Abstract
Study Design
A prospective cohort study was carried out looking at the functional outcome and post-procedure translational segmental instability after multi-level lumbar decompression using a Hinge osteotomy technique.
Objective
The Hinge osteotomy technique involves unilateral subperiosteal muscle dissection with osteotomy of the base of the spinous processes thereby preserving the integrity of the posterior elements. The objective of this study was to demonstrate the results of this technique clinically and radiologically.
Methods
Between February 2005 and February 2007, 120 patients (51 male and 69 female) diagnosed with degenerative and/or congenital lumbar stenosis with a mean age of 64 years, underwent central and bilateral canal decompression using the hinge osteotomy technique. A mean of 2 segments (range 2-4) was decompressed. All patients were followed up for a minimum of three years. Five outcome measures were used: visual analogue scale for leg pain, Likert scale for functional status, symptom specific well-being score, general well-being score, and ODI score. The outcome measures were recorded pre-operatively and at 6 months and 3 years post-operatively. Successful surgical outcome was defined as an improvement in at least four out of five outcome measures.
Results
108 patients (90%) had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (p< 0.001) when measured at the 6-month post-operative mark as compared to pre-operatively, with further marginal significant improvement (p< 0.05) at 3 years post-surgery. There was no evidence of progressive lumbar segmental instability at 3 years post-operatively.
Conclusion
Decompression of multi-level lumbar spine stenosis using the unilateral approach with the Hinge osteotomy technique is a safe approach for multi-level stenosis, with good outcome and no evidence of significant segmental translational spinal instability.
