METHODOLOGY TO SURGICALLY APPROACH FOR LUMBAR CANAL STENOSIS;“WHEN TO” AND “WHEN NOT TO” DO INSTRUMENTAL FUSION- A PROSPECTIVE STUDY.

Abstract

Introduction:Lumbar canal stenosis is dened, as an abnormal narrowing of the ligamento-osseous canal of the lumbar vertebra or of the foramina intervertebralis, causing a direct compression or a compromise of either the dural sac or the nerve root or indirectly to their vasculature producing symptoms of radiculopathy or and claudication.Patient whose symptoms do not show improvement after non-surgical or conservative trial, become eligible for surgical relief. AIM: To Prospectively analyze, Canal decompression, interbody Lumbar fusion with or without posterior stabilization with postero-lateral bone grafting, in cases presenting with MRI proven Lumbar Canal Stenosis, not responding to conservative management. Materials and Methods:Our study was done in Chettinad Hospital and Research Institute from January 2016 to December 2020, Follow-up period was for a minimum period of 12 months. 54 patients participated in the study.JOA and VAS score was recorded at the end of 12 months postsurgery to analyze the functional outcome. Results: There were 32 males and 22 females in the study.Our mean male JOA score was pre-operatively 9.88 which improved to 14.8 at the 12th month follow-up. Our mean JOA for females was at 8.3 which improved post operatively to 13.8.The mean VAS score pre-operatively in the men th and women were 7.4 and 8.6 respectively. This, at the 12 month follow up dropped to 0.8 and 1.2 for men and women respectively.The complications encountered in the study patients are Dural tears in 6 patients, supercial infection in 8 patients, Deep infection and Neurological decit in 4 and 3 patients respectively. All of these complications subsequently got resolved without any long term sequelae. Conclusion:In patients with lumbar canal stenosis whose symptoms do not abate, with conservative management, surgical lumbar spinal canal decompression, whether it is single level or dual level, does provide for a good clinico- functional outcome.