Surgery of lumbar spinal canal stenosis revisited; less invasive approach options: quo vadis?

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Walter Bini

Healthpoint Hospital, UAE

: J Spine Neurosurg

Abstract

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Lumbar spinal stenosis (LSS) is characterized by a narrowing of the lumbar spinal canal and/or the intervertebral foramina resulting from disc degeneration, bulging of the annulus, facet joint hypertrophy and infolding of the ligamentum flavum. With an increasing aging population and advances in diagnostic imaging capabilities, lumbar spinal stenosis in it’s different stages or types is becoming more frequently diagnosed with an estimated prevalence of up to 13%. This, along with newer technical advances being introduced in the surgical management of LSS, continues to pose a topic of discussion among neurologists as well as orthopedics and neurosurgeons as far as treatment strategies are concerned. Especially the cases of moderate or "soft" stenosis, very different than the bony or consolidated type, warrant a detailed analysis of the primary interspinous devices used for both types along with a proposal for a decision making protocol. Based on our experience with the management of these two entities, we will focus on our results and future considerations with less invasive procedures which are proving over the last two decades to be a viable alternative for stenosis patients. Core of our presentation, are our results with a minimal invasive procedure performed in 121 patients and their corresponding initial follow-up over one year with a 92% success rate evaluated by an independent observer. This is clearly in contrast with the 40–90% success rates and 14–35% complication rates reported and associated with standard decompression surgeries. Furthermore, we will present our considerations of a further novel technique and the treatment options that are being developed towards the corresponding scheduled clinical trial.

Biography

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Walter Bini completed his Diploma from Westminster School, Simsbury Connecticut, USA and his Post-graduate Degree from Universidad de Zaragoza, Facultad de Medicina, Zaragoza, Spain. In 2014, he became the Middle East Chairman of ISLASS. He was the Head of Neurosurgery at Sheikh Khalifa General Hospital, UAQ–UAE from 2014–2016. Currently, he is the Lead Neurosurgeon responsible for spinal surgery in the Waldkrankenhaus for special surgeries by Leipzig in Germany and also Visiting Consultant Neurosurgeon of the Orthopaedic Department of Healthpoint Hospital in Abu Dhabi, UAE.