Evaluation of wide interlaminar fenestration surgery in degenerative lumbar canal stenosis

Abstract

Background: With the increasing longevity of population and a continually climbing proportion of middle-aged and elderly persons, the problem of lumbosacral spine is a significant health care issue, causing backache and Neurogenic claudication. Methods: Thirty patients with degenerative lumbar canal stenosis were included in study and wide interlaminar fenestration with or without discectomy was carried out. Patients were followed and analysis of the outcome was done for improvement in pain, neurological improvement and improvement in claudication distance. Results: Diagnosis of degenerative lumbar canal stenosis were made by clinical examination and confirmed by measuring neural canal diameter in MRI. Patients were selected randomly and total 30 patients included in study with mean age of 45.9 year and with mean duration of symptom was 38.67 months. Wide interlaminar fenestration was done at two level (L4-5, L5-S1) in 9 patients and at one level in remaining 21 patients (L4-L5 in 12 and L5-S1 in 9). All the patients improved in terms of back pain, sensory and motor symptoms including neurogenic claudication. Conclusion: At the end of our study we find that Wide Interlaminar fenestration done in degenerative lumbar canal stenosis provides not only full resolution of neurological symptom but also maintains spinal stability at the same time.

Minimally Invasive 360 Degrees Decompression for Ligamentous, Bony and Discogenic Lumbar Canal Stenosis

“…Ischemia of nerve roots is also believed to be involved in the pathogenesis of neurogenic claudication in lumbar stenosis [1]. LCS can be classified according to etiology or anatomical causes, etiological classification may be congenital stenosis or acquired (degenerative), while anatomical classification is according to the site of compression either central, lateral recess or foraminal stenosis [2]. The compressive elements may include bony stenosis either congenital or degenerative facet hypertrophy.…”

“…Current trends in spine surgery favor minimally invasive yet maximally effective surgical techniques in the order to limit surgery-related morbidity and mortality. Spine surgery is one of the subspecialties in which minimally invasive techniques (MIS) are constantly being developed and modified [2] [17]. Some of the MIS techniques which were introduced to treat LCS and lumbar disc herniation include chemonucleolysis, percutaneous lumbar discectomy, microscopic laminotomy or hemi-laminectomy, and transforaminal or inter laminar endoscopic techniques [6] [18].…”

“…Although there are a number of different MIS techniques for treatment of LCS and lumbar disc herniation, all these techniques seem to be inferior to the traditional gold standard direct posterior microsurgical approach. The MIS direct lumbar decompression/discectomy favors a "muscle splitting" rather than a subperiosteal dissection technique as is used in traditional methods [2] [6] [19].…”