Spinal Instability following Multilevel Decompressive Laminectomy without Fusion for Degenerative Lumbar Canal Stenosis

Thamer A Hamdan and Ahmad S Abdul Hassan*

Department of Orthopedic and Spine Surgery, University of Basrah, Iraq

^*Correspondance to: Ahmad S Abdul Hassan, 

 PDF  Full Text Review Article | Open Access

Abstract:

Purpose: This study explores segmental instability as a possible complication of decompressive
laminectomy for lumbar spinal stenosis in terms of its occurrence and its impact on functional
outcomes.
Methods: From March 2017 to March 2019, a prospective cohort study was conducted in
Basrah Teaching Hospital, enrolled 25 patients with degenerative lumbar canal stenosis without
instability, who underwent first-time multilevel decompressive laminectomy preserving both facets
, intervertebral discs and without fusion. They were followed up for a mean of 13 months (4-24);
every patient was evaluated clinically and radiologically utilizing functional radiography to assess
for segmental instability. Oswestry Disability Index (ODI) was used to determine the functional
outcomes as well. Statistical analysis contemplated to explore any significant association between
instability and the following patient characteristics: age, gender, body mass index, the pre-operative
duration of complains diabetes mellitus and hypertension, total levels decompressed, and level of
decompression. The analysis was repeated for any association between ODI and instability or the
factors above.
Results: There was high prevalence of medical and other musculoskeletal comorbidity, the incidence
of post-operative instability was 8%, No significant correlation was measured between the instability
or ODI and patient characteristics.
Conclusion: On short and medium term follow up, facet preserving multilevel decompressive
laminectomy is a rational treatment strategy providing pain relief and good functional outcomes
for wide range of patients with degenerative spinal stenosis and no instability, as well as minimizing
risks of spinal fusion, the indications of fusion should be restricted to patients of lumbar stenosis
accompanied by spinal instability or deformity. Long term follow up is required to validate these
results further.

Keywords:

Segmental instability; Spinal stenosis; Facet sparing laminectomy; Spinal fusion

Cite the Article:

Hamdan TA, Abdul Hassan AS. Spinal Instability following Multilevel Decompressive Laminectomy without Fusion for Degenerative Lumbar Canal Stenosis. World J Surg Surgical Res. 2020; 3: 1193..