الفهرس 
Anatomy of the Lumbar SpineOnly 14 pages are availabe for public view
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Abstract
Background:
Degenerative lumbar spinal stenosis is one of common diseases in elderly, also may occur in younger ages, usually presents with back pain, lower limbs pain and claudication pain. Diagnosis is confirmed by radiological studies such as plain X rays LSS, CT. LSS or MRI LSS.
Surgical treatment for lumbar spinal stenosis is indicated in patients with progressive neurological deficits or those who fail an appropriate trial of non-operative management. All the proposed surgical interventions have a common primary goal of neural element decompression.
Different surgical procedures can be done for treatment of degenerative lumbar canal stenosis, including radical decompressive laminectomy with and without fixation or minimally invasive procedures. Each procedure has its advantages and its complications. So there must be a balance between safety and effectiveness to provide maximum benefit for the patient.
Objective:
The aim of this prospective study is to evaluate the different surgical procedures for the treatment of degenerative lumbar canal stenosis, and how can we choose the appropriate procedure for each patient.
Methods:
A prospective comparative study was done between January 2013 and December 2015, including three groups. group A we treated 20 patients with laminectomy and posterior transpedicular screws fixation. group B we treated 20 patients with laminectomy only without use of any implants. group C we treated 20 patients with minimally invasive procedures as unilateral or bilateral lumbar canal decompression.
We used Oswestry Disability Index and Visual Analogue Score to assess pre and postoperative disabilities and pain.
Results:
In this study, our statistical results revealed that there was no statistically significant difference in the improvement of leg pain and claudication pain between the three groups regarding VAS for leg pain.
But there was significant difference in improvement of back pain, regarding the VAS in group A treated with laminectomy and fixation much more well than group B treated with laminectomy and group C treated minimally invasive.
Also, there was no significant difference between the three groups regarding the ODI, but there was relative improvement of ODI in group A treated by laminectomy and fixation than the other two groups and this was due to the element of back pain in the patients of group A was much more than the other two groups.
Conclusion:
The element of back pain must be respected, and the preoperative VAS for back pain should be compared with the preoperative VAS for leg pain, as the traditional modalities will not improve the back pain.
The VAS for leg pain and claudication pain will improve almost equally by all surgical modalities, so we have to revise our concept about radical laminectomy and to put in our view the minimally invasive procedures as microscopic lumbar canal decompression through unilateral or bilateral fenestration.