Spinal degeneration, such as lumbar spinal stenosis, are common with age and can affect up to 95% of people by the age of 50 years. Spinal decompressions surgeries are used to treat stenosis of the lateral recess, however one third of surgeries are associated with suboptimal outcomes. The latter is likely due to the underappreciated anatomy of the lateral recess, particularly the sublaminar ridge (SLR). The SLR, which is the insertion point of the ligament flava, can hypertrophy with age thereby resulting in adverse clinical outcomes. Imaging of the SLR can be used to inform pre-surgical planning and guide the use of appropriate surgical techniques. Thus, the objective of this study is to retrospectively explore correlations between pre-surgical image findings relating to the SLR and clinical outcomes of spinal decompression surgery.
Materials and Methods
A retrospective analysis of clinical outcomes following spinal decompression will be carried out using the electronic health records (EHR) system, EPIC, at Hamilton Health Sciences (HHS). A review of post-surgical spinal decompression records with a cross reference to available pre-surgical computed tomography (CT) scans will be analyzed. Through this investigation, we intend to establish whether a correlation between SLR status and the success of surgical outcomes exists. Additional demographic data including sex and age will be collected to better appreciate any confounding data.
Results
A total of 12 patients who have undergone spinal stenosis surgery, comprising of 5 males and 7 females with ages ranging from 31-88 years, have been identified as potential candidates for this study. The next steps in methodology are to retrospectively analyze 2D CT data sets to determine and quantify the presence of hypertrophied SLRs. Following this analysis, a clinical correlation of SLR status and post-surgical clinical outcomes will be examined. Additional correlations between sex, age and spinal stenosis surgery outcomes may be identified.
Conclusion
Discrepancies between successful and unsuccessful surgical outcomes emphasize the necessity for morphological understanding of the SLR. This study introduces a novel method to identify the SLR’s presence on pre-surgical CT scans, providing insight on its potential role in spinal stenosis surgical outcomes. The impact of this study directly corresponds to clinical practice, highlighting the importance of identifying the SLR for assessment in spinal interventions.
Significance/Implications
Recognizing the presence of the SLR in the lateral recess when pre-surgical planning for degenerative spinal stenosis may be a crucial component when considering the outcome of degenerative spinal stenosis surgery.
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