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1. Annual Progress Report

2. Project title
“Study of the outcomes of Inter laminar
endoscopy for Lumbar canal stenosis - Analysis
of predictors of poor outcome”

3. Principal Investigator (PI):
Dr VV Ramesh Chandra, Professor & HOD, Department of
Neurosurgery, SVIMS, Tirupati

4. Co-Principal Investigator
• Dr BCM Prasad, Senior Professor, Department of Neurosurgery,
SVIMS, Tirupati

5. Methodology
INCLUSION CRITERIA:
• Patients of symptomatic lumbar canal stenosis not relieved by
conservative treatment.
• Patients with lumbar canal stenosis predominantly central and
foraminal.

6. EXCLUSION CRITERIA:-
• Patients with spinal instability
• Patients with Spondylolisthesis
• Cauda equina syndrome
• Patients who are unfit for surgery and unwilling for surgery.

7. • The written informed consent will be taken from all the study
participants.
• All Patients of lumbar canal stenosis coming to OPD will be examined
and evaluated. Patients requiring surgery will be assessed by blood
investigations and radiological investigations with pre-operative X
ray(SIEMENS, 500mA, India 2009) L S Spine( flexion, extension) ,
whole spine in Ap , Lateral views, Pre-operative CT (128 slice
SEIMENS) L S Spine and MRI (MAGNETOM Aera , 1.5 tesla , Germany
2002) LS spine

8. • C7 plumb line and Sagittal vertical axis SVA obtained from x-ray whole
spine in lateral view. Using lateral standing films of the entire spine
obtained before surgery, the distance between the C-7 plumb line and
the posterior corner of the sacrum (SVA) is measured.
• With CT LS spine interlaminar window width and height will be
assessed. With MRI type details of canal stenosis (central, lateral
recess, foraminal, extra foraminal), Types of disc herniation (shoulder,
axilla, ventral, central), size of the disc, calcifications, Lateral recess
line will be obtained. Pre-operative Visual analog scale (VAS)and
Oswestry Disability Index (ODI) will be calculated based on patient’s
symptoms and neurological deficits

9. • Intra operative details like duration of surgery, approach of
discectomy (through shoulder/axilla), facet drilling, complications like
dural tear, bleeding etc will be recorded.
• The outcome will be measured by using Visual analog scale (VAS),
Oswestry Disability Index (ODI), Japanese Orthopaedic Association
(JOA) lumbar score. Post-operative complications on day 1 to 3, and
complications during follow up at 1 month, 3 months and 6 months
follow-up. Time taken to return to their regular activities will also be
assessed in their follow-up.

10. Date of start
• 1st June 2015

11. Duration
• 8 years

12. Objectives of the proposal
• To study the Outcome of Interlaminar endoscopy surgery in Lumbar
canal stenosis.
• To analyse the predictors for clinical outcomes after surgery by
endoscopic interlaminar approach for Lumbar canal stenosis.

13. Interim modification of objectives /methodology
• None

14. Detail progress of the work carried out during the
period
Study Duration: 8 years
Accomplishments:
• Enrolled 58 patients, meeting the target sample size within the study timeline.
• Conducted comprehensive clinical evaluations and radiological assessments for all
enrolled patients with clinical findings, visual analogue scale score (VAS) for low
backache and leg pain; Oswestry Disability Index (ODI) are assessed preoperatively
• Identified suitable candidates and performed interlaminar endoscopic decompression.
• Oswestry Disability Index (ODI), VAS, Time taken to return to daily activities are
assessed preoperatively and postoperatively day 1, 3, and at 1 month, 3 months and 6
months follow-up.
• Intraoperative details like duration of surgery, approach of discectomy (shoulder/axilla),
facet drilling, complications recorded.

15. • Current Status: The study has progressed as planned, achieving
significant milestones in patient recruitment and evaluation.
Identified suitable candidates and performed interlaminar endoscopic
decompression in 58 patients.
• The project has made substantial progress, meeting key milestones in
patient enrollment and evaluation. The study is well-positioned to
assess outcomes of Inter laminar endoscopy for Lumbar canal stenosis
and analysis of predictors of poor outcome.

16. Results
Demographics
AGE GROUP PATIENTS PERCENTAGE
20-30 2 3.4%
31-40 10 17.2%
41-50 24 41.4%
51-60 22 38%
TOTAL 58 100%
Sex distribution
Male Female

17. Post OP VAS comparison (POD-3)
0
1
2
3
4
5
6
7
8
9
10
Chart Title
Preop VAS Post op VAS

18. Results
ODI
0
10
20
30
40
50
60
70
80
90
Pre Op ODI Post op ODI

19. WORKING IMAGES OF EQUIPMENT IN USE

20. Summary sheet
Introduction:
Lumbar canal stenosis is a degenerative condition characterized by
narrowing of the lumbar spinal canal. Causes for stenosis can be from
Bony structures like Facet osteophytes, Uncinate spur, Spondylolisthesis
or soft tissue structures like herniated intervertebral disc, hypertrophy of
ligamentum flavum.
Surgical treatment for Lumbar canal stenosis can be open or minimally
invasive surgeries. Open techniques include Decompressive
laminectomy, Facetectomy, Foraminotomy, Fusion.

21. • Minimally invasive surgeries are by endoscopic techniques either by
transforaminal or Interlaminar approach. Interlaminar approach is the
latest approach. Interlaminar approach can be done either by
unilateral uniportalor Unilateral biportal. We are accessing the
outcome of predictors of poor outcome in lumbar canal stenosis
operated by endoscopic interlaminar Unilateral uniportal approach.

22. Objectives:
1.To study the Outcome of Interlaminar endoscopy surgery in Lumbar
canal stenosis.
2.To analyse the predictors for clinical outcomes after surgery by
endoscopic interlaminar approach for Lumbar canal stenosis.

23. Methodology:
• Patient Enrollment: Inclusion criteria based on low back pain characteristics
and inclusion criteria.
• Pain Assessment: Quantification of pain severity using the VAS, Disability
by ODI.
• Clinical Evaluation: Detailed medical history and physical examination.
• Radiological Investigations: MRI/CT scans and dynamic X-rays of the
lumbosacral spine.
• Imaging Findings Analysis: Expert radiologist assessment of joint
abnormalities.
• Exclusion of Surgical Conditions: Ensure study relevance by exclusion
criteria.
• Fitness Assessment: Routine investigations to determine patient suitability.
• Interlaminar endoscopic decompression: Minimally invasive procedure
targeting disc/stenosis. Intraop parameters and complications recorded.
• Follow-up and Data Collection: Periodic assessments of pain levels and
patient-reported outcomes.

24. Results:
• Analyzed collected data, including responses and outcomes post
interlaminar endoscopic decompression. .
• Utilised statistical analysis to determine the effectiveness of
interlaminar endoscopic decompression in managing lumbar canal
stenosis.
Translational Potential:
• Discuss how outcomes of interlaminar endoscopy for lumbar canal
stenosis depends on various analyses.
• Emphasize the potential for improved patient outcomes, reduced pain
medication reliance, and enhanced quality of life.

25. RESULTS- PREDICTORS OF POOR OUTCOMES
• Factors responsible for prolonged surgery time are:-
1. Narrow interlaminar window
2. Medialised facets/facetal hypertrophy
3. Ligamentum flavum thickening
4. Severe lateral recess stenosis
5. Duration of symptoms >11 months.
6. Severe canal stenosis
7. Osteophytes.

26. Research work which remains to be done under
the project
Upcoming Steps:
• Follow up assessment of post operative patients for interlaminar
endoscopy for lumbar canal stenosis at 1, 3 and 6 month follow up.
• Publication once the data is collected and analysed after follow up.

27. Applied value of the project
• The study's outcomes hold potential for analysing and
improving the clinical, radiological predictors of outcome and
complications in interlaminar endoscopy for lumbar canal
stenosis.

28. Any publications
• To be sent
• Presented paper on titled "Spinal Endoscopy - Techniques and
Outcomes for Treatment of Lumbar canal stenosis" At 30th Annual
Conference of Andhra Pradesh Neuro Scientists Association (AP-
NEUROCON 2023) held at Kurnool on 7th To 9th July 2023.

29. Any patents applied for
• None

30. If additional budget or staff is required for the
remaining part of the research work
• None