Comparative Analysis of outcome in patients of Lumbar Canal Stenosis undergoing decompression with and without Instrumentation

Abstract

Introduction: There is considerable debate among spine surgeons regarding whether instrumented fusion should be used to augment de-compressive surgery in patients with symptomatic lumbar spinal stenosis. The aim of our study was to compare the clinical and functional outcome of patients undergoing decompression for lumbar canal stenosis with and without instrumentation and to analyze the effect on outcome variables using Japanese Orthopedics Association (JOA) score. Materials and methods: Seventeen patients of degenerative lumbar canal stenosis managed surgically were included in this study. Decompression with instrumentation (n=9) and decompression without instrumentation (n=8) were performed. JOA scoring system for low back pain syndrome was used to assess the patients. The recovery rate was calculated as described by Hirabayashi et al (1981), Surgical outcome was assessed based on the recovery rate and was classified using a four-grade scale: Excellent, improvement of > 90%; Good, 75—89% improvement; Fair, 50- 74% improvement; and Poor, below 49% improvement. The patients were evaluated at 3 months, 6 months and at last follow-up. Results:At 3 month follow up 62.50% patients undergoing decompression with instrumentation showed good outcome and 12.50% patients undergoing decompression without instrumentation showed good outcome. At 6 month follow up 14.29% patients undergoing decompression with instrumentation showed excellent outcome and 12.50% patients undergoing decompression without instrumentation showed excellent outcome. At >6month follow up 42.86% patients undergoing decompression with instrumentation showed excellent outcome and 28.57% patients undergoing decompression without instrumentation showed excellent outcome. Conclusion: Overall recovery rate is higher in patients undergoing decompression with instrumentation than patients undergoing decompression alone. There is gross improvement in JOA score at final follow-up of pre-operative patients but there is no statistically significant difference between the post-operative JOA score at final follow-up of Group-A Vs Group-B.