Decompression and Interlaminar Stabilization for Lumbar Spinal Stenosis: A Cohort Study and Two-Dimensional Operative Video

Background and Objectives: Lumbar spinal stenosis is one of the most common causes of disability in the elderly and often necessitates surgical intervention in patients over the age of 65. Our study aimed to evaluate the clinical efficacy of interlaminar stabilization following decompressive laminectomy in patients with lumbar stenosis without instability. Materials and Methods: Twenty patients with lumbar stenosis underwent decompressive laminectomy and interlaminar stabilization at our academic institution. Clinical outcomes were measured using the visual analog scale (VAS) and Oswestry disability index (ODI) at the 2-month, 6-month, and 1-year postoperative visits, and these outcomes were compared to the preoperative scores. Results: The average VAS scores for low back pain significantly improved from 8.8 preoperatively to 4.0, 3.7, and 3.9 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average VAS scores for lower extremity pain significantly improved from 9.0 preoperatively to 2.7, 2.5, and 2.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average ODI scores significantly improved from 66.6 preoperatively to 23.8, 23.3, and 24.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). There was no statistical significance for difference in VAS or ODI scores between 2 months, 6 months, and 1 year. One patient had an intraoperative durotomy that was successfully treated with local repair and lumbar drainage. Another patient had progression of stenosis and had to undergo bilateral facetectomy and fusion. Conclusions: Decompressive laminectomy and interlaminar stabilization in patients with spinal claudication and low back pain is a good surgical option in the absence of instability and may provide significant clinical improvement of pain and functional disability

Traumatic spinal fracture treated by vertebroplasty: a case report

<p>Abstract</p> <p>Introduction</p> <p>Surgical treatment for lumbar burst fractures is complex and typically involves either a retroperitoneal corpectomy and/or a posterior pedicle screw fixation. We describe the case of a patient with a lumbar burst fracture who was cured via a less invasive approach that has not been previously reported as standalone treatment.</p> <p>Case presentation</p> <p>This 25-year-old Caucasian man presented with excruciating axial low back pain exacerbated by any attempt to elevate the head of the bed after a motor vehicle accident. Computed tomography demonstrated a burst L4 fracture without spinal canal compromise. The patient underwent a bilateral vertebroplasty with an injectable polymer that mimics cortical bone. Postoperatively, the patient was progressively mobilized in a thoracolumbar spinal orthosis brace without any recurrence of pain. Postoperative computed tomography showed no loss of height in the L4 vertebral body. At one-year postoperatively, the patient was symptom free and the computed tomography scan showed good fracture healing.</p> <p>Conclusion</p> <p>Retroperitoneal corpectomy and/or posterior multi-segment fixation for lumbar burst fractures without neural compression in young patients are associated with loss of mobility and potential future adjacent level disease. Our limited vertebroplasty intervention with close postoperative clinical monitoring has not been previously described as standalone treatment, and it offers the advantages of less operative morbidity and maintenance of lumbar mobility in selected patients.</p