Lumbar Canal Stenosis Research Articles

P57. A double blind, randomized controlled, prospective trial assessing the effectiveness of oral corticoids in the treatment of symptomatic lumbar stenosis

P57. A double blind, randomized controlled, prospective trial assessing the effectiveness of oral corticoids in the treatment of symptomatic lumbar stenosis

A study of clinical outcomes of only decompression versus decompression with instrumented fusion for surgical management of lumbar canal stenosis in tertiary health care center in south Gujarat

Lumbar spinal stenosis is one of the most common conditions seen in elderly. It is a degenerative progressive disorder which leads to considerable disability. Patients not responding to conservative management requires surgical intervention. Different modalities for surgical interventions available. Decompression by laminectomy discectomy or micro lumbar discectomy or micro endoscopic discectomy can be done. Decompression with addition of instrumented fusion with help of pedicle screws and rods with or without TLIF/PLIF. Hence to compare the clinical outcomes of decompression and decompression with instrumented fusion this study is done. In most patients, conservative management is considered for relieving pain and functionally improving walking and standing time. The patients not improving with conservative management for at least 6 weeks and having clinically and radiologically lumbar canal stenosis requires surgical intervention. Apart from Minimal invasive surgery Decompression with or without fusion has been traditional definitive therapy offered. In this study we found that surgical treatment was influenced by presenting complaint of the patient. Patients with predominant back pain were more often operated with decompression with fusion whereas patients having radiculopathy or claudication were more often operated with decompression only. In this study clinical outcomes of decompression only and decompression with fusion were found similar. However, blood loss during surgery, duration of surgery and duration for return to work/occupation were more in decompression with fusion surgery which was found statistically significant.

Efficacy of the Unilateral Uniportal Endoscopic Approach in Management of Monosegmental Lumbar Canal Stenosis

Efficacy of the Unilateral Uniportal Endoscopic Approach in Management of Monosegmental Lumbar Canal Stenosis

Retrospective study of minimally invasive surgery verses open laminectomy or laminectomy with diskectomy

Background: Minimally invasive spine surgeries (MIS) are often considered superior to their open counterparts in view of smaller incisions, reduced blood loss, less post-operative pain and less hospital stay. In this study, we compared the clinical outcome of MIS and open procedure of lumbar laminectomy/discectomy. The objective of this study was to compare clinical outcome between the MIS and open procedure of lumbar laminectomy/discectomy.Methods: This was a retrospective study conducted at Government medical college, Kottayam, Kerala, India where we studied the patients who underwent MIS and open laminectomy/laminectomy with discectomy during the period January 2018 to January 2020.Results: We studied a total of 200 patients, among which 60% were males with a mean age of 50.58 years and 40% were females with a mean age of 53.59 years, 45.5% had L5 S1 IVDP, 30% had L4/5 IVDP, and 24.5% had L4/5 lumbar canal stenosis, 75.5% underwent laminectomy with discectomy and the rest (24.5%) underwent laminectomy with foraminotomy, 60% underwent open surgery and 40% underwent MIS.Conclusions: MIS was superior to its open analog in terms of intra operative blood loss as well as hospital stay. But open surgeries required less operation time, less C arm exposure, had better pain control and functional outcome and less recurrence in our study.

Acute-onset paraplegia as an unexpected complication under general anesthesia in supine position during abdominal endovascular aneurysm repair: a case report

BackgroundAcute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR.Case presentationThe patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord.ConclusionsPatients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

Immediate postoperative MRI findings after lumbar decompression surgery: Correlation of imaging features with clinical outcome

An understanding of the common MRI findings observed after decompression surgery is important. However, to date, no study addressing this has been published. The aim of this study was to analyze and describe the immediate postoperative MRI findings after lumbar decompression surgery. We retrospectively analyzed the immediate postoperative MRIs of 121 consecutive patients who underwent lumbar decompression surgery between July 2017 and June 2018. Changes in stenosis at the decompressed and adjacent levels, epidural fat edema, epidural and subdural fluid collections, nerve root swelling, facet joint effusions, intervertebral disc signal, and paravertebral muscle edema were correlated with clinical characteristics. Both groups had reduced central canal stenosis postoperatively (p < 0.001) but worsened stenosis at adjacent segments. Fluid collection, hemorrhagic or non-hemorrhagic, at the laminectomy site was the commonest finding (one-level: 73.8%, two-level: 88.5%), with a higher percentage of severe central canal compromise in the two-level decompression group (p = 0.003). Other postoperative MRI findings, such as epidural fat edema, nerve root swelling, subdural fluid collection, and facet joint effusion, were noted without statistical significance. In conclusion, even with successful decompression for lumbar canal stenosis, increased central canal stenosis at adjacent segments is common on immediate postoperative MRI scans, showing no statistically significant correlation with the immediate postoperative outcome. Postoperative fluid collection at the laminectomy site is the commonest imaging finding, and higher rates of hemorrhagic fluid and more severe central canal compromise occur in two-level decompression, but rarely cause clinical problems.

Intermittent Claudication Secondary to Spine and/or Spinal Cord Diseases

Currently, intermittent claudication is classified into the vascular (mainly secondary to peripheral arterial disease) and neurogenic (mainly secondary to lumbar canal stenosis) types. Intermittent claudication due to spinovascular insufficiency (myelopathy) has rarely been reported since it was first described by J. Dejerine in 1894. However, currently, intrinsic (vascular diseases of the spinal cord) and extrinsic (disorders causing cervicothoracic cord compression) factors are implicated as contributors to this condition. No internationally accepted, transdisciplinary and standardized definition, technical terminology, and classification of intermittent claudication are currently available. I propose a new classification in this article. I have focused on intermittent claudication secondary to spine and/or spinal cord diseases, with regard to its epidemiology, symptomatology, and differential diagnosis.

Hand surgeons and amyloidosis specialists warning: transthyretin-associated amyloidosis with bifid median nerve as a cause of bilateral carpal tunnel syndrome. A case report and literature review

Approximately 75% of patients with carpal tunnel syndrome (CTS) are diagnosed as idiopathic. Despite this, the presence of an underlying cause such as an anatomical variant or a systemic disease must always be suspected, especially in cases of bilateral presentation without an obvious cause, recurrence or complications. The anatomical variant known as the bifid median nerve (BMN) is a very rare abnormality that can occasionally lead to CTS. On the other hands, transthyretin-associated amyloidosis (ATTR) is one of the possible causes of bilateral CTS. We report a case where these two very rare pathologies converge as the cause of bilateral CTS and a review of the literature. We report a 71-year-old male with prior history of lumbar canal stenosis, bilateral trigger finger, rupture of the supraspinatus muscle tendon and of the long portion of the right biceps brachial. He also had 8-year-old bilateral CTS that recurred after CTS surgery. He was surgically re-intervened and was diagnosed incidentally with BMN and an ultrasound of the other hands also showed BMN. Because of all the prior musculoskeletal history, a biopsy of the transverse carpal ligament was taken showing ATTR deposits that led to the diagnosis of cardiac ATTR wild type. This case highlights the natural history of the multiple musculoskeletal manifestations related to ATTR and the importance of performing intraoperative biopsies in patients with CTS surgery as this can lead to early diagnosis of cardiac ATTR.

Indirect Lumbar Decompression Combined With or Without Additional Direct Posterior Decompression: A Systematic Review.

Study Design:Systematic review.Objective:Indirect decompression via lateral lumbar interbody fusion (LLIF) can ameliorate central and foraminal lumbar stenosis. In severe central stenosis, additional posterior direct decompression is utilized. The aim of this review is to synthesize existing literature on these 2 techniques and identify significant differences in outcomes between isolated indirect decompression via LLIF and combined indirect decompression supplemented with direct posterior decompression.Methods:A database search algorithm was utilized to query MEDLINE, COCHRANE, and EMBASE to identify literature reporting adult decompression study groups that involved an oblique or lateral fusion approach through September 2020. Improvement in outcomes measures and complication rates were pooled and tested for significance.Results:A total of 110 publications were assessed with 15 studies meeting inclusion criteria, including 557 patients and 1008 levels. Mean age was 63.1 years with BMI of 27.5 kg/m2. For the combined indirect and direct decompression cohort, lumbar lordosis (LL) increased 133.9%, from 22.8o to 48.7o, while the indirect decompression cohort LL increased 8.9%, from 41.9o to 45.5o. Difference in LL improvement between cohorts was insignificant (P > .05). Oswestry Disability Index (ODI) decreased from 36.5 to 19.4 in the combined indirect and direct decompression cohort, and from 44.4 to 23.1 in the indirect decompression cohort. ODI reduction was insignificant (P = .053).Conclusions:Prior studies of both indirect decompression as well as combined indirect and direct decompression of lumbar spine stenosis are limited by small samples, heterogeneous populations, and lack of direct comparisons. Both procedures result in improved function and pain postoperatively with direct decompression restoring more lordosis in patients with worse preoperative alignment.

Surgical treatment for lumbar spinal stenosis: a single-blinded randomized controlled trial

ObjectiveTo evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis.MethodsSixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale).ResultsNo significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group.ConclusionsLumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment.Trial registrationClinicaltrials.gov (NCT02879461).

Role of redundant nerve roots in clinical manifestations of lumbar spine stenosis.

Background: Redundant nerve roots (RNRs) are defined as elongated, thickened, and tortious appearing roots of the cauda equina secondary to lumbar spinal canal stenosis (LSCS). The study compared the clinical and radiological features of patients with LSCS with versus without RNR.Methods: This retrospective study was performed on 55 patients who underwent decompressive surgery for degenerative LSCS. Patients were divided into two groups based on the presence of RNR in their preoperative magnetic resonance imaging, as evaluated by a radiologist blinded to the study design. Medical records were reviewed for basic demographic, clinical MR presentation, and outcomes utilizing Japanese Orthopaedic Association (JOA) scores.Results: The mean age of enrolled patients was 57.1, with mean follow-up of 4.0 months. RNR was found in 22 (40%) of patients with LSCS. These patients were older than those patients without RNR (62.2 vs. 53.7). Interestingly, there were no statistically significant differences in clinical presentations, duration of symptoms, and outcomes using JOA scores between the two groups.Conclusion: RNR is a relatively common radiological finding (i.e., 40%) in patients with LSCS. It is more likely to be observed in older patients. However, no significant differences were noted in clinical presentation and functional outcomes with respect to the presence or absence of RNR.

Diabetes Mellitus and the Development of Lumbar Canal Stenosis: Is There Any Relevance?

Study DesignRetrospective study.PurposeTo assess the relationship between the severity of lumbar canal stenosis (LCS) and type-II diabetes mellitus (DM).Overview of LiteratureDM is a multiorgan disorder that has an effect on all types of connective tissues. LCS is a narrowing of the spinal canal with nerve root impingement that causes neurological claudication and radiculopathy. Identification of the risk factors of LCS is key in the prevention of its onset or progression.MethodsLCS patients were divided into three groups as per DM status: group A without DM (n=150); group B patients with well-controlled DM; and group C patients with uncontrolled DM. Groups B and C were subdivided into group B1: patients with DM with a duration of ≤10 years (n=76), group B2: DM with duration of >10 years (n=68), group-C1 DM duration ≤10 years (n=56), and group C2 DM duration >10 years (n=48). The severity of LCS was evaluated using the Swiss Spinal Stenosis Scale (SSSS) and Modified Oswestry Disability score (MODS). Operated patients ligamentum flavum sent for histological staining and quantitative immunofluorescence analysis.ResultsThe demographic data of groups did not show any difference except in age. There was no difference between the mean SSSS and MODS of groups A and B1. Groups B2, C1, and C2 had higher average SSSS and MODS than group A (p<0.05). Groups B2 and C2 had higher SSSS and MODS than groups B1 and C1. Groups C1 and C2 had higher scores than groups B1 and B2 (p<0.05). The severity of LCS was significantly related to the duration of DM in groups B and C (p<0.05). Uncontrolled and longer duration of DM had significant elastin fibers loss and also higher rate of disk apoptosis, high matrix aggrecan fragmentation, and high disk glycosaminoglycan content.ConclusionsLonger duration and uncontrolled diabetes were risk factors for LCS and directly correlate with the severity of LCS.

Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-A retrospective study of 239 cases

ObjectiveConventionally spinal surgeries are done under general anaesthesia (GA). Plenty of literature is available on lumbar spine non-instrumented surgeries under spinal anaesthesia (SA) but handful of literature is there on lumbar spinal instrumented fusion surgeries under SA. We retrospectively analysed the data of 131 patients operated under SA and 108 patients under GA. Aim of the study was to evaluate the safety, advantages and disadvantages of doing lumbar spine instrumented fusion surgeries under SA.In time of COVID-19 pandemic, aerosol generating procedure like intubation, can be avoided if lumbar spine instrumented fusion surgeries are performed under SA. Methods239 patients aged between 20 and 79 years operated from January 2014 to December 2019 were included in this study. Indications for surgery were lumbar canal stenosis, degenerative or lytic spondylolisthesis. They underwent L4-L5 or L5-S1 fusion surgeries either TLIF or pedicle screw fixation postero lateral fusion (PLF) and decompression. Out of 239 patients,131 were operated under SA and 108 patients under GA. Heart rate, mean arterial pressure (MAP), blood loss, operating room time, post-op pain relief and need of analgesics, cost of surgery and anaesthesia related complications were analysed. ResultsThe study found significantly less blood loss (p<.05), less OR time, better post-op analgesia and lesser incidence of nausea and vomiting in SA (8.4%) than GA (29.6%). We observed average 10% cost reduction in SA. This study did not find any prone position related complication in regional anaesthesia but one transient brachial plexus palsy and one post-op shoulder pain in GA group. ConclusionSA is a safe alternative to GA for lumbar spine instrumented fusion surgery with significant less blood loss, OR time, better post-op analgesia, average 10% overall cost reduction and no reported prone-position related complications.

Pictorial review: imaging of the spinal manifestations of achondroplasia.

Achondroplasia is the commonest hereditary skeletal dysplasia exhibiting dwarfism with characteristic rhizomelic (proximal) shortening of the limbs. It is predominantly linked with an autosomal dominant inheritance, but sporadic mutations can occur which are associated with advanced maternal age. Approximately 1 in every 25 000-30 000 live births are affected, and the overall life expectancy is marginally reduced by ~10 years. Mutations in the fibroblast growth factor receptor causes a decrease in endochondral ossification, which results in stunted growth of cartilaginous bones. A resultant narrowed foramen magnum and a short clivus are seen which predisposes to craniocervical spinal canal stenosis. Apnoeic events arising from the compression of the vertebral arteries at the level of the craniocervical junction lead to fatality in the young, with a death rate as high as 7.5%. Decrease in the caudal inter-pedicular distance is characteristic and a contributory factor for cervical, thoracic and lumbar spinal canal stenosis, most pronounced in the lumbar spine with patients often requiring surgical intervention to ease symptoms. Thoracolumbar kyphoscoliosis and sacral manifestations such as small sacro-sciatic notches and a horizontal pelvis are seen. The aim of this pictorial review is to demonstrate the imaging findings of the spinal and pelvic manifestations of achondroplasia.

Current Status of Biportal Endoscopic Decompression for Lumbar Central Stenosis

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

"A decade with micro-tubular decompression": Peri-operative complications and surgical outcomes in single and multilevel lumbar canal stenosis.

We present tenyears experience with micro-tubular decompression (MTD) performed for single and multilevel lumbar canal stenosis (LCS) assessing the peri-operative complications and mid-term surgical outcome. The aims of this study were to review the incidence of peri-operative complications and classification of complications and define risk factors to prevent it while negotiating the learning curve. A retrospective review of prospectively collected data over a period of tenyears involving 625 patients who underwent single/multilevel lumbar MTD. Peri-operative clinical-radiological parameters, post-operative complications, clinical outcome (VAS and ODI), and satisfactory outcomes in the form of Wang and Bohlmann's criteria were evaluated. The peri-operative complications were divided into five broad categories based on their time of occurrence, severity, and system affected. The comparison between the patients with and without complications was done to evaluate the causative risk factors. The overall incidence of the peri-operative complication was 12.96% over tenyears with higher rate (29.8%) during the initial threeyears of practice and lower rate (8.78%) in the last seven years. The most common peri-operative complications were urinary tract infections (UTI). The risk factors for complications with MTD revealed in statistical analysis were presence of one or more comorbidities, L4-L5 single-level stenosis, bilateral stenosis with ipsilateral and bilateral decompression done through unilateral approach, and multilevel MTD done through single incision for multilevel LCS. More than 95% patients operated with MTD showed excellent to good outcome as per the Wang and Bohlmann's criteria at the final follow-up. This study represents 12.96% overall incidence of peri-operative complications with higher rate (29.8%) during the initial threeyears of practice and lower rate (8.78%) in the last sevenyears with MTD for single/multilevel LCS with. MTD is an effective procedure with substantial clinical benefits in the form of excellent to good clinico-radiological outcomes at twoyear follow-up. However, there is a learning curve associated with the adoption of the technique. The described classification for peri-operative complications is helpful to record, to evaluate, and to understand the aetiology and risk factors based on its duration of occurrence in the peri-operative period.

Comparison of Short-Term Clinical Results and Radiologic Changes Between Two Different Minimally Invasive Decompressive Surgical Methods for Lumbar Canal Stenosis: Lumbar Spinous Process Splitting Laminectomy and Trans-Interspinous Lumbar Decompression.

A multicenter, retrospective study. To clarify the clinical and radiological effects of removing interspinous contextures in lumbar decompression surgery for patients with lumbar spinal stenosis. There have seldom been reports that have compared both clinical results and radiological changes among minimally invasive decompression methods. Consecutive 52 patients underwent lumbar spinous process-splitting laminectomy (LSPSL), following which 50 patients underwent trans-interspinous lumbar decompression (TISLD). All patients presented with cauda equina type of lumbar spinal stenosis and underwent a minimum 1-year follow-up. The Japanese Orthopaedic Association (JOA) score and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score were evaluated to determine the extent of daily living activities. Propensity score (PS)-matched analysis was used to match patients' age and preoperative JOA scores between the two groups. Lumbar lordosis (LL), disc height (DH), segmental range of motion (ROM), and vertebral anterior translation were measured by functional lumbar lateral x-ray, and changes between preoperative and 1-year postoperative values were evaluated. Twenty-nine pairs of patients were selected by PS-matching. Mean JOA scores increased from 14.4 to 23.5 (mean recovery rate was 62.3%) in the LSPSL group and from 14.0 to 23.2 (61.3%) in the TISLD group at preoperative and 1-year follow-up, respectively. There were no significant differences in clinical results and changes in LL, ROM, and vertebral anterior translation in each group. The DH at L4/5 level at 1-year after surgery revealed significant decrease in the TISLD group compared with the LSPSL group. There was a correlation between preoperative DH and DH decrease in the LSPSL group, but not in TISLD group. Removal of interspinous contextures did not influence clinical outcomes at 1 year after surgery, but it may be likely to cause disc height loss when it applied at the L4/5 level.Level of Evidence: 3.

METHODOLOGY TO SURGICALLY APPROACH FOR LUMBAR CANAL STENOSIS;“WHEN TO” AND “WHEN NOT TO” DO INSTRUMENTAL FUSION- A PROSPECTIVE STUDY.

Introduction:Lumbar canal stenosis is dened, as an abnormal narrowing of the ligamento-osseous canal of the lumbar vertebra or of the foramina intervertebralis, causing a direct compression or a compromise of either the dural sac or the nerve root or indirectly to their vasculature producing symptoms of radiculopathy or and claudication.Patient whose symptoms do not show improvement after non-surgical or conservative trial, become eligible for surgical relief. AIM: To Prospectively analyze, Canal decompression, interbody Lumbar fusion with or without posterior stabilization with postero-lateral bone grafting, in cases presenting with MRI proven Lumbar Canal Stenosis, not responding to conservative management. Materials and Methods:Our study was done in Chettinad Hospital and Research Institute from January 2016 to December 2020, Follow-up period was for a minimum period of 12 months. 54 patients participated in the study.JOA and VAS score was recorded at the end of 12 months postsurgery to analyze the functional outcome. Results: There were 32 males and 22 females in the study.Our mean male JOA score was pre-operatively 9.88 which improved to 14.8 at the 12th month follow-up. Our mean JOA for females was at 8.3 which improved post operatively to 13.8.The mean VAS score pre-operatively in the men th and women were 7.4 and 8.6 respectively. This, at the 12 month follow up dropped to 0.8 and 1.2 for men and women respectively.The complications encountered in the study patients are Dural tears in 6 patients, supercial infection in 8 patients, Deep infection and Neurological decit in 4 and 3 patients respectively. All of these complications subsequently got resolved without any long term sequelae. Conclusion:In patients with lumbar canal stenosis whose symptoms do not abate, with conservative management, surgical lumbar spinal canal decompression, whether it is single level or dual level, does provide for a good clinico- functional outcome.

FOOT PRESSURE MEASURMENT AND MAPPING, IN A CASE SERIES ASSESSMENT FOR DIAGNOSING AND TREATING ORTHOPAEDIC FOOT ABNORMALITIES.

Introduction: The study that measures the existing elds of pressure between a surface that is used to support, and foot surface that is plantar, is called Pedobarography. It has important applications in the analysis of Gait and other Foot Health problems. The requirement of foot pressure measurement sensors, are that they must have mobility with limited cabling. Materials And Methods: This was a prospective study done as an outpatient procedure at Chettinad Hospital and Research Institute, Kelambakkam, Chengalpattu district of Tamil Nadu, from January 2019 to December 2019, for foot related ailments of outpatients presenting in the Department of Orthopaedics. The foot mapping was done by standard static mapping and gait analytical mapping systems. The ndings were recorded and analyzed by a computer and the patients were prescribed custom made foot-wear. Results: 945 cases were included in the study of which 575 patients had foot related orthopaedic pain pathology in the age group of 28 to 57years. Only for the 170 patients in the plantar fasciitis group was Hydrocortisone Injection administered. Remaining foot pathologies were treated with wax bath and ultrasound therapy. For the neurological foot pain segment comprising of 114 patients, neurologist consultation was sought, of which 36 cases turned out to be, due to lumbar canal stenosis and were surgically intervened upon. Of the 208 patients with Achilles tendonitis, 165 patients resolved with a heel and sole raise, with physiotherapy and the remaining 43 patient required spur and bursal surgical exploration and excision. Conclusion: Plantar foot pressure mapping, should be an integral part of the list of investigations, while trying to diagnose and treat the problems related to foot abnormalities and pathologies.

Treatment of lumbar canal stenosis in patients with compensated sagittal balance

IntroductionThe need to combine fusion with decompression in patients with lumbar canal stenosis is still controversial. The aim of this study was to show that isolated decompression leads to the same outcomes as decompression plus fusion in patients who have preserved global sagittal balance. Materials and MethodsA single-center retrospective cohort of 110 patients who were operated for a single-level lumbar stenosis was divided into two groups based on the treatment: isolated decompression or fusion-decompression. These patients had a normal odontoid-hip axis angle (ODHA) (−5° to +2°) and had no spondylolisthesis or frontal deformity. We compared the clinical outcome scores and spinal-pelvic parameters preoperatively and at 1 year of follow-up. We evaluated the minimal clinically important difference (MCID) corresponding to a 12.8-point difference in the Owestry Disability Index (ODI). The analysis in each group was based on the MCID. ResultsThe clinical outcome scores improved significantly in both groups. There was a 77% decrease in the ODI>12.8 points with no significant difference between groups. The analysis based on the MCID showed that patients with a poor clinical result at 1 year in the isolated decompression group were more likely to have lumbar pain, while the ones in the fusion-decompression group were more likely to have radicular pain. ConclusionThe clinical and radiological results of fusion-decompression are not superior at 1 year relative to isolated decompression for treating single-level lumbar canal stenosis in patients with compensated sagittal balance. Full-spine weight bearing radiographs are key to determining the patient's sagittal balance and to ensuring there are no radiological instability factors that may require a stabilizing procedure. Level of evidenceIV Retrospective study of data collected prospectively.