Treatment Of Lumbar Canal Stenosis Research Articles

Stand-Alone Percutaneous Pedicle Screw Lumbar Fixation to Indirectly Decompress the Neural Elements in Spinal Stenosis: A Radiographic Assessment Case Series.

The ideal surgical treatment of lumbar canal stenosis remains controversial. Although decompressive open surgery has been widely used with good clinical outcome, minimally invasive indirect decompression techniques have been developed to avoid the complications associated with open approaches. The purpose of this study was to evaluate the radiologic outcome and safety of the indirect decompression achieved with stand-alone percutaneous pedicle screw fixation in the surgical treatment of lumbar degenerative pathologies. Twenty-eight patients presenting with spinal degenerative diseases including concomitant central and/or lateral stenosis were treated with stand-alone percutaneous pedicle screw fixation. Radiographic measurements were made on axial and sagittal magnetic resonance (MR) images, performed before surgery and after a mean follow-up period of 25.2 months. Measurements included spinal canal and foraminal areas, and anteroposterior canal diameter. Percutaneous screw fixation was performed in 35 spinal levels. Measurements on the follow-up MR images showed statistically significant increase in the cross-sectional area of the spinal canal and the neural foramen, from a mean of 88.22 and 61.05 mm2 preoperatively to 141.52 and 92.18 mm2 at final follow-up, respectively. The sagittal central canal diameter increased from a mean of 4.9 to 9.1 mm at final follow-up. Visual analog scale (VAS) pain score and Oswestry Disability Index (ODI) both improved significantly after surgery (p < 0.0001). Stand-alone percutaneous pedicle screw fixation is a safe and effective technique for indirect decompression of the spinal canal and neural foramina in lumbar degenerative diseases. This minimally invasive technique may provide the necessary decompression in cases of common degenerative lumbar disorders with ligamentous stenosis.

Unilateral laminotomy for bilateral decompression and balloon kyphoplasty to decompress lumber canal stenosis aggravated by osteoporotic vertebral compression fractures: A technical note.

The optimal treatment of lumbar canal stenosis (LCS) associated with osteoporotic vertebral fractures (OVFs) remains unclear. Here, we have combined a minimally invasive unilateral laminotomy for bilateral decompression (ULBD) alone with balloon kyphoplasty (BKP) for LCS aggravated by OVF. ULBD with BKP was performed in three patients who showed LCS associated with OVFs on MR images with progressive lower extremity neurological deficits. Clinical outcomes were assessed using the numerical rating scale (NRS) and the Japanese Orthopaedic Association (JOA) score. Radiological outcomes were evaluated using multiple parameters (i.e., fractured vertebral body height, lumbar lordosis [LL], and focal angle of the fractured vertebral body). Over 6 postoperative months, the NRS and JOA scores were clearly improved while radiological parameters remained maintained (i.e., loss of fractured vertebral body height was only 0.3-1.4 mm in all cases). Two of the three cases showed restoration of LL and focal angle postoperatively. The combination of ULBD with BKP is an effective option for LCS aggravated by OVF.

A meta-analysis of clinical effects of microscopic unilateral laminectomy bilateral decompression (ULBD) versus biportal endoscopic ULBD for lumbar canal stenosis.

OsbjectiveSeveral studies have shown that both microscopic unilateral laminotomy bilateral decompression (ULBD) and unilateral biportal endoscopic (UBE) ULBD are effective for treating lumbar canal stenosis (LCS). However, there are different viewpoints as to which surgical technique is superior. Therefore, this meta-analysis investigated the clinical efficacy and side effects of microscopic ULBD and UBE ULBD for treating LCS.MethodsTo identify relevant studies describing the clinical outcomes and complication rates of microscopic ULBD and UBE ULBD for LCS, several databases were systematically searched in the Internet. The visual analog scale score for back and leg pain and the Oswestry Disability Index were used to assess clinical outcomes. Furthermore, data about perioperative outcomes and complications were documented.ResultsIn total, six studies with 450 participants were included in this meta-analysis. The UBE ULBD was found to be superior to microscopic ULBD in terms of efficacy against early postoperative back and leg pain. However, there was no significant difference between the two procedures in terms of final clinical outcomes and complications. In addition, compared with microscopic ULBD, UBE ULBD was associated with a significant reduction in the length of hospital stay and C-reactive protein levels 2 days after surgery.ConclusionUBE ULBD and microscopic ULBD for the treatment of LCS were similar in terms of final clinical outcomes and complications. However, UBE ULBD has several advantages over microscopic ULBE, including a shorter hospital stay and faster alleviation of postoperative back and leg pain.

Comparison of Microscopic Decompression and Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Canal Stenosis and Herniated Disc: A One-year Follow-up

Backgrounds. Microscopic decompression (MD) has been widely used as an alternative to open decompression. Lately, biportal endoscopic spinal surgery (BESS) - a new approach in minimal-invasive spinal surgery – has also been used with good results. Although both groups can achieve adequate lumbar decompression, there is still a lack of evidence regarding their comparison. We aim to compare the outcomes of both techniques in a one-year follow-up.&#x0D; Methods. This is a retrospective study in 100 consecutive patients with symptomatic lumbar spine compression due to herniated nucleus pulposus (HNP) and lumbar canal stenosis (LCS) that was treated by either BESS or MD. Clinical evaluations using Visual Analog Score (VAS), Oswestry Disability Index (ODI), and SF-36 questionnaire were obtained. Objective data such as surgery duration, amount of postoperative drain production, and hospital length of stay were collected. Complications were noted throughout the follow-up time.&#x0D; Results. The BESS group had a significantly lesser surgical duration, drain production, and length of stay. At one year follow-up, both groups achieved significant improvement in VAS, ODI, and SF-36 compared to the preoperative condition. Complications were not observed in the BESS group.&#x0D; Conclusions. Both procedures were comparably effective to treat lumbar stenosis. Although this study shows superiority with BESS technique in immediate and long-term follow-up, the final choice may depend on the surgeon's preference

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BACKGROUND In this study we wanted to test hypothesis that posterior ligament complex preserving decompression has advantages over conventional decompression surgeries for the treatment of lumbar canal stenosis, assess clinical and functional outcome following decompression surgeries whether preservation has advantages over routine decompression and use radiological parameters pre operatively and post operatively to evaluate whether there is adjacent segment degeneration following decompression surgeries for canal stenosis. METHODS This is a prospective study conducted among in-patient and outpatient follow ups of the Department of Orthopaedics of MIMS Hospital, Calicut, over a period of 22 months from February 2017 to November 2018. RESULTS The mean age of patients included in the study in PLC preserved group was 58.68 ± 11.3 years and in PLC non-preserved group, it was 62.75 ± 11.18 years. There was a slight female predominance in PLC preserved group (60 %) and in PLC non preserved group male to female ratio was 1:1 At 1 year follow up both the groups of patients had significant relief of symptoms and had improved functional outcome. At 1 year follow up ODI and VAS score were better in PLC preserved group compared with PLC not preserved group. There was adjacent segment disc height improvement in both the groups, and was maintained in the PLC preserved group while during the final follow up there was slight reduction in the mean disc height in PLC not preserved group. Intervertebral disc angle and total lumbar lordosis in both the groups were comparable during 1 year follow up. Adjacent segment slip was not noted in both the groups. Adjacent segment degeneration was not detected in both the groups. CONCLUSIONS Lumbar decompressive surgeries with both PLC preserving and non-preserving surgeries can provide significant relief of symptoms to the patient. PLC preserving surgeries provide better functional outcome during the 1 year follow up period. Similarly residual pain was also less in the PLC preserved group. Adjacent segment degeneration was not detected in both the groups during the one year follow up. KEY WORDS Posterior Ligamentous Complex, Decompressive Surgeries, Lumbar Spinal Canal Stenosis

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

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.

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.

Surgical Treatment of Lumbar Spinal Canal Stenosis by Laminectomy and Posterolateral Fusion

Background: Lumbar spinal stenosis is a common spinal disease, which lead to neural compression leading to pain, limitation of individuals function and reduced the quality of life. Aim of the work:To evaluate the results of surgical treatment of lumbar spinal canal stenosis [LCS] by laminectomy and instrumented posterolateral Fusion. Patients and Methods: A prospective study had been conducted at Orthopedic Surgery Department [Al-Azhar University Hospital, Damietta] to evaluate the outcomes of treatment of lumbar canal stenosis by laminectomy and posterolateral fusion. This study included 15 patients, and the average follow up was 6 months from December 2018 to May 2019. Pain, clinical and radiological outcomes had been assessed. Preoperatively, all patients had been evaluated clinical and radiologically. In addition, lab investigations had been performed to assess the patient. Results: The study included 15 patients [10 females and 5 males], their age ranged between 30-55 years [mean age 42.8 years]. The surgical outcome [according to Odom Criteria] revealed that, excellent outcome reported among 26.7%, and 40% had good outcome, fair outcome among 26.7% and poor outcome among 6.7%. Conclusion: Laminectomy with instrumented posterolateral fusion is a good surgery to treat degenerative lumbar canal stenosis, with reasonable outcome.

Video Endoscopic Surgery in the Treatment of Lumbar Canal Stenosis: A systematic review

Video Endoscopic Surgery in the Treatment of Lumbar Canal Stenosis: A systematic review

Comparative Study of Minimally Invasive Lumbar Decompression versus Decompressive Laminectomy with Posterolateral Transpedicular Fixation for the Treatment of Degenerative Lumbar Canal Stenosis.

Background:The classic laminectomy for spinal decompression was the treatment of choice of the degenerative lumbar canal stenosis (LCS). Many surgeons prefer to add instrumented lumbar fusion to avoid future instability after the removal of posterior elements. Adding fusion is associated with more bleeding and longer periods of hospitalization. Minimally invasive lumbar decompression (MILD) has been advocated for successful decompression with less bleeding loss and shorter hospitalization.Aim of the Work:To evaluate and compare the clinical outcomes of two different treatment modalities for degenerative LCS: the classic laminectomy with posterolateral transpedicular screw fixation and the MILD.Patients and Methods:Fifty patients with degenerative LCS were randomized from two institutions: Ain Shams University Hospital and Arab Contractors Medical Center, who underwent surgeries for degenerative LCS between 2016 and 2018 with 1-year follow-up. The study compared two cohorts: Group A – 25 patients underwent classic lumbar laminectomy with posterolateral transpedicular fixation, and Group B – 25 patients underwent MILD.Results:There were no statistically significant differences between both treatment modalities in the VAS for leg pain and back pain, the patient satisfaction index, and the Oswestry disability index after 1 year. The fusion operations were associated with higher estimates of blood loss, longer hospital stay, and more financial costs.Conclusion:MILD has the same satisfactory results as classic laminectomy with posterolateral fixation for the treatment of degenerative LCS with less bleeding loss and shorter hospitalization. Since the results are comparable, MILD is suggested in low-income countries as Egypt for economic reasons.

Short-Term Efficacy of Epidural Injection of Triamcinolone Through Translaminar Approach for the Treatment of Lumbar Canal Stenosis.

BackgroundEpidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy.ObjectivesIn this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis.MethodsIn a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI).ResultsThe study population included 32 (28.8%) males and 79 (71.2%) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r = -0.400, P < 0.001) and BMI (r = -0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r = -0.569, P < 0.001).ConclusionsEpidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis.

Unilateral laminotomy versus conventional laminectomy in treatment of lumbar canal stenosis. A prospective comparative study

Background Data: Lumbar spinal stenosis is common in elderly and obese patients. Surgical intervention should be considered only after all conservative treatment options have been proven unsuccessful. Wide laminectomy was the gold standard of treatment, but surgical failures have been reported. Recently, a less invasive decompressive surgical procedures have emerged as an alternative technique. Purpose: To compare between the unilateral laminotomy approach and conventional laminectomy approach for the treatment of lumbar canal stenosis, regarding clinical outcomes. Study Design: This is a prospective clinical randomized controlled study. Patients and Methods: This study included 30 patients with lumbar canal stenosis. 15 patients underwent unilateral laminotomy approach (Group A), while the other 15 patients underwent conventional laminectomy approach (Group B). Surgical operative time, blood loss, and hospital stay were recorded. Clinical outcomes have been assessed by Visual Analogue Scale (VAS) of leg pain and Oswestry Disability Index (ODI). Patients were followed up for 1 year postoperatively. Results: Male to female ratio was 12:18 patients. The mean age was 52.5±6.62 years in Group A and 52.2±7.24 years in Group B. The mean operative time was 73.5±14.54 minutes in Group A and 85.5±17.07 minutes in Group B. Less blood loss was recorded in Group A (127±37.43 ml) than Group B (152±50.95 ml). Three patients suffered unintended durotomy in both groups and no postoperative CSF leak occurred. Marked reduction of VAS and ODI was achieved in both groups at one-year follow-up without statistically significant difference. Conclusion: Unilateral laminotomy approach used for bilateral neural compression is an effective technique for treatment of lumbar canal stenosis in comparison to conventional laminectomy approach. (2019ESJ184)

PRELIMINARY RESULTS OF VERTEBRAL CANAL DECOMPRESSION BY SPINOUS PROCESS SPLITTING

ABSTRACT Objective Considering that the technique of spinous process splitting has been advocated as a less invasive treatment of lumbar stenosis, the objective of this study was to evaluate the preliminary results of this technique in the surgical treatment of lumbar canal stenosis. Methods Twenty patients with lumbar spinal canal stenosis who underwent surgical treatment for lumbar canal decompression with the spinous process splitting technique were assessed in the preoperative period and on postoperative days 1, 7 and 30 for VAS for lower back and lower limbs pain and radiographic evaluation of the operated segment. Results The mean visual analogue scale score for lumbar pain in the preoperative assessment was 4.2 ± 3.37 and 0.85 ± 0.88, 1.05 ± 1.19 and 1.15 ± 1.04 after 1, 7 and 30 postoperative days, respectively. The mean VAS score for lower limb pain was 8 ± 1.72 preoperatively, and 0.7 ± 1.13, 0.85 ± 1.04, and 1.05 ± 1 after 1, 7, and 30 postoperative days, respectively. There were no radiographic signs of instability of the vertebral segment operated in the radiographic evaluation. Conclusions Decompression of the lumbar canal through the spinous process splitting technique in patients with lumbar canal stenosis had good immediate and short-term results in relation to low back and lower limbs pain. Level of evidence IV; Therapeutic Study.

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.

Efficacy of Endoscopic Surgery in Management of Patients with Lumbar Canal Stenosis

Background Data: The treatment of lumbar stenosis has originally included extensive resections of posterior neural arch components. Moreover, wide muscular dissection and retraction is generally used to accomplish sufficient visualization. With the advancing noninvasive neuro-imaging modalities; the major component of neurological pressure typically occurs at the level of the interlaminar window. Microendoscopic decompressive laminotomies (MEDL) have now increased popularity among spine specialists for the treatment of lumbar canal stenosis. It has been developed from the unilateral hemilaminotomy technique.Purpose: To evaluate the efficacy of lumbar endoscopic decompression in patients of segmental lumbar canal stenosis from a unilateral skin incision.Study Design: A prospective clinical case study.Patients and Methods: A total of 30 patients 10 males and 20 females were operated in Alexandria Main University Hospital, during the period from January 2013 to June 2015. The degree of pain and disability were assessed pre-operatively using the Visual Analogue Scale (VAS), both for radicular pain and back pain (if present), and the Oswestry Disability Index (ODI). The length of the incision, the duration of surgery, the operative blood loss, and duration of hospital stay were calculated. Mean follow up period for patients was 38.5±18.2 months (Range, 36-48).Results: The mean age was 62.7±6.9 years. All patients had claudicating sciatica; 57% had bilateral sciatica, while 43 % had unilateral sciatica. 60% had low back pain. Only 3 patients (10%) had motor weakness preoperatively. 24 patients (80%) had single level affection, while 6 patients (20%) had double level affection. We operated totally on 36 segmental levels. There was a statistically significant reduction for the mean values of VAS both for radicular pain and back pain in the follow up period (P<0.001). Also, there was a statistically significant reduction for the ODI mean value in the follow up period (P<0.001). Operative blood loss was 109.5±63.2 ML. Mean operative time was 103.8±32.7 minutes. Mean duration of hospital stay was 1.5±0.6 days (Range, 1-3 days). We had two patients of intraoperative dural tears (7%) with no postoperative CSF leak occurred, two patients (7%) had superficial wound infection, no patients had deep wound infection or discitis, and no patients encountered of postoperative instability in the follow up period. Conclusion: Endoscopic surgery for bilateral decompression through a unilateral approach is a useful and effective procedure for treating patients with lumbar canal stenosis with encouraging results. (2018ESJ161)

Lumbar canal stenosis: can we treat it endoscopically?

The common treatment for lumbar canal stenosis involves an open surgical decompression with laminectomy and foraminotomy, even if spinal surgery is moving towards minimal invasiveness procedures. Minimally-invasive surgery initially and recently spinal endoscopic techniques are becoming the standard procedures for lumbar disk prolapsed in consideration of the less surgical invasiveness with a considerable reducing in the amount of normal anatomy violation, in less risk of iatrogenic postoperative instability, minimal scar tissue formation and negligible blood loss when compared to the standard open approach. These techniques also reduce the postoperative pain with consequent less need of using pain medications as well as reduced hospital stay. From August 2016 to July 2017, we prospectively collected data on 20 patients operated on for a lumbar canal stenosis using a pure interlaminar endoscopic route. This series includes 2 unilateral and 3 bilateral L5-S1 stenosis; ten L4-L5 stenosis (8 bilateral and 2 unilateral); four L3-L4 bilateral stenosis and one bilateral L2-L3 stenosis. Among these, six were two adjacent multiple levels stenosis: L4-L5-S1 two cases; L3-L4-L5 three cases and L2-L3-L4 one case. We reviewed the demographic data as well as the pre and postoperative Visual Analogue Score and Oswestry Disability Index at 3, 6 and 12 months. We also collected the surgical complications and the result of a six-month questionnaire on patients' satisfaction. The median operative time was 125 minutes (range between 45 and 300 minutes). Twenty-two (90%) of the patients were satisfied with the treatment received in terms of clinical results at one year follow-up. Two patients (10%) had been converted to an open procedure. The use of the endoscopic technique for the treatment of lumbar canal stenosis seems to be correlated with good results and can be a valid alternative to the classic, more invasive, open technique.

Surgical treatment for lumbar canal stenosis in adult achondroplasia

Introduction: Achondroplasia is the most common form of human short-limbed dwarfism caused by mutations in theFGFR3 gene, with an incidence of 1 in 30,000 live births annually in global.Achondroplasia is characterized by foramen magnum stenosis, thoracolumbar kyphosis, spinal stenosis, shortened pedicles, genu varum, and short stature. Methods: We report a female, 51 years old, with lumbar canal stenosis due to degenerative disc disease and achondroplasia. We decided to perform decompression (laminectomy) and posterior stabilization. Post-operatively, we observed the general condition of the patient, neurovascular complication, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), implant position and spinal structure condition. Results: There was no neurovascular complication following the surgery. Mean VAS score of the leg pain improved from 5 to 2. ODI scores also improved consecutively from 18 out of 45 (40%) to 8 out of 45 (17,7%). The sensory function at the L5 and S1 dermatome region of the right leg was improved, as well as the radiological evaluation. Conclusion: Decompression followed by posterior stabilization in a one-stepsurgery isan effective surgical modality to treat lumbar canal stenosis in achondroplastic patients. However, pedicle screw instrumentation in patients with achondroplasia and short stature can be challenging. Safe insertion requires technical experience and knowledge of the achondroplastic pedicle morphometry, which differs markedly from that of the normal spine.

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)

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

BackgroundCorticoids have potent anti-inflammatory effects, which may help in relieving pain and dysfunction associated with lumbar canal stenosis. We assessed the effectiveness of a decreasing-dose regimen of oral corticoids in the treatment of lumbar canal stenosis in a prospective, double-blind, randomized, placebo-controlled trial.ResultsSixty-one patients with lumbar canal stenosis (50–75 years; canal area < 100 mm2 at L3/L4, L4/L5, and/or L5/S1on magnetic resonance imaging; and claudication within 100 m were electronically randomized to an oral corticoid group (n = 31) or a placebo group (n = 30). The treatment group received 1 mg/kg of oral corticoids daily, with a dose reduction of one-third per week for 3 weeks. Patients and controls were assessed by the Short Form 36 Health Survey, Roland–Morris Questionnaire, 6-min walk test, visual analog scale, and a Likert scale. All instruments showed similar outcomes for the corticoid and placebo groups (P > 0.05). Obese patients exhibited more severe symptoms compared with non-obese patients. L4/L5 stenosis was associated with more severe symptoms compared with stenosis at other levels.ConclusionThe oral corticoid regimen used in this study was not effective in the treatment of lumbar canal stenosis.