Abstract
Introduction
Lumbar canal stenosis (LCS) and spondylosis are the major causes of morbidity among the elderly. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. Although the decompression Procedures improve the claudication, the back complaint persist or even increase. We assess the efficacy of combination of microscopic assisted percutaneous decompression (MAPD) and percutaneous transpedicular screw fixation (TPSF) with PEEK rod.
Material and Methods
Prospective study. Between 2009 and June 2012, 20 Patients with LCS and lumbar spondylosis were included in this study. We reviewed demographic information, preoperative (preop.) and postoperative (postop.) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI).
Results
20 patients (14 males and 6 females; mean age 69.2 years), mean follow-up 14.2 months, co-morbidities are found in patients (cardiac 8, DM in 4, renal insufficiency in 4), ASA Score (Class I in 8, III in 10, III in 2). BMI; normal weight (7), overweight (6) and Obesity (7). Mean preop. VAS (back and leg) was 5.5 and 5.6 respectively; ODI was 57.2%, 3 months postop. VAS (2.65 and 1.3), ODI 26.4% and 18.2% at the last follow-up. The operated levels were (one level in 2 patients, two levels in 7, three levels in 7 and four levels in 4), eight patients with degenerative scoliosis (more than 10°) with mean cobb- angle of 15.4° preop. and postop. 5.75°. Mean Lumbar lordosis was 35.6° preop. and 39.5° postop. Sacral Slope was 27.8°preop. and postop. 30.3°. Mean operative time was 196 minutes and blood loss was 233.5 ml. Intraop. complications included 2 patients with dural injuries, no wound healing, Follow-up complications included one case with screw loosening.
Conclusion
Elderly patients are considered good candidates for lumbar surgical decompression using minimally invasive techniques. MAPD is a minimally invasive treatment option that affords a high level of safety, improved functions and decreased pain score. The spinal stabilization using PEEK rod possesses a good solution for spondyolotic back pain not