Sublaminar Decompression and Fusion in the Management of Stenotic Lumbar Degenerative Disorders

Abstract

Background Data: Lumbar degenerative disorders may result in low back pain, leg pain and limitation of walking distance that can disturb the patients' life. Several surgical procedures have been used to treat spinal canal stenosis ranging from minimal invasive to extensive decompression and fusion. However, recurrence of symptoms or instability may occur postoperatively.Purpose: To evaluate efficacy and safety of sublaminar decompression and fusion in the management of lumbar degenerative disorders. Study Design: Prospective clinical case study. Patients and Methods: Twenty patients including; 7 central canal stenosis, 5 degenerative disc disease, 4 foraminal and central stenosis, and 4 central stenosis and spondylolisthesis patients were enrolled in this study. All were treated with sublaminar decompression and fusion. Pre-and post-operative clinical evaluation included Visual Analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI). Pre-and post-operative measurement of anteroposterior thecal diameter, thecal cross-sectional area, right and left foraminal height were obtained using MRI and CT-scan. The mean follow up duration was 13.85±8.30 (Range, 8-33) months.Results: VAS of leg pain improved from 7.3±1.4 to 2.4±0.9, VAS of the back pain improved from 7.4±0.9 to 2.3±0.5. ODI improved from 76±7.5 to 29.5±8.3. Anteroposterior thecal diameter changed from 10.4±1.4 mm to 14.1±1.1mm. Thecal sac cross sectional area improved from 134.2±19.6 mm 2 to 184±20.4 mm 2 . Right foraminal height changed from 4.4±0.5 mm to 5.4±0.5 mm and left foraminal height changed from 4.2±0.5 mm to 5.2±0.5 mm. The mean time to achieve bone fusion in our series was 8.1 months and the fusion rate was 95%.Conclusion: Sublaminar decompression and fusion is safe and effective procedure in treatment of stenotic degenerative spinal disorders. It achieves high fusion rate without serious complications. (2018ESJ166)

Spinopelvic Parameters Following Central Decompressive Laminoplasty in Patients with Degenerative Lumbar Spinal Canal Stenosis

“…The mean Estimated Operative Blood Loss (EBL) was 264.16±50.89ml which was less than that of the Liu et al [3] study which was 291.1mL for sublaminartrimming laminoplasty alone, 657.7mL for sublaminar-trimming laminoplasty with PLF, also it was less than Peddada et al [1] study which was 600ml. The mean operative time was distributed as 93.75±11.7 with a minimum of 80 and maximum of 115 minutes which was less than and less than Liu et al [3] which was126.6min for sublaminar trimming laminoplasty alone, also it was less than Saleh et al [19] study in which the mean operative time was 127.5±35.3 (Range, 85-200) minutes.…”

“…Global sagittal balance, spinopelvic morphology, and sagittal alignment should be considered as important factors in surgical planning. The spinopelvic morphology affects the lumbosacral configuration and consequently, the mechanical forces at the lumbosacral junction [15][16][17][18][19][20][21][22]. In their study, most of the patients had neurologic claudication and the prevalence of sagittal imbalance in patients with lumbar canal stenosis was 31.2% which was significantly higher compared to controls [15][16][17][18][19][20][21][22].…”

“…The spinopelvic morphology affects the lumbosacral configuration and consequently, the mechanical forces at the lumbosacral junction [15][16][17][18][19][20][21][22]. In their study, most of the patients had neurologic claudication and the prevalence of sagittal imbalance in patients with lumbar canal stenosis was 31.2% which was significantly higher compared to controls [15][16][17][18][19][20][21][22]. Over the last few years, Different surgical procedures have been described for lumbar spine decompression.…”

“…Nasca RJ has recommended that an arthrodesis can be performed when lumbar stenosis is associated with spinal instability or in the setting of a spondylotic spine associated with low back pain [19].…”

“…Hermansen et al [20] study showed improvement of the mean DSCSA from 80mm 2 preoperatively to 161mm Postoperatively with an increase of 81mm 2 (101%). A study by Saleh et al [19] showed improvements in the mean thecal sac AP diameter from 10.4±1.4 (Range, 6-13) mm to 14.1±1.1 (Range, 12-16)mm at the last follow-up with 35.6% percent of improvement (P<0.001), while the thecal sac crosssectional area improved from 134.2±19.6 (Range, 110-170)mm 2 to 184±20.4 (Range, 150-220)mm 2 showing 37.1% improvement at the last follow up (P<0.001). The mean Estimated Operative Blood Loss (EBL) was 264.16±50.89ml which was less than that of the Liu et al [3] study which was 291.1mL for sublaminartrimming laminoplasty alone, 657.7mL for sublaminar-trimming laminoplasty with PLF, also it was less than Peddada et al [1] study which was 600ml.…”