Neurogenic Claudication-Operative Management (Decompression and Fusion)

Neurogenic claudication describes buttock and leg pain that develops upon ambulation and may be relieved with rest, sitting or flexion of the spine. Spinal stenosis refers to a narrowing of the caliber of the spinal canal: the resultant compression of neural structures and the microvasculature can lead to the development of neurogenic claudication. Patients with spinal stenosis who continue to be symptomatic despite a reasonable trial of conservative therapy may benefit from surgical decompression. A fusion operation is often performed in addition to decompression if there is evidence of gross instability from spondylolisthesis, spinal deformity, or concern for the development of iatrogenic post-operative instability (due to extensive resection of the facet joints). Although the peri-operative mortality of patients undergoing decompression with or without fusion is low, there are a number of immediate post-operative complications that can occur, including surgical site infections and nerve root injury from instrumentation misplacement. Potential long-term complications include instrumentation failure, adjacent segment disease, and pseudoarthrosis.