Laboratory-Based Pathological Insights into Post-Laminectomy Lumbar Instability: A Cross-Sectional Analysis

Abstract

Background: Laminectomy is a commonly employed decompressive surgical procedure for managing lumbar spinal stenosis. However, it carries a potential risk of inducing iatrogenic lumbar spine instability. Accurate diagnosis and pathological evaluation of post-surgical instability are essential for guiding postoperative care and optimizing treatment outcomes. Objective: This study aimed to investigate the pathological and laboratory-based diagnostic indicators of lumbar spine instability following laminectomy and assess their clinical implications in patient management. Patients and Methods: A cross-sectional study was conducted on 40 patients who developed lumbar spine instability after laminectomy. Patients were recruited from multiple hospitals in Iraq between April 16, 2021, and August 25, 2022. Data collection included clinical records, imaging-based diagnostic findings (MRI and CT), intraoperative pathological observations, and, where available, histopathological assessments of affected spinal tissues. SPSS and Excel were used for data analysis, focusing on correlations between clinical outcomes, pathological changes, and diagnostic findings. Results: The study identified significant pathological features associated with postoperative instability, including incomplete radial posterior annular tears and facet joint degeneration, which were confirmed via imaging and intraoperative observation. Back pain was the predominant clinical symptom, reported in 32.5% of patients. Additionally, preoperative functional status and comorbidities had a statistically significant influence on the severity of postoperative pathology and outcome (p < 0.05). Conclusion: The findings underscore the value of combining clinical, radiological, and intraoperative pathological evaluation in the assessment of post-laminectomy lumbar instability. Laboratory-based diagnostic tools, including imaging and pathological tissue assessment, are vital in identifying high-risk patients and informing decisions regarding the use of spinal fusion techniques. A multidisciplinary approach integrating pathology, radiology, and surgical assessment is recommended to enhance postoperative care and reduce the risk of complications.