COMPARISON OF SURGICAL OUTCOMES OF DECOMPRESSIVE LAMINECTOMY VERSUS DECOMPRESSIVE LAMINECTOMY WITH TRANSPEDICULAR SCREW FIXATION IN PATIENTS WITH MULTILEVEL LUMBAR SPINAL STENOSIS

Abstract

Background: Lumbar spinal stenosis (LSS) is a common degenerative condition that produces neurogenic claudication, radicular pain, and progressive functional disability, and surgery is considered once conservative measures fail. Decompressive laminectomy relieves neural compression, but whether transpedicular screw fixation should be added remains debated, particularly when several levels are involved. This study compared the two approaches in patients with multilevel LSS.

Methods: This randomised controlled trial was conducted at the Department of Neurosurgery, Services Hospital, Lahore, between 07 October 2025 and 07 January 2026. Sixty patients with multilevel LSS were randomly allocated in a 1:1 ratio by the lottery method to two groups. Group A underwent decompressive laminectomy alone, and Group B underwent decompressive laminectomy with transpedicular screw fixation. Patients and outcome assessors were blinded to allocation. Operative time, Visual Analogue Scale (VAS) pain scores at 7 days and 3 months, the Oswestry Disability Index (ODI), bony fusion, spinal stability, and neurological status were assessed at 3 months. The data was analysed using SPSS Version 27.0.

Results: The mean age was 45.37 ± 4.76 years and 36 patients (60.0%) were male. Operative time was markedly longer in Group B (196.3 ± 25.9 vs. 105.0 ± 7.4 minutes; p < 0.001). Despite this, Group B showed better pain relief at 7 days (median VAS 3.0 vs. 4.0; p = 0.006) and 3 months (2.0 vs. 3.0; p = 0.001), lower disability (ODI 23.20 ± 5.57% vs. 28.60 ± 4.99%; p = 0.0002), and higher rates of minimal disability (40.0% vs. 6.7%; p = 0.002), bony fusion (90.0% vs. 60.0%; p = 0.007), preserved spinal stability (96.7% vs. 73.3%; p = 0.026), and neurological improvement (93.3% vs. 66.7%; p = 0.010).

Conclusions: In multilevel LSS, adding transpedicular screw fixation to decompressive laminectomy was associated with better early pain relief, functional recovery, radiological stability, and neurological improvement, at the cost of a substantially longer operative time. Because larger trials of predominantly single-level disease have found decompression alone to be non-inferior, fixation is best reserved for selected patients at higher risk of postoperative instability.