Management Of Lumbar Canal Stenosis Research Articles

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.

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.

Unilateral Biportal Endoscopy Versus Tubular Microendoscopy in Management of Single Level Degenerative Lumbar Canal Stenosis: A Prospective Study.

Prospective clinical study. To the authors knowledge, there are no previous prospective studies to test the feasibility of the unilateral biportal endoscopic (UBE) technique in management of lumbar canal stenosis. The study was conducted to compare clinical results of the UBE technique with the tubular microendoscopic (TME) surgery for management of degenerative lumbar canal stenosis. One hundred fifty-four cases of single level degenerative lumbar canal stenosis were randomly divided into 2 groups. Each group consisted of 77 cases: one group underwent UBE and the other TME. Clinical outcome was assessed periodically: early postoperative, at 1, 3, and every 6 months for 2 years. Clinical outcome assessment operatives included the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and patient satisfaction using Modified Macnab Criteria (MMC). In addition, the admission period, operative time, and estimated blood loss were compared. In UBE cases, ODI and ZCQ were statistically superior to TME for all periods (P<0.05). For both approaches, values presented progressive improvement until the 24th month. Regarding ODI, UBE and TME had an 84% and 79% success rate, respectively. In ZCQ, UBE and TME had a 79% and 73% success rate, respectively, at the end of the 24th month. Regarding the MMC, UBE and TME had 63% and 29% excellent results, respectively. UBE also has shorter admission period (days: 1.11 vs. 1.28), operative time (minutes: 57.74 vs. 65.31), and less estimated blood loss (mL: 49.47 vs. 53.57). Given its demanding learning curve, UBE is considered an effective alternative to TME with a higher clinical success rate.

Lumbar Canal Stenosis: Pre and Post Decompression laminectomy Outcomes in a Single Neurosurgery Private Practice

Lumbar canal stenosis (LCS) or Lumbar Spinal Stenosis (LSS) is the most common degenerative condition affecting older adults. The clinical presentation of LCS includes lower back pain, radiating pain, tingling sensation, and numbness in the lower limbs, as well as nocturnal leg cramps, and bladder dysfunction due to neurological compression. Laminectomy is one of the most common procedures performed for the treatment of LCS. This study aimed to examine the pre-surgical presentations and post-surgical outcomes based on the available clinical records from a single neurosurgeon private practice based in Melbourne, Victoria, Australia. The clinical records of 166 patients were extracted and reviewed for clinical presentation notes, surgical notes, post-surgery follow-up letters between 2010 and 2019. Records without follow-up notes were excluded. The presurgical presentation symptoms included lower back pain, weakness, neurogenic claudication, pins and needles, and sensory and motor deficits. Post-surgical outcomes were evaluated based on the 1-month, 3-month, and 1-year follow up based on the notes and letters. Many patients mentioned significant improvement in symptoms immediately after the decompressive laminectomy. Descriptive analysis was performed; the results have been presented as percentages and charts. Post- laminectomy results reported that 87% improvement in back pain and 85% people reported improvements in neurogenic claudication. This study suggested that decompressive laminectomy was effective in the management of LCS. However, further studies are required due to the limitations, such as small population size, data availability, multiple re-presentations, and lack of proper follow-up.

Functional outcome of instrumented and non-instrumented fusion in lumbar canal stenosis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lumbar canal stenosis (LSS) is a source of significant morbidity and economic burden in the Indian population. Spinal canal compression is the sine qua non of lumbar canal stenosis but whether instrumentation should be done or not is the major dilemma. In this study, we aim to compare the functional outcome of instrumented versus non-instrumented fusions for the treatment of lumbar stenosis along with the post-operative complications and cost-effectiveness of both procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted at a tertiary-care medical college and hospital, Aurangabad specializing in post-graduate training, where all patients who underwent surgical treatment between May 2016 and May 2018 were included. Patients were assessed using the modified Oswestry disability index (MODI) and visual analogue scale (VAS). These evaluations were done at 3, 6, 12 and 24 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; We found similar pain relief and stabilization in both the groups in the initial post-operative period, but after 2 years, there was a significant difference (p=0.0001) between the two groups in terms of VAS (back) and MODI score. Complication rate was higher in instrumented patients. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Patient selection is the most important thing in the management of lumbar canal stenosis. We believe that, with the flowchart on the management of lumbar canal stenosis, it would help choosing patients better as to who would require instrumented fusion. Non-instrumented fusions might cost less and have fewer complications, but the overall outcome of the patient in the future should be kept in mind.&lt;/p&gt;

Evaluation of functional outcome of microsurgical management of lumbar canal stenosis

Evaluation of functional outcome of microsurgical management of lumbar canal stenosis - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2019.040, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Surgical versus Conservative Management of Lumbar Canal Stenosis in Elderly

Background: Degenerative lumbar spinal stenosis is one of the common diseases in elderly, also may occur in younger ages. Usually presents with back pain, lower limbs pain and claudication pain. Diagnosis is confirmed by radiological studies such as plain X rays LSS, CT. LSS or MRI LSS. Objective: The aim of this prospective study was to evaluate the surgical versus conservative management of lumbar canal stenosis in old patient (age of 60 years old or more). Methods: A prospective comparative study was conducted on 100 old patients that were divide into two groups, each group 50 patients. The first 50 patients underwent surgical lumbar canal decompression and the other 50 patients underwent conservative management. Results: This study showed that elderly patients with moderate to severe lumbar stenosis without spondylolisthesis got benefit from surgery. They showed reduction in pain reported in the lower limbs (VAS Leg with p < 0.05) and improved function (Oswestry with p < 0.05) whoever there was no significance change regarding visual analogue scale (VAS) between the two groups. In addition, there was no significant difference between the result between 6 month and oneyear follow up. Conclusion: In patients with lumbar stenosis in old age, there was improvement in leg pain and function in patients underwent surgical posterior decompression but there was no difference in back pain compared to patients underwent conservative management.

Surgical versus Conservative Management of Lumbar Canal Stenosis in Elderly

Surgical versus Conservative Management of Lumbar Canal Stenosis in Elderly

Different surgical modalities in the management of lumbar canal stenosis

Objective The aim of this study was to evaluate the results of different methods of decompression in lumbar canal stenosis (LCS) with regard to the effectiveness of different techniques in relieving symptoms, duration of surgery, intraoperative blood loss, and decreasing of postoperative complications. Background LCS is defined as a narrowing of any part of the lumbar spinal canal. Several surgical techniques for lumbar spine decompression have been described over the last few decades. The aim of surgery for symptomatic LCS is to relieve the symptoms by adequate neural decompression while preserving the anatomy and the biomechanical function of the lumbar spine as much as possible. Patients and methods This prospective study was conducted from September 2015 to August 2017 including three groups: group A treated with conventional laminectomy (CL), group B treated with CL with posterolateral fusion, and group C treated with unilateral laminectomy with bilateral decompression. We used Oswestry disability index to assess preoperative and postoperative disabilities and pain. Results In this study, statistical results revealed that there was statistical significance in the improvement of claudicating sciatica between the three groups as regards the Oswestry disability index (P < 0.001). There was statistical significance between three groups with regard to blood loss (P < 0.001), length of surgical procedure (P = 0.009), postoperative hospital stays (P < 0.001), and postoperative complication. Conclusion On the basis of short-term follow-up, a minimally invasive technique like unilateral laminectomy with bilateral decompression allowed decompression, preserving spine stability with a natural range of motion, with less blood loss, less hospital stay, and decreased intraoperative and postoperative complication rather than CL with or without posterolateral fusion.

Minimally Invasive Spinous Process Splitting Approach for Management of Lumbar Canal Stenosis

Background: for years, the gold standard treatment of symptomatic lumbar canal stenosis refractory to conservative management is a facet preserving laminectomy. However, it has been suggested that extensive resection of the posterior bone, posterior ligaments and muscular structures led to increase postoperative pain, perioperative blood loss, complications and length of hospital stay. More recently, various authors have recommended surgical techniques that preserve posterior midline structures (i.e. spinous processes, vertebral arches, interspinous and supraspinous ligaments), as removal of these structures may contribute to instability after surgery. Objective: the purpose of our prospective study is to evaluate the surgical outcome of minimally invasive spinus process splitting approach in the treatment of lumbar canal stenosis. Patients and Methods: this prospective study included 20 patients that were operated in Al Azhar University Hospitals in the period between January 2017 and March 2018 via minimally invasive spinus process splitting approach in the lumbar canal senosis. Pre- and postoperatively disability and pain scores were measured by using the Oswestry Disability Index (ODI) and Visual Analog Score (VAS). Results: our statistical results revealed that there was a statistically significant difference in the outcome between pre and postoperative after follow up period of 12 months regarding VAS for back pain and leg pain, postoperative ODI changes were significantly better. There was a significant decrease regarding operation time and postoperative hospital stay, blood loss and postoperative pain. Conclusion: so, the relevance of preservation of the posterior midline structures should be clarified in further studies.

Minimally Invasive Spinous Process Splitting Approach for Management of Lumbar Canal Stenosis

Minimally Invasive Spinous Process Splitting Approach for Management of Lumbar Canal Stenosis

Assessment of Clinical Outcome of Bilateral Decompression through Unilateral Approach in Lumbar Canal Stenosis

Background Data: Acquired degenerative lumbar canal stenosis is considered a common indication for lumbar spine surgery in old patients. The traditional approach is wide open laminectomy, medial facetectomy, and foraminotomy, which includes bilateral muscle separation and extensive excision of the posterior spinal structures. Minimal invasive surgeries as microsurgical and endoscopic have been now used for the treatment of lumbar canal stenosis during the last years.Purpose: To assess clinical outcome of unilateral approach in bilateral decompression of lumbar canal stenosis.Study Design: Observational analytic prospective study.Patients and Methods: Twenty patients with degenerative lumbar canal stenosis have undergone bilateral decompression from unilateral approach at Ain Shams university hospitals between May 2014 and April 2016. Prospective analysis of their clinical outcome was conducted.Results: In this study twelve were male (60%) and eight were female (40%). The mean age was 43.1±12.33 (range 35-55years). The duration of clinical presentation ranged from 6 to 24 months. Preoperative clinical presentation was low back pain (95%), sciatica (85%), neurogenic claudication (100%) and sensory changes (80%). Marked improvement of preoperative leg pain has been observed after surgical decompression. Significant reduction of the mean preoperative VAS (7±0.72) (over all back and leg pain) to VAS 2±0.72) at one, (1.85± 0.58) at three and (1.6± 0.68) at 6 months (P>0.001). The mean ODI scores decreased significantly at one (27±9.78), three (23±7.3) and six months (21±4.47) from the mean preoperative ODI score (61±4.47) (P>0.0001). Accidental durotomy was reported in one patient (5%) and it was in the posterior dura under the opposite lamina just off the midline.Conclusion: Unilateral approach in bilateral decompression is an effective procedure for management of lumbar canal stenosis. (2016ESJ119)

Dilemma in the Surgical Management of Lumbar Canal Stenosis

For a long time wide decompressive laminectomy, direct visualization and decompression of affected nerve roots, foraminotomy and when necessary discectomy had remained the gold standard to operate patients with lumbar canal stenosis. There was confusion in the literature concerning the role of fusion even in the presence of instability in degenerative lumbar canal stenosis due to absence of prospective randomized clinical trials. This has led to uncertainty about the correct choice of surgical strategy as no evidence based recommendations on the role of instrumented PLIF in older patients. Such thoughts have compelled some to try minimally invasive instrumentation with micro decompression, transforaminal interbody fusion and percutaneous pedicle screws. It has the advantage of short incision, less morbidity, shortened bed rest and early ambulation which is so essential in older patients with comorbid conditions. In this study we discuss the pathogenesis of development of spinal conditions and their treatment options through the history of spinal surgery. Also discussed is the dilemma that exists in spinal surgeons regarding the selection of appropriate treatment strategy for stenosis amongst the elderly.

The Pitfalls in Surgical Management of Lumbar Canal Stenosis Associated With Rheumatoid Arthritis

There have been few clinical studies in the area of cervical spine that focused on surgery for treating degenerative lumbar disease in patients with rheumatoid arthritis (RA). High rates of wound complications and instrumentation failure have been reported more for RA than for non-RA patients, although clinical outcomes are similar between the two groups. Lumbar canal stenosis in RA is caused not only by degeneration but also by RA-related spondylitis, which includes facet arthritis and inflammation around the vertebral endplate. The pitfalls in surgical management of lumbar canal stenosis in RA patients are highlighted in this study. The study reviewed 12 patients with RA,who were surgically treated for lumbar canal stenosis. Two out of five patients with pulmonary fibrosis died of worsened pulmonary condition, even though there were no perioperative pulmonary complications. Two patients with pedicle screw fixation showed no instrumentation failure, but two patients with spinous process fixation needed re-operation or vertebral fracture. Surgical treatment for lumbar canal stenosis in RA patients needs to be individually adjusted. Preoperative assessments and treatments of pulmonary fibrosis and osteopenia are essential. Surgery for lumbar canal stenosis with RA should be deferred for patients with advanced pulmonary fibrosis because of its potential life-threatening risk. Fusion surgery is indicated only in patients with kyphosis or severe symptoms caused by intervertebral instability. Pedicle screw fixation with hydroxyapatite granules or sublaminar tape is recommended. Closer follow-up after surgery is necessary because of possible delayed wound infection, instrumentation failure, pathological fracture, and respiratory deterioration.