MINIMALLY INVASIVE OVER THE TOP DECOMPRESSION IN MULTILEVEL LUMBAR STENOSIS: CLINICAL RESULTS

ZU REHMAN; B ULLAH; SS SHAH; M SOHAIB; M AAMIR

doi:10.54112/pjicm.v5i01.85

Authors

ZU REHMAN Department of Neurosurgery, MTI/ Lady Reading Hospital Peshawar, Pakistan
B ULLAH Department of Neurosurgery, MTI/ Lady Reading Hospital Peshawar, Pakistan
SS SHAH Department of Neurosurgery, MTI/ Lady Reading Hospital Peshawar, Pakistan
M SOHAIB Department of Neurosurgery, MTI/ Lady Reading Hospital Peshawar, Pakistan
M AAMIR Department of Neurosurgery, MTI/ Lady Reading Hospital Peshawar, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i01.85

Keywords:

Minimally Invasive Surgery, Over-The-Top Decompression, Lumbar Spinal Stenosis, Oswestry Disability Index, Visual Analog Scale, Complications, Surgical Outcomes

Abstract

Background: Multilevel lumbar spinal stenosis (LSS) is a common degenerative spinal condition in the elderly population, often leading to significant disability and reduced quality of life. Traditional open surgeries can be associated with higher morbidity, prompting the shift towards minimally invasive techniques such as “over-the-top” decompression, which preserves spinal stability while achieving effective neural decompression. Objective: To evaluate the clinical outcomes of minimally invasive over-the-top decompression in patients with multilevel lumbar spinal stenosis. Study Design: Cross-sectional study. Setting: Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: Three years, from January 2021 to December 2023. Methods: A total of 320 patients aged 50 years or older with MRI-confirmed multilevel lumbar spinal stenosis were included. All patients underwent minimally invasive over-the-top decompression under general anesthesia. The primary outcome was the change in Oswestry Disability Index (ODI) scores. Secondary outcomes included changes in pain scores using the Visual Analog Scale (VAS), walking distance, analgesic consumption, and postoperative complications. Data were analyzed using SPSS version 25.0. Paired t-tests were employed to compare preoperative and postoperative values, with a significance level set at p < 0.05. Results: The mean age of the cohort was 65.6 ± 7.8 years, with 53.4% male and 46.6% female patients. ODI scores significantly improved from a preoperative mean of 42.6 ± 10.4 to 22.4 ± 8.6 postoperatively (p < 0.001). VAS pain scores decreased from 7.9 ± 1.2 to 3.2 ± 1.4 (p < 0.001). Walking distance increased from 100.6 ± 20.4 meters to 300.8 ± 50.6 meters postoperatively. There was also a marked reduction in analgesic usage. The complication rate was low and within acceptable limits. Conclusion: Minimally invasive over-the-top decompression for multilevel lumbar spinal stenosis offers significant clinical improvement in terms of pain relief, functional disability, and walking capacity, with a favorable safety profile and reduced postoperative morbidity.

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