“A decade with micro-tubular decompression”: Peri-operative complications and surgical outcomes in single and multilevel lumbar canal stenosis

Abstract

We present ten years experience with micro-tubular decompression (MTD) performed for single and multilevel lumbar canal stenosis (LCS) assessing the peri-operative complications and mid-term surgical outcome. The aims of this study were to review the incidence of peri-operative complications and classification of complications and define risk factors to prevent it while negotiating the learning curve. A retrospective review of prospectively collected data over a period of ten years involving 625 patients who underwent single/multilevel lumbar MTD. Peri-operative clinical-radiological parameters, post-operative complications, clinical outcome (VAS and ODI), and satisfactory outcomes in the form of Wang and Bohlmann’s criteria were evaluated. The peri-operative complications were divided into five broad categories based on their time of occurrence, severity, and system affected. The comparison between the patients with and without complications was done to evaluate the causative risk factors. The overall incidence of the peri-operative complication was 12.96% over ten years with higher rate (29.8%) during the initial three years of practice and lower rate (8.78%) in the last seven years. The most common peri-operative complications were urinary tract infections (UTI). The risk factors for complications with MTD revealed in statistical analysis were presence of one or more comorbidities, L4–L5 single-level stenosis, bilateral stenosis with ipsilateral and bilateral decompression done through unilateral approach, and multilevel MTD done through single incision for multilevel LCS. More than 95% patients operated with MTD showed excellent to good outcome as per the Wang and Bohlmann’s criteria at the final follow-up. This study represents 12.96% overall incidence of peri-operative complications with higher rate (29.8%) during the initial three years of practice and lower rate (8.78%) in the last seven years with MTD for single/multilevel LCS with. MTD is an effective procedure with substantial clinical benefits in the form of excellent to good clinico-radiological outcomes at two year follow-up. However, there is a learning curve associated with the adoption of the technique. The described classification for peri-operative complications is helpful to record, to evaluate, and to understand the aetiology and risk factors based on its duration of occurrence in the peri-operative period.