The effect of decompression with posterior spinal fusion on back and leg pain in lumbar canal stenosis
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251132Keywords:
Lumbar spine, Lumbar canal stenosis, Oswestry disability index, Posterolateral fusion, Pedical screw, VAS scoreAbstract
Background: Lumbar canal stenosis, characterized by pain, numbness and neurological claudication, causes gradually worsening back and leg pain, which can lead to neurologic compromise and patient distress. Posterior lumbar interbody fusion (PLIF) has been used for spinal fusion, with any of the decompression procedures. We aimed to examine the effects of decompression with PLIF on back pain, leg pain and neurological claudication in patients with lumbar canal stenosis.
Methods: In this observational study, total of 50 patients with lumbar canal stenosis who underwent PLIF at Bharati Hospital were included from January, 2020, to April, 2022. Selected patients had LS spine X-rays and MRIs. Neurological claudication, VAS scores for back and leg pain and Oswestry Disability Index were assessed at 3 months, 6 months, 9 months and 12 months post-op.
Results: The majority (19 (38%)) of the patients were between the ages of 50 and 60, with 23 men and 27 women in total. 50% of study participants had pain in both legs. Neurologic claudication decreased significantly from pre-op to post-op and at 3, 6, 9 and 12 months' follow up, none of the patients reported it. A significant decrease in the mean of VSB and VSL was reported at post-op, 3, 6, 9 and 12 months. The ODI score also decreased significantly at post-op, 3, 6, 9 and 12 months.
Conclusions: PLIF with interbody fusion and local graft with posterior instrumentation gave significantly improved clinical and functional outcomes by significantly reducing pain, as determined by the VAS scores for back and leg pain.
Metrics
References
Munakomi S, Foris LA, Varacallo M. Spinal Stenosis and Neurogenic Claudication. Treasure Island (FL): StatPearls Publishing. 2022. Available at: https://www.ncbi.nlm.nih.gov. Accessed on 18 November 2024.
Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009;9(7):545-50. DOI: https://doi.org/10.1016/j.spinee.2009.03.005
Daniel J. Mazanec, Vinod K. Podichetty, Augusto Hsia. Lumbar canal stenosis: Start with nonsurgical therapy. Cleveland Clinic Journal of Med. 2002;69(11):909- 17. DOI: https://doi.org/10.3949/ccjm.69.11.909
Arnoldi C, Brodsky A, Cauchoix J. Definition and classification of lumbar spinal stenosis and nerve root entrapment syndromes. Clin Orthop. 1976;115:4-5. DOI: https://doi.org/10.1097/00003086-197603000-00002
Hall S, Bartleson J, Onofrio B, Baker H Jr, Okazaki H, O’Duffy D. Lumbar spinal stenosis—clinical features, diagnostic procedures and result of surgical treatment in 68 patients. Ann Intern Med 1985;103:271-5. DOI: https://doi.org/10.7326/0003-4819-103-2-271
Gelalis ID, Stafilas KS, Korompilias AV, Zacharis KC, Beris AE, Xenakis TA. Decompressive surgery for degenerative lumbar spinal stenosis: long-term results. Int Orthop. 2006;30(1):59-63. DOI: https://doi.org/10.1007/s00264-005-0030-6
Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18.
Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine. Spine (Phila Pa 1976). 2002;15;27(4):432-8. DOI: https://doi.org/10.1097/00007632-200202150-00021
Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976). 2008;1;33(1):90-4. DOI: https://doi.org/10.1097/BRS.0b013e31815e3a10
Matsui H, Tsuji H, Sekido H, Hirano N, Katoh Y, Makiyama N. Results of expansive laminoplasty for lumbar spinal stenosis in active manual workers. Spine (Phila Pa 1976). 1992;17(3):37-40. DOI: https://doi.org/10.1097/00007632-199203001-00008
Postacchini F, Cinotti G, Perugia D, Gumina S. The surgical treatment of central lumbar stenosis: multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br. 1993;75:386-92. DOI: https://doi.org/10.1302/0301-620X.75B3.8496205
Sanderson PL, Getty CJ. Long-term results of partial undercutting facetectomy for lumbar lateral recess stenosis. Spine. 1996;s21:1352-6. DOI: https://doi.org/10.1097/00007632-199606010-00015
Seong YJ, Lee JS, Suh KT, Kim JI, Lim JM, Goh TS. Posterior decompression and fusion in patients with multilevel lumbar foraminal stenosis: a comparison of segmental decompression and wide decompression. Asian Spine J. 2011; 5(2):100-6. DOI: https://doi.org/10.4184/asj.2011.5.2.100
Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;24(2):253-265. DOI: https://doi.org/10.1016/j.berh.2009.11.001
Singh V, Bansal A, Kumar A, Rawat S, Kela BS. Outcomes of lumbar canal stenosis treated with posterior decompression and spinal. Indian J Orthop Surg. 2019;5:21-8. DOI: https://doi.org/10.18231/j.ijos.2019.005
Chen B, Lv Y, Wang ZC, Guo XC, Chao CZ. Decompression with fusion versus decompression in the treatment of lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99(38):21973. DOI: https://doi.org/10.1097/MD.0000000000021973
Kim DH, Jeong ST, Lee SS. Posterior lumbar interbody fusion using a unilateral single cage and a local morselized bone graft in the degenerative lumbar spine. Clin Orthop Surg. 2009;1:214-21. DOI: https://doi.org/10.4055/cios.2009.1.4.214
Kok D, Grevitt M, Wapstra FH, Veldhuizen AG. The Memory Metal spinal system in a Posterior Lumbar interbody Fusion (PLIF) Procedure: A Prospective, Non-comparative study to evaluate the safety and performance. The Open Orthop J. 2012;6:220-2. DOI: https://doi.org/10.2174/1874325001206010220
Murthy H, Reddy TVS. VAS score assessment for outcome of posterior lumbar interbody fusion in cases of lumbar canal stenosis. Int J Res Orthop. 2016;2:164-9. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20163124
Fox MW, Onofrio BM, Onofrio BM, Hanssen AD. Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg. 1996; 85(5):793-802. DOI: https://doi.org/10.3171/jns.1996.85.5.0793
Lee CH, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Decompression only versus fusion surgery for lumbar stenosis in elderly patients over 75 years old: which is reasonable? Neurol Med Chir (Tokyo). 2013;53(12):870-4. DOI: https://doi.org/10.2176/nmc.oa2012-0415
Donnarumma P, Tarantino R, Nigro L, Rullo M, Messina D, Diacinti D, et al. Decompression versus decompression and fusion for degenerative lumbar stenosis: analysis of the factors influencing the outcome of back pain and disability. J Spine Surg. 2016;2(1):52-8. DOI: https://doi.org/10.21037/jss.2016.03.07
Bevevino AJ, Kang DG, Lehman Jr RA, Van Blarcum GS, Wagner SC, Gwinn DE. Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion. J Clin Neurosci. 2014;21(10):1686-90. DOI: https://doi.org/10.1016/j.jocn.2014.02.021
Sim HB, Murovic JA, Cho BY, Lim TJ, Park J. Biomechanical comparison of single-level posterior versus transforaminal lumbar interbody fusions with bilateral pedicle screw fixation: segmental stability and the effects on adjacent motion segments. J Neurosurg: Spine. 2010;12(6):700-8. DOI: https://doi.org/10.3171/2009.12.SPINE09123