Introduction: Lumbar spinal stenosis (LSS), characterized by spinal canal narrowing that compresses nerves, primarily impacts older adults due to degenerative changes. Symptoms include low back and leg pain that typically eases with rest. Diagnosis is based on clinical evaluation and imaging (MRI, CT). Initial management involves conservative treatments: physical therapy and epidural injections. Decompression surgery is considered when these fail, though it remains uncertain whether decompression alone or with instrumented fusion is more effective in cases of LSS with grade I spondylolisthesis. This study aimed to compare these approaches and effects on quality of life.
Methods: Conducted over four years, this prospective study included 75 LSS patients who underwent either laminectomy alone (Group 1) or laminectomy with instrumented fusion (Group 2). Data on physical and mental health were collected preoperatively and at 6 months and 2 years post-surgery using the Physical Component Summary (PCS), Mental Component Summary (MCS) of the Short Form 36 questionnaire (SF-36), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS). SPSS software was used for statistical analysis, and significance was defined as p< 0.05 . All participants provided informed consent, and ethical approval was obtained.
Results: Among the 75 patients (average age 59.9 years), 34 underwent laminectomy alone, and 41 had additional fusion . Both groups showed significant improvements in PCS, MCS, ODI, and VAS scores post-surgery. Patients who had only laminectomy initially demonstrated greater physical improvements, while those with fusion showed better long-term mental health and reduced leg pain. Analyses for two-level laminectomies mirrored these findings. No significant differences were observed between groups for SF-36, ODI, VAS back, and VAS leg scores. Six complications were recorded, with two classified as major; complication rates did not significantly differ between groups.
Conclusion : Spinal decompression improved quality of life in LSS patients at both 6 months and 2-year follow-ups, with no substantial difference between those undergoing laminectomy alone or with fusion. This questions the necessity of fusion, suggesting longer follow-ups could clarify benefits, especially for patients with grade I spondylolisthesis.
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