Lumbar canal stenosis in "young" - How does it differ from that in "old" - An analysis of 116 surgically treated cases

"Only fixation" in cases with failed decompression for lumbar canal stenosis - Analysis of outcome in 14 cases

Aim

The rationale of "only fixation" of affected spinal segments without any form of bone or soft-tissue decompression in cases with failed decompressive laminectomy for lumbar canal stenosis is discussed on the basis of an experience with 14 cases.

Materials and Methods

During the period between 2010 and 2022, 14 patients who symptomatically worsened or did not improve following a long-segment "wide" decompressive laminectomy for multisegmental lumbar canal stenosis were identified. All patients were treated by segmental spinal stabilization aimed at arthrodesis by facetal distraction by Goel's facetal spacers (6 cases) or Camille's transarticular facetal fixation (8 cases). No bone, soft tissue, or disc resection was done for spinal or neural canal "decompression." Oswestry Disability Index and Visual Analog Scale were used to clinically assess the patients before and after the surgery and at follow-up. In addition, video recordings of patient's self-assessment of clinical outcome were used to monitor the outcome.

Results

During the average period of follow-up of 71 months (range 6 months to 16 years), all patients recovered in majority of their major symptoms, the recovery was observed in the immediate postoperative period. During the period of follow-up, none of the patients complained of recurrent symptoms or needed any additional surgery. There was firm stabilization and evidences of bone fusion of the treated spinal segments in all patients. There were no infections or implant failure. No patient worsened after treatment.

Conclusions

Instability of the spinal segments is the primary issue in cases with lumbar canal stenosis and stabilization in the treatment.

[Research progress of spontaneous facet fusion after lumbar spine surgery]

OBJECTIVE

To summarize the research progress on spontaneous facet fusion (SFF) after lumbar spine surgery, and provide reference for further research on SFF.

METHODS

The definition, development, clinical significance, and related influence factors of SFF were throughout reviewed by referring to relevant domestic and foreign literature in recent years.

RESULTS

SFF is a phenomenon of joint space disappearance and fusion of upper and lower articular processes, which starts in a ring shape from the outermost edges to the central regions. Currently reported SFF occurred after posterior lumbar pedicle screw fixation. SFF may increase the stability of surgical segments and relieve clinical symptoms of patients. SFF is closely related to the method of lumbar internal fixation, facet osteoarthritis, interbody fusion, age, body mass index, type B fracture (according to AO classification), and the operative segment.

CONCLUSION

Most reported SFF occur after posterior lumbar pedicle screw fixation, which can increase lumbar stability, but the mechanism and influencing factors remain to be further clarified.