Treatment of 44 Cases With Lumbar Spine Stenosis and Degenerative Instability: Outcomes of Surgical Intervention

Background and Aim: Degenerative lumbar spine disease can lead to lumbar spine instability. The patients can present with Low Back Pain (LBP), radicular pain, and motor and sensory dysfunction. Age > 50, female sex and pregnancies are among prevalent risk factors. The degeneration process usually starts from the intervertebral discs progressing to involve facet joints, ligaments, and vertebral bodies leading to spinal instability and deformity. This study aims to evaluate the effect of lumbar decompression and Posterolateral Fusion (PLF) on the short- and long-term outcomes of these patients. Methods and Materials/Patients: This prospective study assessed the effect of lumbardecompression and PLF in patients with lumbar instability referred to the Neurosurgery Clinic of Chamran hospital between March 2011 and March 2013. Forty-four patients with degenerative lumbar spine instability and stenosis were eligible for participation to undergo lumbar decompression and PLF. Its clinical effect was evaluated using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). The change in sagittal and coronal planes was also assessed according to pre- and post-operative findings at 2-year follow-up. The statistical method of assessment was repeated using paired t-test. P<0.05 was considered statistically significant. Results: The mean preoperative VAS score decreased significantly at 2 years after the surgery (6.87±1.07 vs. 2.20±1.15; P<0.001). The comparison between preoperative ODI and its 6-month, 1 and 2-year counterparts showed a significant improvement (P<0.001). Moreover, 82.7% of the patients showed a good fusion rate. The sagittal and coronal angles were reduced significantly after the surgery (P<0.05). Short vs. long segment fusion and inclusion of sacral body did not significantly affect the VAS, ODI scores and the deformity angles.Conclusion: Lumbar decompression and PLF is a safe and effective method for patients suffering from degenerative lumbar instability.

Keywords:

Lumbar spine stenosis , Degenerative instability , Posterior lumbar fusion , Visual Analogue Scale , Oswestry Disability Index