VAS score assessment for outcome of posterior lumbar inter body fusion in cases of lumbar canal stenosis
Keywords:Lumbar canal stenosis, VAS, Posterior lumbar interbody fusion, Time interval
Background: One of the major causes for disability in adult working population is degenerative lumbosacral spine disorders are fairly common in middle aged and elderly population. Lumbar canal stenosis remains one of the most frequently encountered clinically important degenerative spinal disorders requiring operative treatment in the aging population. The objective of the present study is to assess the outcome of posterior lumbar inter body fusion in cases of lumbar canal stenosis
Methods: The present study, 30 cases of lumbar canal stenosis, who were treated operatively with decompression and posterior lumbar inter body fusion, which was carried out over a period of 6 months in a tertiary care center were included. 16 women and 14 men were included in the study.
Results: Most patients were in the age group of 41-50 years (36.7%) followed by 51-60 years (33.3%). In this study it was found that there was significant improvement in VAS score for back pain and leg pain over the 6 month follow-up. There is significant difference between mean improvement in VAS score with respect to number of levels involved for leg pain (p =0.01). There is no statistical significance difference between number of levels involved and improvement in back pain (p =0.66).Conclusions:VAS score showed posterior lumbar interbody fusion with interbody cage and local graft with posterior instrumentation gave significantly improved clinical and functional outcome by causing significant reduction in pain and patient disability.
Katz JN, Harris MB (2008) Clinical practice: lumbar spinal stenosis. N Engl J Med. 2008;358:818-25.
Sairyo K, Katoh S, Sasa T, Goel VK, Vadapalli S, Masuda A, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: A clinical and biomechanical study. American Journal of Sports Medicine. 2005;33(4):583-90.
Lee CH, Hyun SJ, Kim KJ et al: Decompression Only Versus Fusion Surgery for Lumbar Stenosis in Elderly Patients Over 75 Years Old: Which is Reasonable?. Neurol Med Chir. 2013;5(3):194-200.
Truszczynska A, Rqpala K, Truszczynski O, Tarnowski A, Łukawski S. Return to work after spinal stenosis surgery and patients' quality of life. lnt J Occup Med Environ Health. 2013;26(3):394-400.
Postacchini F. The diagnosis of lumbar spinal stenosis: analysis of clinical and radiographic fi ndings in 43 cases. Ital J Orlhop Traumatol. 1985;11:5-21 .
Tan SB. Spinal canal stenosis. Singapore Med J. 2003;44:168-9 .
Epstein NE, Maldonado VC, Cusick JF. Symptomatic lumbar spinal stenosis. Surg Neurol. 1998;50:3-10 .
Alvarez JA, Hardy RH Jr. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Physician. 1998;57:1825-40 .
Krag MH, Beynnon BD, Pope MH, Frymoyer JW, Haugh LD, Weaver DL. An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine: design and testing. Clin Orthop Relat Res. 1986;203:75-98.
Roy-Camille R, Saillant G, Mazel C. lnternal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986;203:7-17.
Hur JW, Kim SH, Lee JW, Lee HK. Clinical analysis of postoperative outcome in elderly patients with lumbar spinal stenosis. J Korean Neurosurg Soc. 2007;41:157-160.
Hanley EN Jr. The indications for lumbar spinal fusion with and without instrumentation. Spine. 1995;20:1435-53.
Kwon BK, Berta S, Daffner SD, Vaccaro AR, Hilibrand AS, Grauer JN, et al. Radiographic analysis of transforaminal lumbar interbody fusion for treatment of adult isthmic spondylolisthesis. J Spinal Disord Tech. 2003;16:469-76.
Lowe TG, Tahernia AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop. 2002;394:64-72.
Whitecloud TS 3rd, Roesch WW, Ricciardi JE. Transforaminal interbody fusion versus anterior-posterior interbody fusion of the lumbar spine: a financial analysis. J Spinal Disord. 2001;14:100-3.
France JC, Yaszemski MJ, Lauerman WC, Cain JE, Glover JM, Lawson KJ, et al. A randomized prospective study of posterolateral lumbar fusion: outcomes with and without pedicle screw instrurnentation. Spine. 1999;24:553-60.
Mdller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesis-a prospective randomized study: part 1. Spine. 2000;25:1711-5.
Fritzell P, Hdgg O, Wessberg P, Nordwall A. 2001 Volvo award winner in clinical studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicentre randomized controlled trial from the Swedish Lumbar Spine Study group. Spine. 2001;26:2521-34.
Hallett A, Huntley JS, Gibson JN. Foraminal stenosis and single-level degenerative disc disease: a randomized controlled trial comparing decompression with decompression and instrumented fusion. Spine. 2007;32:1375-80.
Lin PM. A technical modification of Cloward's posterior lumbar interbody fusion. Neurosurgery. 1977;1(1):18-24.
Diedrich O, Luring C, Pennekamp PH, Perlick L, Wallny T, Kraft CN. Effect of posterior lumbar interbody fusion on the lumbar sagittal spinal profile. Z Orthop lhre G renzgeb. 2003;141(4):425-32.
Cunningham BW, Polly DW Jr. The use of interbody cage devices for spinal deformity: a biomechanical perspective. Clin Orthop Relat Res. 2002;394:73-83.
Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine. 2002;27:1526-42.
Hacker RJ. Comparison of interbody fusion approaches for disabling low back pain. Spine. 1997;22:660-5.
Nath R, Middha S, Gupta AK, Nath R. Functional outcome of surgical management of degenerative lumbar canal stenosis. lndian J Orthop. 2012;46(3):285-90.
Audat Z, Moutasem O, Yousef K, Mohammad B. Comparison of clinical and radiological results of posterolateral fusion, posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine. Singapore Med J. 2012;53(3):183-7.
Zhao J, Zhang F, Chen X, Yao Y. posterior interbody fusion using a diagonal S" with unilateral transpedicular screw fixation for lumbar stenosis. Clin Neurosci. 2011;19(3):324-9.
Kim DH, MD, Jeong ST, MD, Lee SS. Posterior Lumbar Interbody Fusion using a Unilateral single cage and a Local Morselized Bone Graft in the Degenerative Lumbar Spine. Clinics in Orthopedic Surgery. 2009;1:214-21.
Kok D, Grevitt M, Wapstra FH, Veldhuizen AG. The Memory Metal spinal system in a Posterior Lumbar lnterbody Fusion (PLIF) Procedure: A Prospective, Non-comparative study to Evaluate the safety and performance. The open orthopaedics Journal. 2012;6:220-2.
Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, et al. The Maine Lumbar spine study, part lll. 1-year outcomes of surgical and, nonsurgical management of lumbar spinal stenosis. Spine. 1996;21(15):1787-94.
Herron LD, Mangelsdorf C. Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord. 1991;4:26-33.
Ng LC, Sell P. Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study. J Bone Joint surg Br. 2004;86(4):546- 9.