Same Segement Early Recurrence in Surgery of Lumbar Canal Stenosis – Role of Dissectomy
Journal Title: Journal of Bone and Joint Diseases - Year 2018, Vol 0, Issue 0
Abstract
Background: Symptomatic lumbar canal stenosis (LCS) usually responds well to surgery. However, in a subset of patients symptoms recur aer variable periods of time. Aims: e aim of this study was to identify the subset of patients having same segment early recurrence (recurrence <2 years) in surgery of LCS and the role of discectomy in causing it. Materials and Methods: A prospective analysis of 100 patients who were operated for LCS from 2013 to 2015. All patients were followed up for at least 2 years. Inclusion Criteria: Symptomatic LCS with or without Grade 1 xed listhesis was included in the study. Exclusion Criteria: LCS associated with listhesis of Grade 2 or more, LCS with mobile listhesis of any grade, presence of degenerative scoliosis, and follow-up >2 years. Based on type of surgical procedure performed initially, patients were divided into three categories. Category - 1 decompression through laminectomy and foraminotomy, Category - 2 Category 1 along with discectomy, and Category - 3 Category 2 with transforaminal lumbar interbody fusion (TLIF) combined. Redosurgical options included as follows: (1) Excision of scar and foraminotomy, (2) excision of scar and pedicle screw-rod xation, and (3) only pedicle screw-rod xation with distraction. Results: In Category 1, of 5 patients (9.09%) developed recurrence, and in Category 2, of 9 patients (22.5%) developed recurrence (P < 0.0001). Conclusions: The strongest predictor of early recurrence is discectomy combined with decompression. Excision of disc material leads to vertebral settling resulting in loss of height of foraminal space. Hence, in surgery for LCS, discectomy should only be done if frank herniation is present causing signicant compression. When discectomy is done, it should always be supplemented with standalone TLIF. In redosurgery, excision of scar tissue leads to major dural tears. Pedicle screw-rod fixation with distraction is an excellent option in these cases as it leads to restoration of foraminal height.
Authors and Affiliations
Amit Agarwal, Imran Sazid, Namit Singhal, Harish Chandra
Keywords
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