1 Dr. Zia Ur Rehman, 2Dr. Haider Ali
1 Assistant Professor Department of Neurosurgery MTI/ Lady Reading Hospital – Peshawar
2 Registrar Neurosurgery LRH
Correspondence: Dr. Haider Ali Registrar Neurosurgery LRH
| Abstract Background: Lumbar spinal stenosis, a degenerative condition, narrows the spinal canal. This compression causes pain and reduced mobility. Traditional laminectomy, although effective, often involves significant tissue damage and lengthy recovery periods. Over-thetop laminectomy offers a less invasive alternative, aiming to minimize these drawbacks while providing effective decompression. Objective: The primary objective was to evaluate the efficacy of over-the-top laminectomy in patients with multiple levels of lumbar spinal stenosis. Methods: This study took place at Lady Reading Hospital, Peshawar, from September 2022 to July 2024. We included 359 patients aged 50 and older, diagnosed with multiple levels of lumbar spinal stenosis via MRI. The intervention was over-the-top laminectomy, performed under general anesthesia. The primary outcome was the improvement in Oswestry Disability Index (ODI) scores from preoperative to postoperative assessments. Secondary outcomes included pain relief (measured by the Visual Analog Scale, VAS), improvement in walking distance, reduction in analgesic use, and incidence of postoperative complications. Data were meticulously collected and analyzed using SPSS software (version 26.0). Results: The mean preoperative ODI score significantly decreased from 42.5 to 22.3 postoperatively (p < 0.001). The VAS score also showed a marked reduction from 7.8 preoperatively to 3.1 postoperatively (p < 0.001). Walking distance improved dramatically from 100.5 meters to 300.7 meters (p < 0.001). Analgesic use reduced notably from 2.5 to 0.8 daily (p < 0.001). The overall complication rate was 14.8%, with wound infections at 5.3%, dural tears at 3.9%, and reoperations at 2.8%. Conclusion: Over-the-top laminectomy significantly improves disability, pain levels, and functional outcomes in patients with multiple levels of lumbar spinal stenosis. The procedure’s manageable complication rate underscores its viability as a surgical option, supporting broader adoption in clinical practice. Keywords: Lumbar spinal stenosis, over-the-top laminectomy, Oswestry Disability Index, Visual Analog Scale, minimally invasive surgery. |