A Prospective Comparative Study of Instrumented versus Noninstrumented Decompression in Lumbar Canal Stenosis

Lumbar canal stenosis (LCS) results in neurogenic claudication and functional impairment. Surgical decompression is advised when conservative treatment fails; however, the benefits of including instrumentation are still under debate.

To prospectively compare clinical, functional, and radiological outcomes of instrumented versus non instrumented decompression in patients with LCS.

A prospective cohort study was conducted at a tertiary care facility from August 2023 to February 2025, involving 59 patients with MRI verified LCS. Patients were grouped into instrumented (n = 25) and non instrumented (n = 25) decompression, with 9 patients lost to follow up. Clinical outcomes included Visual Analog Scale, neurogenic claudication, and Medical Research Council grading. Functional status was assessed using the Oswestry Disability Index, Swiss Spinal Stenosis Questionnaire, and Japanese Orthopaedic Association score. MRI evaluated cross sectional area, antero-posterior diameter, foraminal size, and lateral recess height. Spinal stability was assessed by dynamic X rays using White and Panjabi criteria. Operational times, hospital stays, and blood loss were documented. Follow-ups were conducted at 3 and 6 months.

Both groups showed significant improvement (P < 0.01). The instrumented group showed superior pain relief, motor recovery, and functional improvement, along with better spinal stability, despite longer surgery and higher blood loss.

Instrumented decompression offers better clinical, functional, and radiological outcomes in selected LCS cases, with trade offs of increased operative time and blood loss.