The outcomes of flavectomy with foraminotomy versus hemilaminectomy with foraminotomy in patients with lumbar neurogenic intermittent claudication: A comparative study in Sulaimaniyah, Kurdistan region, Iraq

Authors

  • Rawsht Omed Abdalla Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. Author
  • Omar Ali Rafiq Barawi Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. Author
  • Hamid Ahmed Mahmood Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. Author

DOI:

https://doi.org/10.17656/jzs.10899

Keywords:

Lumbar spine stenosis, intermittent neurogenic claudication, flavectomy, foraminotomy, hemilaminectomy

Abstract

Background: The main prominent and classical symptom of lumbar spinal stenosis is intermittent neurogenic claudication, which is characterized by pain, aching, cramping, and paresthesia in the lower extremities induced by standing, walking, and back extension. Surgical decompression is the best choice when conservative methods fail. There are various decompressive techniques have been introduced, among them flavectomy with foraminotomy (F/F) and hemilaminectomy with foraminotomy (H/F).

 

Objectives: To compare the outcomes of F/F versus H/F, in patients with neurogenic claudication and to determine the predictors that may interfere with the outcomes.

 

Materials and Methods: Twenty-one patients with lumbar spinal stenosis having neurogenic claudication were divided into two groups sequentially. The first group (n=10) underwent F/F, and the other group (n=11) underwent H/F. Follow-up was done in the first and sixth months postoperatively for postoperative complications, Oswestry disability index (ODI), claudication distance, and patients' satisfaction regarding symptoms.

 

Results: In the last follow-up, the first group, after F/F, showed improvement in walking distance as 80% reported unlimited,10% improved with >1500 m, and 10% less improved with 500 m. These cases got lesser ODI scores and mostly were <10% despite one case remaining with moderate disability. Patient satisfaction rates were higher but not significant. While those who underwent H/F, nearly 40% showed unlimited walking distance, 45% improved with >1000 m, the remaining reported less improvement, and one remained with <100 m walking distance. Their ODI scores were higher than the previous group, mostly >10%, and 2 cases remained with moderate disability and complained of remaining back ache and leg paresthesia while improving in walking distance.

 

Conclusions: both surgical procedures showed benefits in treating lumbar spinal stenosis, but F/F is better than H/F due to its high success and patient satisfaction rate. It can significantly improve a patient's quality of life by increasing postoperative walking distance, resolving neurogenic claudication, reducing ODI score, and relieving back pain, lower limbs pain, and paresthesia postoperatively. The increase in age is associated with less improvement after both procedures.

References

Messiah S., Tharian A.R., Candido K.D., & Knezevic N.N. (2019). Neurogenic claudication: a review of current understanding and treatment options. Current Pain and Headache Reports. 23(5):1-8. DOI: https://doi.org/10.1007/s11916-019-0769-x

Genevay S. & Atlas S.J. (2010). Lumbar spinal stenosis. Best Practice & Research Clinical Rheumatology. 24(2):253-65. DOI: https://doi.org/10.1016/j.berh.2009.11.001

Zaina F., Tomkins‐Lane C., Carragee E., & Negrini S. (2016). Surgical versus non‐surgical treatment for lumbar spinal stenosis. Cochrane Database of Systematic Reviews. (1). DOI: https://doi.org/10.1002/14651858.CD010264.pub2

Markman J.D., Frazer M.E., Rast S.A., McDermott M.P., Gewandter J.S., & Chowdhry A.K. (2015). Double-blind, randomized, controlled, crossover trial of pregabalin for neurogenic claudication. Neurology. 84(3):265-72. DOI: https://doi.org/10.1212/WNL.0000000000001168

Kobayashi S. (2014). Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World Journal of Orthopedics. 5(2):134-45. DOI: https://doi.org/10.5312/wjo.v5.i2.134

Burgstaller J.M., Schüffler P.J., Buhmann J.M., Andreisek G., Winklhofer S., & Del Grande F. (2016). Is there an association between pain and magnetic resonance imaging parameters in patients with lumbar spinal stenosis? Spine. 41(17):E1053-E62. DOI: https://doi.org/10.1097/BRS.0000000000001544

Ammendolia C., Stuber K.J., Rok E., Rampersaud R., Kennedy C.A., & Pennick V. (2013). Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database of Systematic Reviews. (8). DOI: https://doi.org/10.1002/14651858.CD010712

Lurie J.D., Tosteson T.D., Tosteson A., Abdu W.A., Zhao W., & Morgan T.S. (2015). Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine. 40(2):63-76. DOI: https://doi.org/10.1097/BRS.0000000000000731

Fu Y.S., Zeng B.F., & Xu J.G. (2008). Long-term outcomes of two different decompressive techniques for lumbar spinal stenosis. Spine. 33(5):514-18. DOI: https://doi.org/10.1097/BRS.0b013e3181657dde

Winn HR. Cervical, thoracic and lumber stenosis in Youmans and Winn neurological surgery. Elsevier Health Sciences; 2022. Chapter 319, p. 2498-509.

Rahim N.R. & Kadir M.R. Comparing the effects of laminotomy and hemilaminectomy to the spinal segment. IEEE EMBS Conference on Biomedical Engineering and Sciences (IECBES); 2010: IEEE.

Munting E., Röder C., Sobottke R., Dietrich D., & Aghayev E. (2015). Patient outcomes after laminotomy, hemilaminectomy, laminectomy and laminectomy with instrumented fusion for spinal canal stenosis: a propensity score-based study from the Spine Tango registry. European Spine Journal. 24(2):358-68. DOI: https://doi.org/10.1007/s00586-014-3349-0

Parker S.L., Adogwa O., Davis B.J., Fulchiero E., Aaronson O., Cheng J., Devin C.J., & McGirt M.J. (2013). Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis. Clinical Spine Surgery. 26(1):42-47. DOI: https://doi.org/10.1097/BSD.0b013e318232313d

Smeets R., Köke A., Lin C.W., Ferreira M., & Demoulin C. (2011). Measures of function in low back pain/disorders: Low back pain rating scale (LBPRS), oswestry disability index (ODI), progressive isoinertial lifting evaluation (PILE), quebec back pain disability scale (QBPDS), and roland‐morris disability questionnaire (RDQ). Arthritis Care & Research. 63(S11):S158-S73. DOI: https://doi.org/10.1002/acr.20542

Fairbank J.C. & Pynsent P.B. (2000). The Oswestry disability index. Spine. 25(22):2940-53. DOI: https://doi.org/10.1097/00007632-200011150-00017

Weinstein J.N., Tosteson T.D., Lurie J.D., Tosteson A., Blood E., Herkowitz H., Cammisa F., Albert T., Boden S.D., Hilibrand A., & Goldberg H. (2010). Surgical versus non-operative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine. 35(14):1329-38. DOI: https://doi.org/10.1097/BRS.0b013e3181e0f04d

Nath R., Middha S., Gupta A.K., & Nath R. (2012). Functional outcome of surgical management of degenerative lumbar canal stenosis. Indian Journal of Orthopaedics. 46(3):285-90. DOI: https://doi.org/10.4103/0019-5413.96380

Sinikallio S., Aalto T., Airaksinen O., Herno A., Kröger H., & Savolainen S. (2007). Lumbar spinal stenosis patients are satisfied with short-term results of surgery–younger age, symptom severity, disability and depression decrease satisfaction. Disability and Rehabilitation. 29(7):537-44. DOI: https://doi.org/10.1080/09638280600902646

Atlas S.J., Keller R.B., Robson D., Deyo R.A., & Singer D.E. (2000). Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the main lumbar spine study. Spine. 25(5):556-62. DOI: https://doi.org/10.1097/00007632-200003010-00005

Costandi S., Chopko B., Mekhail M., Dews T., & Mekhail N. (2015). Lumbar spinal stenosis: therapeutic options review. Pain Practice. 15(1):68-81. DOI: https://doi.org/10.1111/papr.12188

Yukawa Y., Lenke L.G., Tenhula J., Bridwell K.H., Riew K.D., & Blanke K. (2002). A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. JBJS. 84(11):1954-59. DOI: https://doi.org/10.2106/00004623-200211000-00008

Thornes E., Ikonomou N., & Grotle M. (2011). 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. The Open Orthopaedics Journal. 5:372-78. DOI: https://doi.org/10.2174/1874325001105010372

Yamashita K., Ohzono K., & Hiroshima K. (2006). Five-year outcomes of surgical treatment for degenerative lumbar spinal stenosis: a prospective observational study of symptom severity at standard intervals after surgery. Spine. 31(13):1484-90. DOI: https://doi.org/10.1097/01.brs.0000219940.26390.26

Published

2023-06-20

How to Cite

The outcomes of flavectomy with foraminotomy versus hemilaminectomy with foraminotomy in patients with lumbar neurogenic intermittent claudication: A comparative study in Sulaimaniyah, Kurdistan region, Iraq. (2023). Journal of Zankoy Sulaimani - Part A, 25(1), 12. https://doi.org/10.17656/jzs.10899