Volume 3, Issue 3 (12-2017)                   Iran J Neurosurg 2017, 3(3): 79-88 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Farrokhi M R, Yadollahikhales G, Gholami M. Treatment of 44 Cases With Lumbar Spine Stenosis and Degenerative Instability: Outcomes of Surgical Intervention. Iran J Neurosurg. 2017; 3 (3) :79-88
URL: http://irjns.org/article-1-91-en.html
1- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran & Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran , farrokhimr@yahoo.com
2- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran & Department of Neurology, University of Illinois at Chicago, Chicago, Illinois, United States
3- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract:   (3299 Views)
Background and Aim: Degenerative lumbar spine disease can lead to lumbar spine instability. The patients can present with Low Back Pain (LBP), radicular pain, and motor and sensory dysfunction. Age >50, female sex and pregnancies are among prevalent risk factors. The degeneration process usually starts from the intervertebral discs progressing to involve facet joints, ligaments, and vertebral bodies leading to spinal instability and deformity. This study aims to evaluate the effect of lumbar decompression and Posterolateral Fusion (PLF) on the short- and long-term outcomes of these patients. 
Methods and Materials/Patients: This prospective study assessed the effect of lumbar decompression and PLF in patients with lumbar instability  referred to the Neurosurgery Clinic of Chamran hospital between March 2011 and March 2013. Forty-four patients with degenerative lumbar spine instability and stenosis were eligible for participation to undergo lumbar decompression and PLF. Its clinical effect was evaluated using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). The change in sagittal and coronal planes was also assessed according to pre- and post-operative findings at 2-year follow-up. The statistical method of assessment was repeated using paired t-test. P<0.05 was considered statistically significant.
Results: The mean preoperative VAS score decreased significantly at 2 years after the surgery (6.87±1.07 vs. 2.20±1.15; P<0.001). The comparison between preoperative ODI and its 6-month, 1 and 2-year counterparts showed a significant improvement (P<0.001). Moreover, 82.7% of the patients showed a good fusion rate. The sagittal and coronal angles were reduced significantly after the surgery (P<0.05). Short vs. long segment fusion and inclusion of sacral body did not significantly affect the VAS, ODI scores and the deformity angles. 
Conclusion: Lumbar decompression and PLF is a safe and effective method for patients suffering from degenerative lumbar instability.
Full Text [PDF 1313 kb]   (842 Downloads) |   |   Full Text (HTML)  (1263 Views)  
Type of Study: Research | Subject: Gamma Knife Radiosurgery

1. Pope MH, Panjabi M. Definitions of spinal instability. Spine. 1985; 10(3):255–6. doi: 10.1097/00007632-198504000-00013 [DOI:10.1097/00007632-198504000-00013]
2. Frymoyer J, Selby D. Segmental instability. Spine. 1985; 10(3):280–6. doi: 10.1097/00007632-198504000-00017 [DOI:10.1097/00007632-198504000-00017]
3. Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar intervertebral instability: A review. Radiology. 2007; 245(1):62–77. doi: 10.1148/radiol.2451051359 [DOI:10.1148/radiol.2451051359]
4. Farrokhi MR, Haghnegahdar A, Rezaee H, Sharifi Rad MR. Spinal sagittal balance and spinopelvic parameters in patients with degenerative lumbar spinal stenosis; A comparative study. Clinical Neurology and Neurosurgery. 2016; 151:136–41. doi: 10.1016/j.clineuro.2016.10.020 [DOI:10.1016/j.clineuro.2016.10.020]
5. Farrokhi MR, Ghaffarpasand F, Khani M, Gholami M. An evidence-based stepwise surgical approach to cervical spondylotic myelopathy: A narrative review of the current literature. World Neurosurgery. 2016; 94:97–110. doi: 10.1016/j.wneu.2016.06.109 [DOI:10.1016/j.wneu.2016.06.109]
6. Farrokhi MR, Gholami M. In reply to the letter to the editor regarding "an evidence-based stepwise surgical approach to cervical spondylotic myelopathy: a narrative review of the current literature". World Neurosurgery. 2017; 98:848–9. doi: 10.1016/j.wneu.2016.11.108 [DOI:10.1016/j.wneu.2016.11.108]
7. Farrokhi MR, Vasei M, Fareghbal S, Bakhtazad A. Effect of honey on peridural fibrosis formation after laminectomy in rats: a novel experimental study. Evidence-Based Complementary and Alternative Medicine. 2011; 2011:1–6. doi: 10.1155/2011/504967 [DOI:10.1155/2011/504967]
8. Farrokhi MR, Gholami M. Can cerebral disease cause cognitive disorders? A review of the literature. Chirurgia (Turin). In Press. doi: 10.23736/S0394-9508.18.04766-6
9. Kirkaldy-Willis W, Farfan H. Instability of the Lumbar Spine. Clinical Orthopaedics and Related Research. 1982; (165):110-123. doi: 10.1097/00003086-198205000-00015 [DOI:10.1097/00003086-198205000-00015]
10. Fitzgerald J, Newman P. Degenerative spondylolisthesis. The Journal of Bone and Joint Surgery British volume. 1976; 58-B(2):184–92. doi: 10.1302/0301-620x.58b2.932080 [DOI:10.1302/0301-620X.58B2.932080]
11. MacNab I. Spondylolisthesis with an intact neural arch—the so-called pseudo-spondylolisthesis. Journal of Bone & Joint Surgery, British Volume. 1950; 32(3):325-33. doi: 10.1302/0301-620x.32b3.325 [DOI:10.1302/0301-620X.32B3.325]
12. Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. European Spine Journal. 2007; 17(3):327–35. doi: 10.1007/s00586-007-0543-3 [DOI:10.1007/s00586-007-0543-3]
13. Herkowitz HN, Sidhu KS. Lumbar Spine Fusion in the Treatment of Degenerative Conditions: Current Indications and Recommendations. Journal of the American Academy of Orthopaedic Surgeons. 1995; 3(3):123–35. doi: 10.5435/00124635-199505000-00002 [DOI:10.5435/00124635-199505000-00002]
14. Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine Journal. 2008; 8(5):747–55. doi: 10.1016/j.spinee.2007.06.013 [DOI:10.1016/j.spinee.2007.06.013]
15. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson ANA, Blood EA, et al. Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis. New England Journal of Medicine. New England Journal of Medicine. 2007; 356(22):2257–70. doi: 10.1056/nejmoa070302 [DOI:10.1056/NEJMoa070302]
16. Kuroki H, Tajima N, Kubo S. Clinical results of posterolateral fusion for degenerative lumbar spinal diseases: a follow-up study of more than 10 years. Journal of Orthopaedic Science. 2002; 7(3):317–24. doi: 10.1007/s007760200054 [DOI:10.1007/s007760200054]
17. Chen K, Yang Q, Liu X, Li H. Treatment of degenerative lumbar spondylolisthesis through posterolateral fusion and fixation with pedicle screws. Zhongguo gu shang= China journal of orthopaedics and traumatology. 2010; 23(4):254-6.
18. Liao JC, Chen WJ, Chen LH, Niu CC. Outcome of the L5-S1 segment after posterior instrumented spinal surgery in degenerative lumbar diseases. Chang Gung Medical Journal. 2009; 32(1):81-8. PMID: 19292943 [PMID]
19. Maleci A, Sambale RD, Schiavone M, Lamp F, Özer F, von Strempel A. Nonfusion stabilization of the degenerative lumbar spine. Journal of Neurosurgery: Spine. 2011; 15(2):151–8. doi: 10.3171/2011.3.spine0969 [DOI:10.3171/2011.3.SPINE0969]
20. Farrokhi MR, Alibai E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. Journal of Neurosurgery: Spine. 2011; 14(5):561–9. doi: 10.3171/2010.12.spine10286 [DOI:10.3171/2010.12.SPINE10286]
21. Farrokhi MR, Lotfi M, Masoudi MS, Gholami M. Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial. Journal of Neurosurgery: Spine. 2016; 24(1):7–15. doi: 10.3171/2015.3.spine141172 [DOI:10.3171/2015.3.SPINE141172]
22. Farrokhi M, Nouraei H, Kiani A. The efficacy of percutaneous vertebroplasty in pain relief in patients with pathological vertebral fractures due to metastatic spinal tumors. Iranian Red Crescent Medical Journal. 2012; 14(9):523-30. PMCID: PMC3482324 [PMID] [PMCID]
23. Farrokhi MR, Yazdanpanah H, Gholami M, Farrokhi F, Mesbahi AR. Pain and functional improvement effects of methylene blue injection on the soft tissue around fusion site after traumatic thoracolumbar fixation: A double-blind, randomized placebo-controlled study. Clinical Neurology and Neurosurgery. 2016; 150:6–12. doi: 10.1016/j.clineuro.2016.08.018 [DOI:10.1016/j.clineuro.2016.08.018]
24. Fairbanks JCT, Couper J, Davies JB. Modified Oswestry Low Back Pain Disability Questionnaire. Physiotherapy. 1980; 66:271-3.
25. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions. Spine. 2006; 31(14):E454–E459. doi: 10.1097/01.brs.0000222141.61424.f7 [DOI:10.1097/01.brs.0000222141.61424.f7]
26. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care & Research. 2011; 63(S11):S240-52. doi: 10.1002/acr.20543 [DOI:10.1002/acr.20543]
27. Farrokhi MR, Razmkon A, Maghami Z, Nikoo Z. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. European Spine Journal. Springer Nature; 2010; 19(10):1651–6. doi: 10.1007/s00586-010-1449-z [DOI:10.1007/s00586-010-1449-z]
28. Farrokhi MR, Kazemi AP, Eftekharian HR, Akbari K. Efficacy of Prophylactic Low Dose of Tranexamic Acid in Spinal Fixation Surgery. Journal of Neurosurgical Anesthesiology. 2011; 23(4):290–6. doi: 10.1097/ana.0b013e31822914a1 [DOI:10.1097/ANA.0b013e31822914a1]
29. Farrokhi MR, Nikoo Z, Gholami M, Hosseini K. Comparison Between Acrylic Cage and Polyetheretherketone (PEEK) Cage in Single-level Anterior Cervical Discectomy and Fusion. Clinical Spine Surgery. 2017; 30(1):38–46. doi: 10.1097/bsd.0000000000000251 [DOI:10.1097/BSD.0000000000000251]
30. Farrokhi MR, Rahmanian A, Masoudi MS. Posterolateral versus Posterior Interbody Fusion in Isthmic Spondylolisthesis. Journal of Neurotrauma. 2012; 29(8):1567–73. doi: 10.1089/neu.2011.2167 [DOI:10.1089/neu.2011.2167]
31. Farrokhi MR, Jamali M, Gholami M, Farrokhi F, Hosseini K. Clinical and radiological outcomes after decompression and posterior fusion in patients with degenerative scoliosis. British Journal of Neurosurgery. 2017; 31(5):514-525. doi: 10.1080/02688697.2017.1317717 [DOI:10.1080/02688697.2017.1317717]
32. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. The Journal of Bone & Joint Surgery 1991; 73(6):802–8. doi: 10.2106/00004623-199173060-00002 [DOI:10.2106/00004623-199173060-00002]
33. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo award winner in clinical studies: degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine. 1997; 22(24):2807-12. doi: 10.1097/00007632-199712150-00003 [DOI:10.1097/00007632-199712150-00003]
34. Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. :union: versus non:union: after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. European Spine Journal. 2008; 17(8):1107–12. doi: 10.1007/s00586-008-0695-9 [DOI:10.1007/s00586-008-0695-9]
35. Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG, Harrington JF, Magge SN, et al. Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. Journal of Neurosurgery: Spine. 2004; 1(3):267-72. doi: 10.3171/spi.2004.1.3.0267 [DOI:10.3171/spi.2004.1.3.0267]
36. Madan S, Boeree N. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine. 2002; 27(14):1536-42. doi: 10.1097/00007632-200207150-00011 [DOI:10.1097/00007632-200207150-00011]
37. Glassman S, Gornet MF, Branch C, Polly Jr D, Peloza J, Schwender JD, et al. MOS short form and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience. Spine Journal. 2006; 6(1):21-6. doi: 10.1016/j.spinee.2005.09.004 [DOI:10.1016/j.spinee.2005.09.004]
38. Lidar Z, Beaumont A, Lifshutz J, Maiman DJ. Clinical and radiological relationship between posterior lumbar interbody fusion and posterolateral lumbar fusion. Surgical Neurology. 2005; 64(4):303-8. doi: 10.1016/j.surneu.2005.03.025 [DOI:10.1016/j.surneu.2005.03.025]
39. Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Lee TJ, et al. Short fusion versus long fusion for degenerative lumbar scoliosis. European Spine Journal. 2008; 17(5):650-6. doi: 10.1007/s00586-008-0615-z [DOI:10.1007/s00586-008-0615-z]
40. Jutte P, Castelein R. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. European Spine Journal. 2002; 11(6):594-8. doi: 10.1007/s00586-002-0469-8 [DOI:10.1007/s00586-002-0469-8]
41. Wenger M, Sapio N, Markwalder T-M. Long-term outcome in 132 consecutive patients after posterior internal fixation and fusion for Grade I and II isthmic spondylolisthesis. Journal of Neurosurgery: Spine. 2005; 2(3):289-97. doi: 10.3171/spi.2005.2.3.0289 [DOI:10.3171/spi.2005.2.3.0289]

Add your comments about this article : Your username or Email:

Send email to the article author

© 2020 All Rights Reserved | Iranian Journal of Neurosurgery

Designed & Developed by : Yektaweb