anxiety/depression have higher pain intensity and low HRQoL, which was persistent in postoperative period (p < .001).ConclusionED-5D 5L and OLBPD are good indices to assess all the components of quality of life and give valuable information overall. Anxiety has shown important correlation with the pain component in both preoperative and postoperative phase.

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

Posterior Lumbar Decompression:Variations and Pitfalls

Lumbar canal stenosis is the most common pathological condition causing spinal degeneration. Symptomatic patients who fail conservative treatment are considered candidates for surgical treatment. Many types of minimally invasive procedures for lumbar decompression have been proposed, most of which are effective and have shown good long-term results. However, in special cases, a second operation may be needed for spondylolisthesis caused by degeneration of the same segment. Two major minimally invasive approaches are available for bilateral decompression of lumbar canal stenosis: unilateral approach and midline approach. The unilateral approach is used to preserve midline structures, the contralateral facet joint, and the contralateral paravertebral muscle. The midline approach is used to preserve the left and right facet joints and the enthesis of the paravertebral muscle. These two approaches are suitable for specific situations based on their own concepts. Nevertheless, it is important to understand the advantages and disadvantages of each procedure. In this article, the varieties of lumbar decompressive methods and the pitfalls of decompression procedures will be discussed.

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]

Correlation of Tumor Necrosis Factor-α Expression with Pain Level in Degenerative Lumbar Canal Stenosis Patients

Introduction: Pain in degenerative lumbar canal stenosis is caused by osteoarthritis of a facet joint and intervertebral disc degeneration. Some inflammatory mediators such as tumor necrosis factor (TNF)-α are present in degenerative lumbar canal stenosis. This study aimed to evaluate the correlation of pain and functional pre-operative scores with the expression of TNF-α in nucleus pulposus, annulus fibrosus, and facet joint. Methods: Patients diagnosed with degenerative lumbar canal stenosis and planned for surgical treatment were included in this study. Patients with history of fracture, neoplasm, and/or infection of the spine were excluded. Tissue samples were collected from the nucleus pulposus, annulus fibrosus, facet joint, flavum ligament and paraspinal muscles of the spine during the surgery. TNF-α expression was examined semi-quantitively and correlated with the axial and radicular pain that were measured using Visual Analog Score (VAS) score. The result was then statistically analyzed. Results: The expression of TNF-α in the paraspinal muscle (6.30±14.20) was significantly higher compared to other locations. TNF-α expression in the facet joint group was significantly correlated with the intensity of low back pain measured by VAS score (r=0.893, p &lt; 0.001), and pre-operative functional outcome based on Oswestry Disability Index (ODI) (r=0.948, p &lt; 0.001). Conclusion: TNF-α expression, especially in the facet joint, is significantly associated with the pain intensity and pre-operative ODI that allow pain reduction with less invasive treatment in lumbar canal stenosis patients.

EPIDURAL STEROID INJECTION IN HERNIATED DISC AND LUMBAR CANAL STENOSIS: IS IT JUST A PLACEBO?

ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value&lt;0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value &lt;0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value &lt;0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value &lt;0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.

The use of minimally invasive interspinous process devices for the treatment of lumbar canal stenosis: a narrative literature review.

Minimally invasive interspinous process devices (IPD), including interspinous distraction devices (IDD) and interspinous stabilizers (ISS), are increasingly utilized for treating symptomatic lumbar canal stenosis (LCS). There is ongoing debate around their efficacy and safety over traditional decompression techniques with and without interbody fusion (IF). This study presents a comprehensive review of IPD and investigates if: (I) minimally invasive IDD can effectively substitute direct neural decompression and (II) ISS are appropriate substitutes for fusion after decompression. Articles published up to 22nd January 2020 were obtained from PubMed search. Relevant articles published in the English language were selected and critically reviewed. Observational studies across different IPD brands consistently show significant improvements in clinical outcomes and patient satisfaction at short-term follow-up. Compared to non-operative treatment, mini-open IDD was had significantly greater quality of life and clinical outcome improvements at 2-year follow-up. Compared to open decompression, mini-open IDD had similar clinical outcomes, but associated with higher complications, reoperation risks and costs. Compared to open decompression with concurrent IF, ISS had comparable clinical outcomes with reduced operative time, blood loss, length of stay and adjacent segment mobility. Mini-open IDD had better outcomes over non-operative treatment in mild-moderate LCS at 2-year follow-up, but had similar outcomes with higher risk of re-operations than open decompression. ISS with open decompression may be a suitable alternative to decompression and IF for stable grade 1 spondylolisthesis and central stenosis. To further characterize this procedure, future studies should focus on examining enhanced new generation IPD devices, longer-term follow-up and careful patient selection.

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

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;

Use of Vancomycin Mixed Bone Graft and Vancomycin Mixed Saline Wash Before Wound Closure Reduces the Rate of Infection in Lumbar Spine Fusion Surgery.

This study aims to evaluate whether surgical site vancomycin mixed in bone grafts and local vancomycin mixed in normal saline wash before wound closure decrease the infection rates in patients undergoing lumbar spinal instrumentation and posterolateral fusion. A retrospective study was performed on cases between 2017 and 2019, who underwent lumbar spine instrumentation and posterolateral fusion for lumbar canal stenosis or listhesis. The routine prophylactic procedures were performed in all patients as per institutional protocol. Patients' records were analysed and categorised into two groups, the vancomycin group (VG), where vancomycin mixed in bone graft and normal saline wash was used at the surgical site, and the control group (CG), where vancomycin was not used. The study included 63 patients, 31 in VG and 32 in CG. There is no statistical difference in age, sex, and diabetes mellitus in both groups. A total of seven cases were infected, six in CG (6/32) and one in VG (1/31). Out of six infections in CG, three patients had diabetes and four infected cases underwent surgery for debridement. In VG, the only single case got infected and treated with intravenous antibiotics. We found that the use of vancomycin added to the bone graft and normal saline in posterior lumbar spinal instrumentation and posterolateral fusion is associated with significantly lower rates of infection (p value=0.049).

Manual therapy and canal enlargement exercises versus conventional physiotherapy in lumbar stenosis – a study protocol

INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as ‘Neurogenic Claudication’ (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy &amp; Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), Antero-Posterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.