Salim, Azizul Akram
(2016)
Endoscopic decompressive surgery for lumbar spinal stenosis : analysis of clinical outcome and predictive factors.
Masters thesis, Universiti Sains Malaysia.
Abstract
BACKGROUND CONTEXT : Endoscopic approach is one of the approaches that
maintained the aim of surgery while minimize the collateral tissue destruction. Its
efficacy and safety have been advocated by numerous studies. To our knowledge,
there are number of studies done for lumbar stenosis with regards to the outcome and
related issues in endoscopic spine surgery, however there are lacked of literature that
evaluate the outcome of the decompressive lumbar spine surgery.
PURPOSE : To assess the outcome result of endoscopic surgery for lumbar stenosis
and to determine it’s predictive factors .
STUDY DESIGN : A retrospective cohort study of patients with degenerative
lumbar spinal stenosis who underwent endoscopic percutaneous surgery using
unilateral approach for bilateral decompression.
PATIENT SAMPLE : Sixty patients with lumbar spinal stenosis underwent
endoscopic decompressive surgery between 2009 and 2013.
METHODS : Between 2009 and 2013, 60 eligible patients who undergone
endoscopic interlaminar decompressive spine surgery (Destandau’s method) for
lumbar degenerative spinal stenosis in Hospital Universiti Sains Malaysia were
selected for the study. The clinical outcome was measured pre and post-operative for
Visual Analogue Scale (VAS) for back and leg pain, motor grading, sensory,
Oswestry Disability Index (ODI), and MacNab’s criteria. The cohort was group into
two categories: excellent to good result was grouped into favourable category and
fair to poor result was grouped into unfavourable category. Paired t-test and Fisher
exact test was used for statistical analysis.
RESULTS : Mean age of patients were 60.82 years old. The mean follow-up period
was 30.1 months (range 17.2 to 43 months). There were 23 (38.3%) male and 37
(61.7%) female. The mean operation time was 183.6 minutes (ranging from 124.8
minutes to 242.4 minutes). Mean blood loss was 150.18ml (ranging from 30.82 ml to
269.54 ml). Post-operative hospital stay mean was 2.45 days (ranging from 1.34
days to 3.56 days). Most frequently involved level were L4/L5 in 51 patients
(52.6%), followed by L3/L4 in 19 patients (19.6%), L5/S1 in 24 patients (24.7%),
and L2/L3 in 3 patients (3.1%). VAS for back pain and leg pain and ODI for pre and
post operation was statistically significant (p<0.001). Reduction in neurology is
statistically insignificant. Based on Macnab’s criteria, 88.4% showed excellent to
good outcome and 11.7% showed fair outcome. There was no significant predicitive
factor for the outcome. As for complication, 13.3% of patients had dural tear; 1.6%
had nerve root injury, wrong level and delay wound healing; 11.6 % had leg
dysesthesia; 11.6% had recurrent stenosis; and 1.6% and 6.6% had reduced motor
and sensory respectively..
CONCLUSIONS : Endoscopic decompressive lumbar stenosis surgery is a safe
surgery. It has an excellent outcome in term of reducing the back and leg pain, and
improve quality of life beside a shorter hospital stay and early mobilization.
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