Surgical outcome of “Neurogenic claudication and walking limitation” due to degenerative Lumbar spinal canal stenosis

Authors

  • Handern M. Rasheed Department of Neurosurgery, Shar teaching hospital, Sulaymaniyah, Kurdistan Region, Iraq.
  • Amanj H. Ali Department of Neurosurgery, Shar teaching hospital, Sulaymaniyah, Kurdistan Region, Iraq.
  • Nashaddin A. Mohammed Department of Neurosurgery, Shar teaching hospital, Sulaymaniyah, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.22317/imj.v7i2.1242

Keywords:

Degenerative stenosis, Interlaminar decompression, Neurogenic claudication

Abstract

Objectives: This study aimed to evaluate the efficacy of surgical decompression of the lumbar spinal canal, a procedure involving the removal of ligamentum and other degenerated elements causing pressure on the thecal sac, nerve roots, and neurovascular structures. The procedure is considered essential for patients experiencing neurogenic claudication, low back pain, lower limb pain and paresthesia, and decreased walking performance, to effectively decompress the lumbar canal.

Methods: A retrospective analysis was conducted on patients who underwent surgical decompression at Shar hospital between 2018 and 2020. A total of 57 eligible patients were followed up to assess the outcomes related to neurogenic claudication and walking ability after 12-24 months postoperatively.

Results: The postoperative results for neurogenic claudication and walking ability were found to be satisfactory in nearly three-quarters of the cases. The duration of symptoms significantly influenced the results, while factors such as gender, body mass index, smoking history, the number of stenosed levels operated, and the type of stenosis did not show significant impact.

Conclusion: Surgical decompression for degenerative lumbar canal stenosis is a relatively low-risk procedure with a very high rate of postoperative patient satisfaction regarding neurogenic claudication and improved walking distance. These positive outcomes are particularly evident when the procedure is performed promptly, by an experienced surgeon, and with appropriate patient selection.

References

Dilip K. Sengupta, MD Harry N. Herkowitz, MD, Lumbar spinal stenosis Treatment strategies and indications for surgery. Orthop Clin N Am 34 (2003) 281 – 295

Judith A. Turner, Mary Ersek Mn., Larry Herron, et al. Surgery for lumbar spinal stenosis, attempted meta-analysis of the literature. Spine. Volume 17. Number 1. 1992.

Leonid Kalichman, Robert Cole, David H. Kim, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. The Spine Journal 9 (2009) 545–550.

Ai-Min Wu, Fei Zou, Yong Cao, et al. Lumbar spinal stenosis: an update on the epidemiology, diagnosis and treatment. AME Medical Journal, 2017.

Robert Gunzburg, Marek Szpalski, The conservative surgical treatment of lumbar spinal stenosis in the elderly. Eur Spine J (2003) 12 (Suppl. 2): S176–S180.

Jeffrey N. Katz, and Mitchel B. Harris. Lumbar Spinal Stenosis. N Engl J Med 2008; 358:818-25.

Avraam Ploumis, Ensor E. Transfledt, Francis Denis. Review Article Degenerative lumbar scoliosis associated with spinal stenosis. The Spine Journal 7 (2007) 428–436.

Christy C. Tomkins-Lanea, Michele C. Battiéb, Richard Hu, et al. Pathoanatomical characteristics of clinical lumbar spinal stenosis. Journal of Back and Musculoskeletal Rehabilitation 27 (2014) 223–229.

Tom Amundsen, Henrik Weber, Finn Lilleas, et al. Lumbar spinal stenosis: clinical and radiological features. Spine. Volume 20. Number 10. pp 1178-1186. 1995.

Janan Abbas, Kamal Hamoud, Youssef M. Masharawi, et al. Ligamentum Flavum Thickness in Normal and Stenotic Lumbar Spines. SPINE Volume 35, Number 12, pp 1225–1230.

Naime Altinkaya, Tulin Yildiri m, Senay Demir, et al. Factors Associated with the Thickness of the Ligamentum Flavum. SPINE Volume 36, Number 16, pp E1093–E1097.

Jeffrey N. Katz, Stephen J. Lipson, Gregory W. Brick, et al. Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine. Volume 20. Number 10. pp 1155-1160. 1995.

L Penning MD, Functional pathology of lumbar spinal stenosis; Review paper. Clinical Biomechanics 1992; 7: 3- 17.

L. Penning, J. T. Wilmink. Poster-dependent bilateral compression of L4 or L5 nerve roots in facet hypertrophy; a dynamic CT-myelography study. Spine. Volume 12. Number 5. 1987.

Ehud Arbit, and Susan Pannullo. Lumbar Stenosis a Clinical Review. Clinical orthopaedics and related research. Number 384, pp. 137–143.

Evelien I. T. de Schepper, Gijsbert M. Overdevest, Pradeep Suri, et al. Diagnosis of Lumbar Spinal Stenosis an Updated Systematic Review of the Accuracy of Diagnostic Tests. SPINE Volume 38, Number 8, pp E469–E481.

J. N. BLAU, Valentine Logue. The natural history of intermittent claudication of the cauda equina a long-term follow-up study. brain (1978), 101, 211-222.

Rajendra Nath, Sanjay Middha, Anil Kumar, et al. Functional outcome of surgical management of degenerative lumbar canal stenosis. Indian Journal of Orthopaedics, May 2012, Vol. 46, Issue 3.

Jeffrey N. Katz, Marianne Dalgas, Gerold Stucki, et al. degenerative lumbar spinal stenosis Diagnostic Value of the History and Physical Examination. ARTHRITIS & RHEUMATISM Val. 38, No. 9, September 1995, pp 1236-1241.

Kjell Olmarker, Bjorn Rydevik, Sten Holm, et al. Effects of Experimental Graded Compression on Blood Flow in Spinal Nerve Roots. A Vital Microscopic Study on the Porcine Cauda Equina. Journal of Orthopaedic Research 7:817-823 Raven Press, Ltd., New York.

Ehud Arbit, and Susan Pannullo. Lumbar Stenosis a Clinical Review. Clinical orthopaedics and related research. Number 384, pp. 137–143.

Keisuke Takahashi, Kenji Kagechika, Tetsuya Takino, et al. Changes in epidural pressure during walking in patients with lumbar spinal stenosis. Spine Volume 20, Number 24, pp 2746-2749.

Gx. Dong, R. W. Porter. Walking and cycling tests in neurogenic and intermittent claudication. Spine. Volume 14. Number 9. 1989.

Shigeru Kobayashi. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World J Orthop. 2014 April 18; 5(2): 134-145.

Stephen Hall, John D. Bartleson, Burton M. Onofrio, et al. Lumbar Spinal Stenosis Clinical Features, Diagnostic Procedures, and Results of Surgical Treatment in 68 Patients. Annals of Internal Medicine. 1985; 103:271-275.

P. Gopinathan. Lumbar spinal canal stenosis-special features. Journal of orthopaedics 12 (2015) 123-125.

Peter Cowley, BA Oxon. Neuroimaging of Spinal Canal Stenosis. Magn Reson Imaging Clin N Am 24 (2016) 523–539.

Hazim M. El-Nagdi, Amer A. Tantawy, Ihab M. Said. Diagnostic value of plain radiography and myelography in lumbar canal stenosis. Benha M.J. Volume 10. Number 2. May.1993.

Nils S. R. Schonstrom, Nicole-Francoise Bolender, Dan M. Spengler. The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine. Spine. Volume 10. Number 9. 1985.

Scott D. Boden, and Sam W. Wiesel. Lumbar Spine Imaging: Role in Clinical Decision Making. Journal of Am. Acad. Orthop. Surg 1996; 4:238-248.

J. Roulleau and J. Guillaume (Toulouse). Plain X-Ray Diagnosis of Developmental Narrow Lumbar Canal. A. Wackenheim et al., The Narrow Lumbar Canal. Springer-Verlag Berlin Heidelberg 1980.

Constantin Schizas, Nicolas Theumann, Alexandre Burn, et al. Qualitative Grading of Severity of Lumbar Spinal Stenosis Based on the Morphology of the Dural Sac on Magnetic Resonance Images. SPINE Volume 35, Number 21, pp 1919–1924.

James N. Weinstein, Tor D. Tosteson, Jon D. Lurie, et al. Surgical Versus Nonoperative Treatment for Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcomes Research Trial. SPINE Volume 35, Number 14, pp 1329–1338.

Steven J. Atlas, Robert B. Keller, Yen A. Wu, et al. Long-Term Outcomes of Surgical and Nonsurgical Management of Lumbar Spinal Stenosis: 8 to 10 Year Results from the Maine Lumbar Spine Study. SPINE Volume 30, Number 8, pp 936–943.

Poletti, Charles E. Central Lumbar Stenosis Caused by Ligamentum Flavum: Unilateral Laminotomy for Bilateral Ligamentectomy: Preliminary Report of Two Cases. Neurosurgery 37; 343-347, 1995.

Nancy E. Epstein. Decompression in the surgical management of degenerative spondylolisthesis: Advantages of conservative approach in 290 patients. Journal of spinal disorders, Volume 11. Number 2. PP. 116-122, 1998.

Manucher J. Javid, Eldad J. Hadar. Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. Journal of Neurosurg. Volume 89. July, 1998.

Shunji Tsutsui, Ryohei Kagotani, Hiroshi Yamada, et al. Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis? Eur Spine J. 24 April 2013.

Elisabeth Thornes, Nikolaos Ikonomou, and Margreth Grotle. Prognosis of Surgical Treatment for Degenerative Lumbar Spinal Stenosis: A Prospective Cohort Study of Clinical Outcomes and Health-Related Quality of Life Across Gender and Age Groups. Open Orthop J. 2011; 5: 372–378.

Shay Shabat, Yoram Folman, Zeev Arinzon, et al. Gender differences as an influence on patients’ satisfaction rates in spinal surgery of elderly patients. Eur Spine J (2005) 14: 1027–1032.

Martin N. Stienena, Holger Joswiga, Nicolas R. Smoll, et al. Short- and long-term effects of smoking on pain and health-related quality of life after non-instrumented lumbar spine surgery. Clinical Neurology and Neurosurgery 142 (2016) 87–92

Shaun Previn Appadurai, Patrick Lo. Effects of diabetes and smoking on lumbar spinal surgery outcomes. Journal of Clinical Neuroscience 20 (2013) 1713–1717

B. C. M. Prasad, VV Ramesh Chandra, B Vijayalakshmi Devi, et al. Clinical, radiological, and functional evaluation of surgical treatment in degenerative lumbar canal stenosis. Neurol India 2016; 64:677-683.

Yukawa, Yasutsugu MD, Lawrence G. MD et al. A Comprehensive Study of Patients with Surgically Treated Lumbar Spinal Stenosis with Neurogenic Claudication.

The Journal of Bone & Joint Surgery: November 2002 - Volume 84 - Issue 11 - p 1954-1959.

Leslie C. L. Ng, Suhayl Tafazal, and Philip Sell. The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis. Eur Spine J (2007) 16: 199–206

Downloads

Published

2023-06-26

How to Cite

1.
Rasheed HM, Ali AH, Mohammed NA. Surgical outcome of “Neurogenic claudication and walking limitation” due to degenerative Lumbar spinal canal stenosis . Iraq Med J [Internet]. 2023 Jun. 26 [cited 2024 Dec. 21];7(2):55-9. Available from: https://iraqmedj.org/index.php/imj/article/view/1242

Issue

Section

Articles