Outcome of decompression with transpedicular screw fixation and posterolateral fusion in stable degenerative lower lumbar canal stenosis

Abstract

Background: Treatment of choice in degenerative lumbar canal stenosis (LCS) is laminectomy. Adding lumbar fusion to decompression is another option preferred by some surgeons to prevent possible instability after posterior elements removal.
Methods: A prospective study where we evaluated 64 patients with degenerative lower LCS in Benha University Hospitals from January 2017 to January 2020, those underwent decompression of lower two levels L4-5 and L5-S1 with instrumented fusion of L4,5and S1 with 2-year follow-up. Pain changes were evaluated using VAS score at 1- and 2-year post-operative and functional outcome at 1- and 2-year post-operative using Oswestry Disability Index (ODI) compared to preoperative scores.
Results: Age of our patients ranged from 38 to 62 years with a mean of 54.4 ±6.8 years and 42 patients were females (65.6%). VAS  changes for low back pain and leg pain recorded at 1 and 2-year post-op. compared to preop. showed statistically significant improvement (P<0.001), also there was a significant decrease in VAS for both that recorded 2-year post-op. compared to 1-year post-op. (P<0.001). We found improvements in means regarding ODI recorded at 1 and 2-year post-op. compared to preop. mean statistically significant (P<0.001)
Conclusions: We hereby recommend laminectomy of L4 and L5, with instrumented posterolateral fusion of L4,5, and S1 regarding the significant pain reduction and excellent functional outcome without perioperative major complications to avoid the high possibility of spine instability and the need for second surgery with added risk and cost that may follow posterior decompression alone in such cases.