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Research Paper | Orthopaedic Surgery | India | Volume 12 Issue 2, February 2023
Prospective Study of Clinical and Functional Outcome of Laminectomy in a Case of Lumbar Canal Stenosis in Adults
M. B Lingayat [2] | Yogendra Agiwal | Ahmed Beary
Abstract: Objective: This is prospective study to analyse the surgical management of patients with lumbar canal stenosis. Study focuses on-To assess the neurological and functional outcome of Laminectomy procedure done. Methods: Inclusion Criteria: Adult patient with back pain, sciatica, neurogenic claudication-Fresh MRI finding suggestive of lumbar canal stenosis-absolute stenosis (mid sagittal diameter of the canal < 10mm)-Relative stenosis (mid sagittal diameter of the canal 10mm-13mm)-Patient willing to participate and co-operate. Exclusion Criteria: Congenital lumbar canal stenosis.-MRI suggestive of Lumbar Canal stenosis but patient symptomatically normal.-Patient not willing.-Psychiatric patient.-Patient with traumatic lumbar canal stenosis.-Patient with bowel and bladder involvement.-Patient with neurological Disorders like parkinsonism, Alzheimer?s, CVA, cerebral disorders. Patients satisfying inclusion criteria were included in the study after obtaining written informed consent.30 patients with lumbar canal stenosis were recruited and underwent surgical intervention. Postoperative Protocol: Neurological charting was done after 2 weeks of surgery along JOA score and VAS score. Patients were followed-up regularly every month during the first 3 months and thereafter every 3 months upto 12 months. RESULTS: The long-term outcomes of decompressive surgery on reliefof pain and disability in degenerative lumbar canal stenosis are unclear. Thirty patients of degenerative lumbar canal stenosis managed surgically were included in this study. We excluded patients with congenital lumbar canal stenosis, traumatic LCS, patient with neurological disorders. Mean age of the patients in our study was 51.9 years. There was slight male preponderance with male 16 (53%) and female 14 (47%). Decompressive Laminectomy without instrumentation was performed using standard posterior midline approach. JOA scoring system for low backache was used to assess the patients. The recovery rate was calculated as described by Hirabayashi et al. (1981). Surgical outcome was assessed based on the recovery rate and was classified using a four? grade scale: Excellent, improvement of >75%; good, 50- 75% improvement; fair, 25-50% improvement; and poor, below 25% improvement. At 1-year followup 46.6% patients showed excellent outcome, 46% showed good outcome, and 7.4% showed fair outcome. No patient had poor outcome. Outcome of the patients improved as the time after surgery increased till 1 year and was sustained thereafter till the last follow-up. Conclusion: This study was carried out in 30 patients to observe the efficiency of Decompressive Laminectomy in management of Lumbar canal stenosis. Surgical management of lumbar canal stenosis gives an excellent relief of symptoms and good functional outcome All patients had improved claudication distance post-operatively All patients had drastic improvement in straight leg raising post-operatively No correlation was found between gender and functional outcome No correlation was found between outcome and Obesity of patient. All patients had improved mobility decreasing their family burden. Operative treatment in patients of degenerative lumbar canal stenosis yields excellent results as observed on the basis of JOA scoring system. No patient got recurrence of symptoms of nerve compression.
Keywords: Laminectomy, Lumbar Canal Stenosis, Midline Decompression, Low Back Pain, Degenerative Spine Disease
Edition: Volume 12 Issue 2, February 2023,
Pages: 454 - 467