Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Abstract

Background:Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability.Materials and Methods:610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotationsResults:All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse.Conclusion:Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

Biomechanical effects of iatrogenic muscle-ligaments complex damage on adjacent segments following posterior lumbar interbody fusion: A finite element analysis

“…This innovative laminoplasty restored the integrity of the posterior tension band, and good results were obtained during follow-up. 37 Kim et al 38 also demonstrated that similar lamina reconstruction could better preserve the segmental stability using FE analysis. Lee et al 25 found that either proximal screw-rod-based hybrid stabilization or interspinous device-based hybrid stabilization can provide a transition zone of activity in the proximal region, limiting excessive ROM and intradiscal stress increase in the adjacent segment.…”

Evaluations of Computed Tomography Images and Lumbar Specimens in Mimic Operations of Transverse Rotation Laminoplasty for Lumbar Spinal Stenosis

“…In order to prevent the formation of hematoma and scar tissue, several laminoplasty have been carried out for LSS. [ 16 ] Restorative laminoplasty was also reported. However, it is difficult to restore the excised laminae precisely.…”

Limited Laminectomy and Restorative Spinoplasty in Spinal Canal Stenosis

“…However, too limited a decompression can be accompanied by re-growth of the bone that affects the long term results. The best option would be an adequate decompressive limited laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity [ 11 ]. The integrity of the posterior ligament complex (spinous process, intraspinous ligaments and supraspinous ligaments) and paraspinal muscles minimizes the risk of developing de novo postoperative spinal instability.…”