IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 8 Ver. II (August. 2016), PP 34-40 www.iosrjournals.org DOI: 10.9790/0853-1508023440 www.iosrjournals.org 34 | Page Same Segment Early Recurrence in Surgery of Lumbar Canal Stenosis- Role of Dissectomy Dr. Amit Agarwal 1 , Dr. Imran Sajid 2 , Dr. Namit Singhal 3 , Dr. Anubhav Agarwal 4 & Dr. Harish Chandra 5 1 Associate Professor, M.S. (Ortho), M.Ch. (Ortho), F.H. Medical Colllege, Agra. 2 Assistant Professor, M.S. (Ortho), M.Ch. (Ortho), F.H. Medical Colllege, Agra. 3 M.S., M.Ch., Neuro Surgeon, S.S. Hospital, Agra 4 M.S., M.Ch. (Ortho), Chandra Orthopedic & Maternity Institute, Agra 5 M.S.(Ortho), Chandra Orthopedic & Maternity Institute, Agra Abstract: Background: Symptomatic lumbar canal stenosis (LCS) usually responds well to surgery. However, in a subset of patients symptoms recur after variable periods of time. Aims: The aim of this study was to identify subset of patients having same segment early recurrence (recurrence <2 years) in surgery of LCS and the role of dissectomy in causing it. Materials And Methods: A prospective analysis of 100 patients who were operated for LCS from 2013 to 2015. All patients were followed up for atleast 2 years. Inclusion Criteria: Symptomatic LCS with or without Grade 1 fixed listhesis. Exclusion Criteria: LCS associated with Listhesis of grade 2 or more, LCS with mobile listhesis of any grade, presence of degenerative scoliosis and follow up more than 2 years. Based on type of surgical procedure performed initially patients were divided into 3 categories. CATEGORY-1 Decompression via laminectomy and foraminotomy. CATEGORY-2 Category 1 along with dissectomy. CATEGORY-3 Category 2 with TLIF combined. Redo surgical options included 1. Excision of scar and foraminotomy. 2. Excision of scar and pedicle screw rod fixation. 3. Only pedicle screw rod fixation with distraction. Results:In category 1 out of 5 patients (9.09%) developed recurrence, in category 2 out of 9 patients (22.5%) developed recurrence (p<0.0001). Conclusions: The strongest predictor of early recurrence is dissectomy combined with decompression. Excision of disc material leads to vertebral settling resulting in loss of height of foraminal space. So in surgery for LCS, dissectomy should only be done if frank herniation is present causing significant compression. When dissectomy is done it should always be supplemented with stand alone TLIF. In redosurgery, excision of scar tissue leads to major dural tears. Pedicle screw rod fixation with distraction is an excellent option in these cases as it leads to restoration of foraminal height. I. Introduction Symptomatic lumbar canal stenosis usually responds well to surgery. Patients of lumbar canal stenosis usually present with neurogenic claudication, occasionally with radicular pain. Radicular Pain in this subset of patients usually gets relieved on sitting, in contradiction to radicular pain of patients with disc prolapse.This contradiction is due to compression being dorsal to neural structures in LCS. Sometimes patients ofLCS have associated with spinal instability.Traditionally spinal instability is defined as “loss of ability of spine under physiological loads to maintain relationships between vertebrae in such a way that there is neither damage nor subsequent irritation to spinal cord or nerve roots and in addition, there is no development of incapacitating deformity or pain due to structural changes”. Louis two column concept assigns significance to vertebral body and facet joint complexes on either side of spine. Dennis emphasizes on three column concept: spinal instability is said to be present when any two columns are involved. Hence according to Dennis concept, grade1 fixed spondylolisthesis is stable; rest others are unstable. Preoperative identification of instability is very important as this leads to high chances of early recurrence. There are only few studies who have dealt with recurrence of symptoms, not responding to conservative measures, after decompressive surgery for LCS. This studyaims to identify subset of patients of LCS who have a higher change of early recurrence (<2 years), using the JOA score. We have also analyzed the surgical options in redo surgery.