Posterior Lumbar Interbody Fusion with Spinal Decompression using Minimally Invasive Spine Surgery in the Treatment of Symptomatic Degenerative Spinal Stenosis
Keywords:Orthopaedics, Minimal Invasive, Spine, PLIF, Surgery
Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. The incidence of this case is 3.57% (3570 per 100,000) population in Southeast Asia. The main symptoms are low back pain, numbness, and weakness in the lower extremity that occur and intensify on walking caused by the load of the body weight on the spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis , all contribute to impact the spinal canal and intervertebral foramen in lumbar stenosis . There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or become destabilized following decompression who would benefit from fusion procedure.
Surgical treatment of lumbar spinal stenosis by posterior lumbar interbody fusion is indicated for patients with symptoms of low back pain and lower limb radicular pain, that are unsuccessful treated with medicines and /or patients with persisting or worsening neurological deficit.However, this procedure may lead to possible complications. This case report study was conducted to show how our hospital handling spinal stenosis case.
A 67-year-old woman presented with low back pain that has occured for two years, and had been worsening for the past 3 months. She described the pain as an intermitten ache down on her leg, the pain was severe and worsened when the patient is standing, sitting, or walking for a long time , The pain severity was measured by visual analog score (vas), graded between 7/10 to 9/10. She also complained numbness from the bilateral gluteal region to the lateral side of lower extremities, when she feel too tired. On the physical examination, She was found to have limited range of motion for flexion and extension, on the lumbar spine, due to pain. The motoric strength of both lower limbs were decreased, so did the sensory function. The Radiological examination showed a severe stenosis at lumbar spinal bone region on L4-L5 area. After the examination, the patient agreed to undergo the suggested operative procedure and gare the consent at the hospital.
Plum Analytics Artifact Widget Block
Farrokhi MR, Yadollahikhales G, Gholami M, Mousavi SR, Mesbahi AR, Asadi-Pooya AA. Clinical outcomes of posterolateral fusion vs. posterior lumbar interbody fusion in patients with lumbar spinal stenosis and degenerative instability. Pain Physician. 2018;21(4):383-406. https://doi.org/10.36076/ppj.2018.4.383 PMid:30045595
Kim DH, Jeong ST, Lee SS. Posterior lumbar interbody fusion using a unilateral single cage and a local morselized bone graft in the degenerative lumbar spine. Clin Orthop Surg. 2009;1(4):214-21. https://doi.org/10.4055/cios.2009.1.4.214 PMid:19956479
Tomita K. Diagnosis and treatment of lumbar spinal canal stenosis. J Jpn Med Assoc. 2012;128:1790-4.
Choi JM, Choi MK, Kim SB. Perioperative results and complications after posterior lumbar interbody fusion for spinal stenosis in geriatric patients over than 70 years old. J Korean Neurosurg Soc. 2017;60(6):684-90. https://doi.org/10.3340/jkns.2017.0203 PMid:29142628
Liang L, Jiang WM, Li XF, Wang H. Effect of fusion following decompression for lumbar spinal stenosis: A meta-analysis and systematic review. Int J Clin Exp Med. 2015;8(9):14615-24. PMid:26628944
Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: Techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18. https://doi.org/10.28962/01.3.072 PMid:27683674
Dharma AS, Ermawan R, Utomo P, Handojo HT. Correlation of fusion rate on lumbar spinal stenosis post PLIF with functional outcome. Biomedika. 2009;11(2):61-7. https://doi.org/10.23917/biomedika.v11i2.7613
Fenton-White HA. Trailblazing: The historical development of the posterior lumbar interbody fusion (PLIF). Spine J. 2021;10(2):1529-9127-3. https://doi.org/10.1016/j.spinee.2021.03.016 PMid:33757870
Yang LH, Liu W, Li J, Zhu WY, An LK, Yuan S, et al. Lumbar decompression and lumbar interbody fusion in the treatment of lumbar spinal stenosis: A systematic review and metaanalysis. Medicine (Baltimore). 2020;99(27):e20323. https://doi.org/10.1097/md.0000000000020323 PMid:32629626
Lam K, Al-Mousa A, Manson N. Do outcomes vary following minimally invasive lumbar interbody fusion (MILIF) in patients with spinal stenosis? A multi-centre subgroup analysis study. Spine J. 2016;16(4):S47. https://doi.org/10.1016/j.spinee.2016.01.032
How to Cite
Copyright (c) 2021 Michael Rothmans Silaban, Pranajaya D Kadar (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.