Data of all patients with chronic refractory pain to conservative treatment for 6 weeks and who underwent surgical interference were collected at the Neurosurgery Department, Faculty of Medicine, Menofia University at the period from June 2016 to July 2018 and were followed-up throughout a period of 6 months. The present study includes data of patients with evident manifestations of LCS as sever claudicating pain, recurrent lumbar pain that was not relieved by conservative treatment.
Data of patients with infrequent pain, mild pain relieved spontaneously or by rest, peripheral neuropathy, diabetes mellitus, cardiac, hepatic or renal diseases, coagulopathy, and all cases of spinal instability were excluded from this study.
The present study involved patients’ demographic and clinical data, full medical history concerning type, site, and radiation of pain, and precipitating and relieving factors, drug history by using a 0 to 4 points Likert scale with 0, no medication; 1, simple analgesics as oral non-steroidal anti-inflammatory drugs (NAISD); 2, injectable NAISD analgesia; 3, as needed opioid prescription medications; 4, scheduled opioid prescription medications were also evaluated at 3 and 6 months post-operative and considered one of the secondary outcome evaluation parameters.
Data of clinical examinations includes the following:
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-Pain severity assessment of back and lower limb by using an 11-point numeric rating scale (NRS) with numbers from 0 to 10 where 0 indicates no pain and 10 indicates worst pain imaginable [9, 10].
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-Assessment of disability secondary to pain by using the low back pain Oswestry disability index (ODI) that determines disability as minimal (0-20), moderate (20–40), severe (40–60), and ODI of 60–80 indicated that patient is crippled and 80–100 indicates that the patient is either bed-bound or exaggerating his or her symptoms [11,12,13]. Pain severity and ODI scores were assessed at 3 and 6 months post-operative and serves as primary outcome evaluation parameters.
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-Assessment of the strength of EHL (extensor halucies longus) and feet dorsiflexor muscles at 3 and 6 months post-operative and considered one of the secondary outcome evaluation parameters by using the Oxford scale and was evaluated at 3 and 6 months post-operative and considered one of the secondary outcome evaluation parameters, with 5—strong, 4—partial resistance, 3—complete movement, 2—partial movement, 1—contraction, and 0—paralyzed [14, 15].
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-Assessment of improvement was assessed by using Odom’s criteria at 3 and 6 months post-operative and considered one of the secondary outcome evaluation parameters that included 4 grades: excellent—relief of all preoperative symptoms and all abnormal findings were improved; good—minimal persistence of preoperative symptoms and all abnormal findings were either unchanged or improved; fair—definite relief of some preoperative symptoms, while other symptoms were either unchanged or slightly improved; poor—all preoperative symptoms and signs were unchanged or exacerbated [16].
Patients’ satisfaction with the procedure was assessed with a 4-point questionnaire, ranging from 4 points (very satisfied) to 1 point (very dissatisfied) at 3 and 6 months post-operative and considered one of the secondary outcome evaluation parameters.
Finally, data of radiological workup including X-ray imaging in anteroposterior (AP), lateral views and dynamic views (flexion-extension-oblique), and computerized tomography (CT) lumbosacral spine then, magnetic resonance imaging (MRI) for lumbar spine also were obtained (Figs. 1, 2, 3, and 4).
Files of patients undertook wide laminectomy, foraminotomy, discectomy, and medial facetectomy without spinal fixation as a single therapeutic procedure were categorized as group A, while files of patients undertook wide laminectomy, foraminotomy, discectomy and medial facetectomy, and spinal fixation using transpedicular screws were categorized as group B. Both groups were equal in number.
Statistical analysis
The data collected were tabulated and analyzed by SPSS (statistical package for the social science software) statistical package version 23, 2015 on IBM compatible computer for Windows statistical package and were presented as mean ± SD, numbers, and percentages by using one-way ANOVA test, Student t test and chi-square test (X2 test). P value < 0.05 was considered statistically significant.