Lumbar Fusion in Treatment of Neurogenic Claudications

Introduction Neurogenic claudication is one of the main reasons for major lumbar spine surgery. Clinical sign of lumbar instability is manifested as uni/bilateral sciatica in upright position, while it is absent or mild in laying position. Radiological testing (MRI) most commonly is described as a focal of dispersed, central, or foraminal stenosis due to different degenerative changes.

The aim of this work is to present effectiveness of lumbar fusion in treatment of clinical lumbar instability (sciatica, pronounced in upright position).

Materials and Methods We have analyzed 58 patients older than 27 years, on whom we have performed fusion surgery without decompression. Thirty-three of them have suffered listhesis, 11 degenerative scoliosis, 5 posttraumatic kyphosis, and 9 of them focal stenosis.

Results After average follow-up more than 2 years, there were only four revision surgeries (one infection, two reinstrumentation with decompression, one decompression). Patient's satisfaction was high, in general.

Conclusion When patient is pain free in laying position and painful in upright position, lumbar spine instability should be the most appropriate clinical diagnosis. Stabilization of spine should be our preference, rather than “decompression only” surgery. Symptoms make an indication for surgery, MRI just confirm our clinical exam. MRI is rather inconclusive since spine position is rather altered in upright in comparison to the laying position.

Keywords spine; instability; sciatica; spondylodesis