The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Indirect Decompression in Lumbar Degenerative Pathology: Analysis of Imaging Changes at 48 Hours with One-year Follow-up

Document Type : RESEARCH PAPER

Authors
Matias Leonardo Cullari 1
Juan Pablo Taleb 1
Lucio Gutierrez 1
Facundo Martin Aguirre 1
Santiago Alejandro Aguer 1
Ruy Lloyd 1
Glenda Ernst 2
1 Orthopedic Surgery British Hospital of Buenos Aires, Buenos Aires, Argentina
2 Scientific Advisory Board, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
10.22038/abjs.2024.79458.3637
Abstract
Objectives: Investigate the immediate resonance magnetic image changes undergone by the lumbar 
canal after indirect decompression and compare them at one-year post-intervention. We also 
investigate the clinical outcome of indirect decompression at one-year follow-up.
Methods: Imaging changes in patients who underwent indirect lumbar decompression and percutaneous posterior 
fixation were analyzed with one-year follow-up. Radiographic measurements were performed preoperatively and 
postoperatively (at one year), and the area of lumbar canal occupation and yellow ligament by nuclear magnetic 
resonance was compared preoperatively, at 48 hours post-surgery, and at one year. Radiographic measurements 
included disc height, foraminal height, total lumbar lordosis, and segmental lordosis. The VAS lumbar and lower 
limb scales and the Oswestry Disability Index (ODI) were used to assess clinical outcomes.
Results: A total of 21 male and 23 female patients underwent indirect decompression at 64 lumbar levels. A 
significant improvement was observed in the clinical evaluation of all patients’ post-surgery (p < 0.001) in all 
radiographic parameters. There was an immediate increase in the lumbar canal at 48 hours (p < 0.001), which 
continued to increase at one year post-intervention (p < 0.05). The yellow ligament occupation area decreased at 
48 hours (p < 0.001) and continued to decrease until one year (p < 0.01). Four complications were recorded, one of 
which was a posterior tract infection requiring open decompression.
Conclusion: Indirect decompression for degenerative lumbar disease provided successful clinical outcomes, 
including indirect expansion of the dural sac at 48 hours post-procedure, with progressive increase in the lumbar 
canal area at one-year follow-up.
 Level of evidence: III
Keywords
Degenerative spine disorders
Ligamentotaxis
Lumbar region
Magnetic resonance imaging
Minimally invasive
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 11
November 2024
Pages 779-788

  • Receive Date 23 April 2024
  • Revise Date 10 September 2024
  • Accept Date 11 September 2024