Introduction: Lumbar spinal canal stenosis is usually treated with laminectomy with or without fixation. This prospective cohort study is conducted to analyze the clinical and radiological results of lumbar laminotomy laminoplasty using transverse rotational reconstruction technique of the lamina in treating lumbar spine canal stenosis.
Methods: Twenty one patients suffering from claudication sciatica resulted from lumbar spinal stenosis were treated by laminotomy laminoplasty and transverse rotation of the laminae to create a wider space for spinal cord and dural sac. There were twelve men and nine women with a mean age of 49.7 years. The mean duration of follow-up period was 11 months. Preoperatively, eleven patients had only bony stenosis while ten had combined stenosis (disc herniation and bony stenosis). The clinical results were assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). The rate of recovery was calculated. Radiographic findings were analyzed on the basis of the cross-sectional area of the spinal canal and range of motion of the lumbar spine.
Results: All patients included in this study showed significant improvement in walking distance (P< 0.001). Leg pain was significantly improved in 95.2% of patients (P<0.05). Radiographic analysis revealed a significant increase of the spinal canal cross-sectional diameter in all patients (P < 0.001). Moreover, there were no cases of instability or sublaxation of affected spine on X-rays. One patient showed displacement of one mini screw without any clinical effect; in contrast no displacement of restored laminae was seen.
Conclusions: Transverse rotational reconstruction laminoplasty enables surgeons to obtain a sufficient field of vision and rigid early fixation of the reconstructed laminae at the time of surgery with no reported serious complications. It also, demonstrates excellent results along the whole time of follow-up for improvement of neurogenic claudication and patient’s postoperative satisfaction. Furthermore, transverse rotational reconstruction laminoplasty preserves the posterior arch of the spine, and prevents the invasion of hematoma and scar tissue, postoperative instability and subluxation.
Patient Care: 1. It will prevent serious complications resulting from neural adhesions with muscles.
2. Outcome of the patients will be improved significantly.
3. This technique decrease the incidence of postoperative instability.
Learning Objectives: 1. To know the importance of treating lumbar stenosis by laminoplasty.
2. To know an alternative technique to treat lumbar canal stenosis.
3. To evaluate the clinical and radiological results of rotating transversely the lamina in such cases.