Introduction: Lumbar spinal stenosis is a common disorder that can result in significant disability, debilitating back pain and bad quality of life. Minimally invasive laminectomy and in situ posterior fusion surgery (MILISF) as a modality to treat different causes of debilitating symptomatic back pain can lead to excellent clinical outcomes.
Methods: we reviewed 403 charts retrospectively with symptomatic lumbar stenosis operated using minimally invasive surgery. Data was collected on patient demographics, pre-operative imaging, complications, and reoperation rates. Outcome scales (Oswetry Disability Index (ODI) and Visual Analogue Scale (VAS)) were answered prospectively and over a 6-years follow-up period.
Results: In 403 patients, 242 (60.8%) were females and 161 (39.2%) were males. The mean age was 63.9±12.4 years and mean BMI was 29.8±6.1 kg/m2 (. The average follow-up time was 2.3±1.6 years. Minimally invasive laminectomy was most commonly performed at the L3-4 level in 23.1% and at L4-5 level in 58.1% and at L5-S1 levels in 32.5%. Complications occurred in 34 (8.4%) cases and included wound problem (n=4, 0.9%), malpositioned screws (n=2, 0.5%), neurological post-operative deficit (n=2, 0.5%), bone graft and cage problem (n=1, 0.3%) and pulmonary embolism (n=3, 0.7%). Additional transient complications included post-operative pain (n=12, 2.9%), post-operative weakness (n=1, 0.3%),. Complications were evaluated by third party neurosurgeons. Mean OR time was 202.86±26.6 minutes, mean EBL was 97.5±51.8 cc3, and mean LOS was 3.6±3 days. Mean VAS scores improved from 6.98±2.2 pre-operative to 2.32±1.9, 2.86±1.6 at 1 year and 5 years follow up consequently (p>0.001). Mean ODI improved from 45.89±16.3 pre-operative to 21.98±17.7, and 22.01±17.6 at 1 and 5 years follow up consequently (p>0.001). Fusion rate was >97% measured at 3months and one year follow-up.
Conclusions: MIL-ISF for lumbar stenosis is a safe and effective technique with excellent clinical outcomes and low complications rates.
Patient Care: Minimally invasive laminectomy and in situ posterior fusion surgery (MILISF) as a modality to treat different causes of debilitating symptomatic back pain can lead to excellent clinical outcomes.
Learning Objectives: MIL-ISF for lumbar stenosis is a safe and effective technique with excellent clinical outcomes and low complications rates.