Introduction: To study presenting features in patients with degenerative lumbar canal stenosis and management with bilateral minimally invasive laminotomy- foraminotomy: An experience of 60 patients.
Methods: Retrospective-prospective study evaluating relation between MRI imaging and surgical outcome in patients treated for degenerative lumbar canal stenosis.60 consecutive patients with neurogenic claudication with radiological evidence of lumbar canal stenosis without spondylolisthesis treated between January 2007 and December 2012 . Presenting complaints with radiological findings were studied in all patients with bony canal cross sectional area and thecal sac area diameter at the disc level studied in last 20 patients. Surgical technique with failure rates and outcomes were assessed.
Results: M:F::2:1. Age range 29 to 82 years, mean age of 60.1 years. Claudication distance 15 to 200 meters, mean being 130 meters. 42 patients had lumbago along with neurogenic claudication. Duration of symptoms 2 months to 28 years with mean of 6 years. Number of levels : Single level in 29 patients, two levels in 23 patients and three levels in 8 patients. L4-5 level was most commonly affected (55%) and L2-L3 was least involved in 6% of cases. Cross sectional areas had bony area more than 1.8 cm2 and thecal compression was due to soft tissue component with grade I(mild stenosis) in24%, grade II(moderate) in 36% and grade III(severe) in 40% of patients. Bilateral laminotomy with total of 87 levels done with 20 levels requiring bilateral foraminotomy in addition. 3 patients had persisting symptoms requiring re-operation (laminectomy).
Conclusions: Degenerative lumbar canal stenosis is primarily due to non bony soft tissue compression of thecal sac and bilateral laminotomy- foraminotomy is a good treatment option for this group of patients. Patients with combined congenital and degenerative canal stenosis may require more extensive procedure for surgical decompression.
Patient Care: Minimalising removal of posterior spinal elements thus preserving spinal stability.
Learning Objectives: 1.Degenerative lumbar canal stenosis is primarily due to non bony soft tissue compression of thecal sac
2.Bilateral laminotomy- foraminotomy is a good treatment option for this group of patients.
3.Combined congenital and degenerative canal stenosis may require more extensive procedure for surgical decompression.