En Bloc Partial Laminectomy and Posterior Lumbar Interbody Fusion in Foraminal Spinal Stenosis

Study Design A retrospective study. Purpose An en bloc partial laminectomy and posterior lumbar interbody fusion (PLIF) in spinal stenosis patients with severe foraminal narrowing has a shorter operation time, less neural manipulation and allows indirect decompression by restoring the interforaminal height compared to other procedures. This study investigated the efficacy of the procedure. Overview of Literature PLIF is one of the most popular surgery for degenerative spine such as foraminal spinal stenosis, instability spondylolisthesis and discogenic pain. Various techniques for PLIF have their own advantages and disadvantages. But in some severe cases, we need an efficient method of PLIF for decompression and fusion. Methods This study examined 61 patients, who had 85 levels treated with PLIF using an en bloc partial laminectomy and facetectomy, and could be followed up for more than 2 years. The mean age of the patients and mean follow up period was 66 years and 39 months, respectively. The clinical results were evaluated using the MacNab's criteria, Visual Analogue Scale (VAS) score, and Korea Version Oswestry Disability Index (KODI). The union of the intervertebral space was evaluated using Lenke's criteria. The intervertebral angle and height of the posterior intervertebral disc were also measured. Results Excellent and good results were obtained in 54 cases (89%) according to MacNab's criteria. The VAS and KODI scores were 8.1 and 34.6, preoperatively, and 3.4, and 14.1, postoperatively. Bone union was A and B grades according to Lenke's criteria in 57 cases. The mean segmental angle and mean height of the posterior disc were respectively, 7.4° and 6.5 mm preoperatively, 9.1° and 10.6 mm postoperatively, and 8.0° and 9.7 mm in the last follow-up. There were 5 cases of postoperative infection, 4 cases of junctional problems and 1 case of screw malposition. Conclusions En bloc partial laminectomy and PLIF is an effective method for treating severe spinal stenosis with foraminal narrowing.

[1]  M. Liang,et al.  Seven‐ to 10‐year Outcome of Decompressive Surgery for Degenerative Lumbar Spinal Stenosis , 1996, Spine.

[2]  D. Perugia,et al.  Long-term results of surgery in lumbar stenosis. 8-year review of 64 patients. , 1993, Acta orthopaedica Scandinavica. Supplementum.

[3]  V. Podichetty,et al.  Complications Associated With Minimally Invasive Decompression for Lumbar Spinal Stenosis , 2006, Journal of spinal disorders & techniques.

[4]  R. Fessler,et al.  Microendoscopic Decompressive Laminotomy for the Treatment of Lumbar Stenosis , 2002, Neurosurgery.

[5]  M. McKeehen,et al.  Anterior lumbar fusion improves discogenic pain at levels of prior posterolateral fusion. , 2000, Spine.

[6]  J. Weinstein,et al.  Long-term Follow-up of Lower Lumbar Fusion Patients , 1987, Spine.

[7]  Kevin T Foley,et al.  Minimally Invasive Lumbar Fusion , 2003, Spine.

[8]  L. Lenke,et al.  The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. , 1993, Journal of spinal disorders.

[9]  A. Luessenhop,et al.  Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. , 1992, Journal of neurosurgery.

[10]  M. Liang,et al.  The outcome of decompressive laminectomy for degenerative lumbar stenosis. , 1991, The Journal of bone and joint surgery. American volume.

[11]  G. Csécsei,et al.  Posterior interbody fusion using laminectomy bone and transpedicular screw fixation in the treatment of lumbar spondylolisthesis. , 2000, Surgical neurology.

[12]  H. Oh,et al.  Minimally Invasive Posterior Lumbar Interbody Fusion: Comparison with Traditional Open Surgery , 2006 .

[13]  F. Postacchini.  Surgical Management of Lumbar Spinal Stenosis , 1987, Spine.

[14]  R. Betz,et al.  Results of in situ fusion for isthmic spondylolisthesis. , 1992, Journal of spinal disorders.

[15]  R Roy-Camille,et al.  Internal fixation of the lumbar spine with pedicle screw plating. , 1986, Clinical orthopaedics and related research.

[16]  Y. Ohkoshi,et al.  Clinical Results of Single-Level Posterior Lumbar Interbody Fusion Using the Brantigan I/F Carbon Cage Filled With a Mixture of Local Morselized Bone and Bioactive Ceramic Granules , 2002, Spine.

[17]  J W Frymoyer,et al.  An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine. Design and testing. , 1986, Clinical orthopaedics and related research.

[18]  P. Newman,et al.  Degenerative spondylolisthesis. , 1975, The Orthopedic clinics of North America.

[19]  Jae Chul Lee,et al.  A Minimum Follow-up Study of 10 years After Pedicle Screw Fixation and Fusion for Degenerative Lumbar Diseases , 2006 .