Lumbar canal stenosis: analyzing the role of stabilization and the futility of decompression as treatment

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The authors report their current experience with their previously published novel form of treatment in 70 cases of lumbar canal stenosis. The treatment consisted of only fixation of the spinal segments by the transarticular screw fixation technique. No bone, ligament, osteophyte, or disc resection was done for spinal canal and neural foraminal decompression. The proposed treatment is based on the concept that vertical instability that results in telescoping of the facets on physical activity forms the nodal point of pathogenesis of lumbar canal stenosis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>During the period June 2014 to May 2018, 70 patients presenting with the classically described symptoms of lumbar canal stenosis were treated surgically by only fixation of involved spinal segments. Apart from clinical and radiological guides, instability was diagnosed on the basis of physical observation of the status of articulation by direct manipulation of bones of the region. The operation involved transarticular insertion of 2 or 3 screws for each articulation. The Oswestry Disability Index and visual analog scale were used to assess the patients before and after surgery and at follow-up. Additionally, a personalized patient satisfaction score was used to assess the outcome of surgery.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Clinical symptomatic recovery was observed in all patients in the immediate postoperative period. During the average follow-up period, 100% of patients had varying degrees of symptomatic relief. The patient satisfaction score suggested that all patients were very satisfied with the surgical procedure. The transarticular fixation technique provided strong spinal segment fixation and a reliable ground for bone arthrodesis. No patient needed any additional modality of treatment or reoperation for recurrence of symptoms.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Spinal instability is the nodal point of pathogenesis of spinal degeneration–related lumbar canal stenosis. Only fixation of the involved spinal segments is necessary—decompression by bone or soft-tissue resection is not necessary.</jats:p></jats:sec>

Unilateral Tubular Approach for Bilateral Laminotomy vs Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

“…Bilateral dissection and retraction of the paraspinal muscles, wide laminectomy, medial facetectomy and foraminotomy were traditional decompression strategy involved in treatment of LSS. Excessive disruption of supraspinous/interspinous ligament complex and posterior bony contribute to spinal instability, which eventually increase the rate of surgical failures and revision surgery 12,13 . Meanwhile, minimally invasive laminectomy approaches have been widely recognized to be associated with decreased approach related morbidity.…”

Adult idiopathic de novo lumbar scoliosis: Analysis of surgical treatment in 14 patients by “only fixation”

“…Patients analyzed in the previous reports specifying the treatment strategy for patients having lumbar canal stenosis have been included in the study. [ 15 ]…”

“…To objectively assess the clinical status, based on a brief questionnaire in the patient's own vernacular language, a personalized patient satisfaction scoring (PSS) system was developed [ Table 6 ]. [ 15 ]…”

“…Gratifying clinical results were achieved following surgical treatment that involved only spinal stabilization without any form of “decompression” for both cervical and lumbar spinal degeneration that leads to symptoms of radiculopathy and/or myelopathy. [ 11 12 13 14 15 16 17 ] In the long run, we identified regression of all secondary manifestations that are attributed to be pathological in spinal degeneration. [ 11 12 13 14 15 16 17 ] It was observed that AIDLS is a manifestation of multisegmental lumbar spinal instability that is more pronounced at a single level and on one side.…”

Editorial. Use of fixation/fusion to treat lumbar spinal stenosis

“…T he authors present a paper that challenges many long-established principles in the treatment of lumbar spinal stenosis (LSS). 1 They treated 70 consecutive patients with LSS over a 4-year period with posterior lumbar fixation and fusion-without performing neural decompressions-as the sole treatment modality. This concept is unique and new to the treatment of lumbar spine disorders.…”