A Comparative Study to Assess the Advantages of Preservation of Posterior Ligamentous Complex in Decompressive Surgeries for Lumbar Spinal Canal Stenosis

Abstract

BACKGROUND In this study we wanted to test hypothesis that posterior ligament complex preserving decompression has advantages over conventional decompression surgeries for the treatment of lumbar canal stenosis, assess clinical and functional outcome following decompression surgeries whether preservation has advantages over routine decompression and use radiological parameters pre operatively and post operatively to evaluate whether there is adjacent segment degeneration following decompression surgeries for canal stenosis. METHODS This is a prospective study conducted among in-patient and outpatient follow ups of the Department of Orthopaedics of MIMS Hospital, Calicut, over a period of 22 months from February 2017 to November 2018. RESULTS The mean age of patients included in the study in PLC preserved group was 58.68 ± 11.3 years and in PLC non-preserved group, it was 62.75 ± 11.18 years. There was a slight female predominance in PLC preserved group (60 %) and in PLC non preserved group male to female ratio was 1:1 At 1 year follow up both the groups of patients had significant relief of symptoms and had improved functional outcome. At 1 year follow up ODI and VAS score were better in PLC preserved group compared with PLC not preserved group. There was adjacent segment disc height improvement in both the groups, and was maintained in the PLC preserved group while during the final follow up there was slight reduction in the mean disc height in PLC not preserved group. Intervertebral disc angle and total lumbar lordosis in both the groups were comparable during 1 year follow up. Adjacent segment slip was not noted in both the groups. Adjacent segment degeneration was not detected in both the groups. CONCLUSIONS Lumbar decompressive surgeries with both PLC preserving and non-preserving surgeries can provide significant relief of symptoms to the patient. PLC preserving surgeries provide better functional outcome during the 1 year follow up period. Similarly residual pain was also less in the PLC preserved group. Adjacent segment degeneration was not detected in both the groups during the one year follow up. KEY WORDS Posterior Ligamentous Complex, Decompressive Surgeries, Lumbar Spinal Canal Stenosis