Indian Journal of Orthopaedics Surgery


Lumbar Canal Stenosis - A Study of Spinous Process Osteotomy in Posterior Decompression


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Author Details: Manish Dwivedi, Vikas Sawla, Atul Varshney, Apoorv Acharya

Volume : 1

Issue : 3

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 176

Article End Page : 182


Abstract

Study Design: Prospective

Background: Lumbar canal stenosis (LCS) remains one of the most frequently encountered, clinically important degenerative spinal disorders in the ageing population. Diagnosing it clinicallyis made more difficult due tocoexisting degeneration of the spine, hip or knee joint or diseased vessels and nerves of lower limbs or due to de-conditioning of spinal musculature and ligaments.
Purpose of the study: The purpose of our study was to assess the results of spinous process osteotomy & laminotomy in cases of lumbar canal stenosis.
Material and Methods: It was prospective study with 25 confirmed cases of lumbar canal stenosis adhering to inclusion criteria and stable spine. Patients were assessed pre-operative and post- operative using LINS Functional Ability Criteria, VAS scale for back pain and leg pain, JOAS score and Satisfactory Recovery Rate- Hirabayashi Method( Based on Pre-op and Post-op JOAS scores) with an average follow-up of 1 year.
Results: There were 25 patients, 12 (48%) males and 13 (52%) females. Mean age of group was 44.48 ± 7.52.There were14 (56%) patients with two level involvement followed by 6 (24%) patients with three level involvement and 5 (20%) patients with single level involvement. In single level involvement maximum number was of L4-L5.All 25 (100%) patients presented with Claudication and radiculopathy; 9 (36%) had unilateral radiculopathy while 16 (64%) had bilateral radiculopathy.10(40%) patients had motor weakness and sensory involvement.1(4%) patient presented with cauda equina syndrome with associated sphincter involvement.All patients were treated with Spinous process osteotomy and fenestration and foraminotomy. In addition to that, discectomy was done in 14 (56%) patients while laminotomy was required in 3 (12%) patients Functional assessment as per LINS criteriashowed that satisfactory results (Percentage of patients in Excellent and Good Class) were achieved in 90% of the patients.There were significant improvement in back pain (60%) and excellent improvement in leg pain (76%) in terms of VAS. Improvement in JOAS score was also excellent (72%).according to Hirabayashi method, 12 (48%) patients had ‘Excellent’ results (JOAS recovery rate >70%); and 10 (40%) patients had ‘Good’ results (JOAS recovery rate between 45% and 70%).
Conclusion: The Spinous Process Osteotomy (SPO) technique is one of the surgeries associated with minimal muscle injury, effective andfaster long lasting decompression, and satisfactory neurological and functional outcomes with acceptable low risk of complication highly safe for all concerned and maintenance of spinal stability by utilizing standard outcome measures with logical expectation to maintain excellent to good results at long term follow up.

Keywords: Lumbar Canal Stenosis, Spinous Process Osteotomy, SPO, JAOS score, LINS criteria, Hirabayashi Method