Background Data: Lumbar degenerative disorders may result in low back pain, leg pain and limitation of walking distance that can disturb the patients' life. Several surgical procedures have been used to treat spinal canal stenosis ranging from minimal invasive to extensive decompression and fusion. However, recurrence of symptoms or instability may occur postoperatively.Purpose: To evaluate efficacy and safety of sublaminar decompression and fusion in the management of lumbar degenerative disorders. Study Design: Prospective clinical case study. Patients and Methods: Twenty patients including; 7 central canal stenosis, 5 degenerative disc disease, 4 foraminal and central stenosis, and 4 central stenosis and spondylolisthesis patients were enrolled in this study. All were treated with sublaminar decompression and fusion. Pre-and post-operative clinical evaluation included Visual Analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI). Pre-and post-operative measurement of anteroposterior thecal diameter, thecal cross-sectional area, right and left foraminal height were obtained using MRI and CT-scan. The mean follow up duration was 13.85±8.30 (Range, 8-33) months.Results: VAS of leg pain improved from 7.3±1.4 to 2.4±0.9, VAS of the back pain improved from 7.4±0.9 to 2.3±0.5. ODI improved from 76±7.5 to 29.5±8.3. Anteroposterior thecal diameter changed from 10.4±1.4 mm to 14.1±1.1mm. Thecal sac cross sectional area improved from 134.2±19.6 mm 2 to 184±20.4 mm 2 . Right foraminal height changed from 4.4±0.5 mm to 5.4±0.5 mm and left foraminal height changed from 4.2±0.5 mm to 5.2±0.5 mm. The mean time to achieve bone fusion in our series was 8.1 months and the fusion rate was 95%.Conclusion: Sublaminar decompression and fusion is safe and effective procedure in treatment of stenotic degenerative spinal disorders. It achieves high fusion rate without serious complications. (2018ESJ166)

Introduction: Sublaminar decompression is a new technique that includes partial laminectomy and facetectomy providing a wide central, foraminal, and lateral recess decompression and leaving maximal bone posterior and posterolateral to allow adequate fusion. The aim of this study was to evaluate the efficacy and safety of sublaminar decompression in comparison to standard transforaminal lumbar interbody fusion (TLIF). Methods: Forty patients with degenerative lumbar disorders were managed with spinal fusion at the Zagazig University Hospital. The patients were divided into two groups. Group 1 included 20 patients managed with sublaminar decompression and instrumented fusion with a mean patient age of 47.7±10.4 yr. The patients in group 2 had a mean age of 45.3±10.3 yr and were managed with TLIF. The patients were assessed clinically and by radiographs, and using a visual analogue scale (VAS) of pain and Owestry Disability Index (ODI) as outcome measures. Statistically significant differences between preoperative and the final follow-up means were assessed using paired t-test test. P<0.05 was statistically significant. Results: In comparing the two groups regarding correction rate for different radiographic and clinical parameters, this study found significant changes in anteroposterior thecal diameter (P=0.002) and right foraminal height (P=0.004) and highly significant differences in left foraminal height (P<0.001) and thecal sac area (P<0.001) in favor of the sublaminar group. There were no significant differences in VAS for leg (P=0.979) and back pain (P=0.119) or ODI (P=0.0.497). Conclusion: When compared to TLIF, sublaminar decompression and fusion is a safe and effective procedure in the treatment of stenotic degenerative spinal disorders. Level of Evidence: Level III.

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Background: Many surgical options for treating lumbar degenerative disorders have been used to improve health related outcome of those patients. The aim of the study is to compare the functional and radiological outcome of the two techniques in management of Lumbar spinal stenosis (LSS). Methods: Sixty patients with Lumbar spinal stenosis were included in a retrospective cohort study at zagazig university hospital. The inclusion criteria were patients with single level LSS with back and /or leg pain with instability on dynamic radiology not responding to medical treatment. We excluded patients with pathological fracture, high grade spondylolisthesis and infection. Patients were divided into two groups according to the method of treatment done. Group one included patients with sublaminar trimming Laminoplasty with instrumented fusion. The second group included patients with sublaminar decompression with instrumented fusion. Patients were assessed clinically using visual analogue scale (VAS) for back and leg pain and the Owestry Disability Index (ODI) for the disability. Plain x-ray, CT and MRI was done for all patients preoperative and we measured AP-thecal sac area, foraminal height and the thecal sac area for all patients (pre- and post-operative). Results: comparing both groups there were no difference in relation to demographic data nor in the diagnosis of the spinal stenosis. Group-2 had longer hospital stay. Both groups improved clinically post-operatively with no statistical difference between them. However, the rate of improvement in group-2 in relation to leg pain was better. Both groups improved radiologically, but AP-thecal sac area, foraminal height and the thecal sac area were much improved in group-2 (p-value<0.001) in comparison to group-1. Conclusion: Sublaminar decompression can particularly achieve better central, foraminal and lateral recess decompression together with a better fusion rate and hence, can be used as alternative to different laminotomy decompression techniques for treating different lumbar degenerative disorders.