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Karlsson T, Försth P, Öhagen P, Michaëlsson K, Sandén B. Decompression alone or decompression with fusion for lumbar spinal stenosis: five-year clinical results from a randomized clinical trial. Bone Joint J 2024; 106-B:705-712. [PMID: 38945544 DOI: 10.1302/0301-620x.106b7.bjj-2023-1160.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Aims We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences. Methods The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded. Results Five-year follow-up was completed by 213 (95%) of the eligible patients (mean age 67 years; 155 female (67%)). After five years, ODI was similar irrespective of treatment, with a mean of 25 (SD 18) for decompression alone and 28 (SD 22) for decompression with fusion (p = 0.226). Mean EQ-5D was higher for decompression alone than for fusion (0.69 (SD 0.28) vs 0.59 (SD 0.34); p = 0.027). In the no-DS subset, fewer patients reported decreased leg pain after fusion (58%) than with decompression alone (80%) (relative risk (RR) 0.71 (95% confidence interval (CI) 0.53 to 0.97). The frequency of subsequent spinal surgery was 24% for decompression with fusion and 22% for decompression alone (RR 1.1 (95% CI 0.69 to 1.8)). Conclusion Adding fusion to decompression in spinal stenosis surgery, with or without spondylolisthesis, does not improve the five-year ODI, which is consistent with our two-year report. Three secondary outcomes that did not differ at two years favoured decompression alone at five years. Our results support decompression alone as the preferred method for operating on spinal stenosis.
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Affiliation(s)
- Thomas Karlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Aleris Elisabeth Hospital, Uppsala, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- SDS Life Science, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Sandén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
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Katiyar P, Malka M, Reyes JL, Lombardi JM, Lenke LG, Sardar ZM. Innovative technologies in thoracolumbar and lumbar spine surgery failing to reach standard of care: state-of-art review. Spine Deform 2024:10.1007/s43390-024-00898-9. [PMID: 38795313 DOI: 10.1007/s43390-024-00898-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/15/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE To evaluate previously popular technologies in the field of spine surgery, and to better understand their advantages and limitations to the current standards of care. Spine surgery is an ever-evolving field that serves to resolve various spinal pathologies in patients of all ages. While there are established treatments for various conditions, such as lumbar spinal stenosis, idiopathic scoliosis, and degenerative lumbar disease, there is always further research and development in these areas to produce innovative technologies that can lead to better outcomes. As this process progresses, we must remind ourselves of previously tried and tested inventions and their outcomes that have fallen short of becoming a standard to ensure we are able to learn lessons from the past. METHODS A thorough literature review was conducted with the aim of compiling literature of previously utilized technologies in spine surgery. Biomedical databases were utilized to gather relevant articles including PubMed, MEDLINE, and EMBASE. Emphasis was placed on gathering articles with technologies or therapeutics aimed at treating common spinal pathologies including lumbar spinal stenosis (LSS), adolescent idiopathic scoliosis (AIS), and other degenerative lumbar spine diseases. The keywords used were: "failed technologies", "historical technologies", "spine surgery", "spinal stenosis", "adolescent idiopathic scoliosis", and "degenerative lumbar spine disease". A total of 47 articles were gathered after initial review. RESULTS Different technologies pertaining to spine surgery were identified and critically evaluated. Some of these technologies included X-STOP, Vertiflex, Vertebral Body Stapling, and Dynesys. These technologies were evaluated for their strengths and limitations across their spinal pathology applications. While each type of technology had their benefits, the data tended to be mixed with various limitations across studies. CONCLUSION These technologies have been trialed in the field of spine surgery across various spinal pathologies, but still prove of limited efficacy and shortcomings to the current standards of care.
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Affiliation(s)
- Prerana Katiyar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Matan Malka
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA.
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
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Banitalebi H, Hermansen E, Hellum C, Espeland A, Storheim K, Myklebust TÅ, Indrekvam K, Brisby H, Weber C, Anvar M, Aaen J, Negård A. Preoperative fatty infiltration of paraspinal muscles assessed by MRI is associated with less improvement of leg pain 2 years after surgery for lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1967-1978. [PMID: 38528161 DOI: 10.1007/s00586-024-08210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Fatty infiltration (FI) of the paraspinal muscles may associate with pain and surgical complications in patients with lumbar spinal stenosis (LSS). We evaluated the prognostic influence of MRI-assessed paraspinal muscles' FI on pain or disability 2 years after surgery for LSS. METHODS A muscle fat index (MFI) was calculated (by dividing signal intensity of psoas to multifidus and erector spinae) on preoperative axial T2-weighted MRI of patients with LSS. Pain and disability 2 years after surgery were assessed using the Oswestry disability index, the Zurich claudication questionnaire and numeric rating scales for leg and back pain. Multivariate linear and logistic regression analyses (adjusted for preoperative outcome scores, age, body mass index, sex, smoking status, grade of spinal stenosis, disc degeneration and facet joint osteoarthritis) were used to assess the associations between MFI and patient-reported clinical outcomes. In the logistic regression models, odds ratios (OR) and 95% confidence intervals (CI) were calculated for associations between the MFI and ≥ 30% improvement of the outcomes (dichotomised into yes/no). RESULTS A total of 243 patients were evaluated (mean age 66.6 ± 8.5 years), 49% females (119). Preoperative MFI and postoperative leg pain were significantly associated, both with leg pain as continuous (coefficient - 3.20, 95% CI - 5.61, - 0.80) and dichotomised (OR 1.51, 95% CI 1.17, 1.95) scores. Associations between the MFI and the other outcome measures were not statistically significant. CONCLUSION Preoperative FI of the paraspinal muscles on MRI showed statistically significant association with postoperative NRS leg pain but not with ODI or ZCQ.
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Affiliation(s)
- Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Erland Hermansen
- Kysthospitalet in Hagevik. Orthopaedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik. Orthopaedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | | | - Jørn Aaen
- Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Negård
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Victorio, Shen R, Nasution MN, Mahadewa TGB. Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:247-253. [PMID: 38957755 PMCID: PMC11216654 DOI: 10.4103/jcvjs.jcvjs_48_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Laminectomy has long been a "gold standard" to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT). Materials and Methods A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman's correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted. Results The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient. Conclusions FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.
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Affiliation(s)
- Victorio
- Department of Neurosurgery, Lamina Pain and Spine Center, South Jakarta, Indonesia
- Department of Neurosurgery, TK. II Moh. Ridwan Meuraksa Military Hospital, East Jakarta, Indonesia
| | - Robert Shen
- Atma Jaya Neuroscience and Cognitive Center, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, Jakarta, Indonesia
- Department of Emergency, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia
| | - Mahdian Nur Nasution
- Department of Neurosurgery, Lamina Pain and Spine Center, South Jakarta, Indonesia
- Department of Neurosurgery, Mayapada Hospital Kuningan, South Jakarta, Indonesia
| | - Tjokorda Gde Bagus Mahadewa
- Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Gülensoy B, Şimşek S. Retrospective Study to Compare the Effectiveness of Minimally Invasive Microscopic Unilateral Laminotomy with Microscopic Bilateral Laminotomy for Bilateral Decompression in the Early Postoperative Period in 142 Patients with Single-Level Lumbar Spinal Stenosis. Med Sci Monit 2024; 30:e943815. [PMID: 38491725 PMCID: PMC10953316 DOI: 10.12659/msm.943815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND We aimed to compare the effectiveness of microscopic unilateral laminotomy for bilateral decompression (ULBD) and microscopic bilateral laminotomy for bilateral decompression (BLBD) in the early postoperative period among patients with single-level lumbar spinal stenosis (LSS). MATERIAL AND METHODS A retrospective cohort study was conducted on patients with LSS who underwent ULBD or BLBD between January 2020 and December 2023, including 94 patients who underwent ULBD and 58 who underwent BLBD. Patient demographics, comorbidities, smoking status, and data related to LSS were reviewed. Preoperative and postoperative assessments on day 10 included back pain visual analog scale (VAS), walking distance, and Odom criteria. Disability was evaluated using the self-assessment Oswestry Disability Index (ODI) preoperatively and on day 30. Additionally, wound infection, postoperative modified MacNab criteria, and pain (back, leg, and hip) were recorded. RESULTS Age and sex were similar in the 2 groups. Both surgeries significantly reduced low back pain, increased walking distance, and improved Odom category on day 10, compared with baseline (P<0.001 for all). A significant decrease in 30-day ODI, compared with baseline, was observed in both groups (P<0.001 for both). The ULBD group had a significantly higher percentage of patients with wound infection (P=0.014); however, the ODI score among ULBD recipients was significantly lower (better) on day 30 (P=0.047). CONCLUSIONS ULBD may represent a less invasive, more effective, and safer surgical alternative than BLBD and classical laminectomy in patients with single-level LSS, but precautions are essential concerning wound infection.
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Affiliation(s)
- Bülent Gülensoy
- Department of Neurosergury, Lokman Hekim University Faculty of Medicine, Ankara, Turkey
| | - Serkan Şimşek
- Department of Neurosergury, Medipol University Faculty of Medicine, Ankara, Turkey
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Indrekvam K, Bånerud IF, Hermansen E, Austevoll IM, Rekeland F, Guddal MH, Solberg TK, Brox JI, Hellum C, Storheim K. The Norwegian degenerative spondylolisthesis and spinal stenosis (NORDSTEN) study: study overview, organization structure and study population. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4162-4173. [PMID: 37395780 DOI: 10.1007/s00586-023-07827-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To provide an overview of the The Norwegian Degenerative spondylolisthesis and spinal stenosis (NORDSTEN)-study and the organizational structure, and to evaluate the study population. METHODS The NORDSTEN is a multicentre study with 10 year follow-up, conducted at 18 public hospitals. NORDSTEN includes three studies: (1) The randomized spinal stenosis trial comparing the impact of three different decompression techniques; (2) the randomized degenerative spondylolisthesis trial investigating whether decompression surgery alone is as good as decompression with instrumented fusion; (3) the observational cohort tracking the natural course of LSS in patients without planned surgical treatment. A range of clinical and radiological data are collected at defined time points. To administer, guide, monitor and assist the surgical units and the researchers involved, the NORDSTEN national project organization was established. Corresponding clinical data from the Norwegian Registry for Spine Surgery (NORspine) were used to assess if the randomized NORDSTEN-population at baseline was representative for LSS patients treated in routine surgical practice. RESULTS A total of 988 LSS patients with or without spondylolistheses were included from 2014 to 2018. The clinical trials did not find any difference in the efficacy of the surgical methods evaluated. The NORDSTEN patients were similar to those being consecutively operated at the same hospitals and reported to the NORspine during the same time period. CONCLUSION The NORDSTEN study provides opportunity to investigate clinical course of LSS with or without surgical interventions. The NORDSTEN-study population were similar to LSS patients treated in routine surgical practice, supporting the external validity of previously published results. TRIAL REGISTRATION ClinicalTrials.gov; NCT02007083 10/12/2013, NCT02051374 31/01/2014 and NCT03562936 20/06/2018.
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Affiliation(s)
- Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Ingrid Fjeldheim Bånerud
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Erland Hermansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maren Hjelle Guddal
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Tore K Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Wei W, Wang T, Liu J, Mao K, Pan C, Li H, Zhao Y. Biomechanical effect of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion: a finite element study. BMC Musculoskelet Disord 2023; 24:521. [PMID: 37355581 DOI: 10.1186/s12891-023-06649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Adjacent segment degeneration (ASD) is a common complication of lumbar interbody fusion; the paraspinal muscles significantly maintain spinal biomechanical stability. This study aims to investigate the biomechanical effects of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion (PLIF). METHODS Data from a lumbosacral vertebral computed tomography scan of a healthy adult male volunteer were used to establish a normal lumbosacral vertebral finite element model and load the muscle force of the multifidus. A normal model, an L4/5 PLIF model (PFM) based on a preserved proximal multifidus, a total laminectomy PLIF model (TLPFM), and a hemi-laminectomy PLIF model based on a severed proximal multifidus were established, respectively. The range of motion (ROM) and maximum von Mises stress of the upper and lower adjacent segments were analyzed along with the total work of the multifidus muscle force. RESULTS This model verified that the ROMs of all segments with four degrees of freedom were similar to those obtained in previous research data, which validated the model. PLIF resulted in an increased ROM and maximum von Mises stress in the upper and lower adjacent segments. The ROM and maximum von Mises stress in the TLPFM were most evident in the upper adjacent segment, except for lateral bending. The ROM of the lower adjacent segment increased most significantly in the PFM in flexion and extension and increased most significantly in the TLPFM in lateral bending and axial rotation, whereas the maximum von Mises stress of the lower adjacent segment increased the most in the TLPFM, except in flexion. The muscle force and work of the multifidus were the greatest in the TLPFM. CONCLUSIONS PLIF increased the ROM and maximum von Mises stress in adjacent cranial segments. The preservation of the proximal multifidus muscle contributes to the maintenance of the physiological mechanical behavior of adjacent segments, thus preventing the occurrence and development of ASD.
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Affiliation(s)
- Wei Wei
- Medical School of Chinese PLA, Beijing, 100048, China
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Tianhao Wang
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jianheng Liu
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Keya Mao
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Chun'ang Pan
- Beijing Engineering and Technology Research Center for Medical Endoplants, Beijing, 100082, China
- Beijing Engineering Laboratory of Functional Medical Materials and Instruments, Beijing, 100082, China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplants, Beijing, 100082, China
- Beijing Engineering Laboratory of Functional Medical Materials and Instruments, Beijing, 100082, China
| | - Yongfei Zhao
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
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Indications for and Outcomes of Three Unilateral Biportal Endoscopic Approaches for the Decompression of Degenerative Lumbar Spinal Stenosis: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13061092. [PMID: 36980400 PMCID: PMC10047819 DOI: 10.3390/diagnostics13061092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Objective: In this systematic review, we summarized the indications for and outcomes of three main unilateral biportal endoscopic (UBE) approaches for the decompression of degenerative lumbar spinal stenosis (DLSS). Methods: A comprehensive search of the literature was performed using Ovid Embase, PubMed, Web of Science, and Ovid’s Cochrane Library. The following information was collected: surgical data; patients’ scores on the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Macnab criteria; and surgical complications. Results: In total, 23 articles comprising 7 retrospective comparative studies, 2 prospective comparative studies, 12 retrospectives case series, and 2 randomized controlled trials were selected for quantitative analysis. The interlaminar approach for central and bilateral lateral recess stenoses, contralateral approach for isolated lateral recess stenosis, and paraspinal approach for foraminal stenosis were used in 16, 2, and 4 studies, respectively. In one study, both interlaminar and contralateral approaches were used. L4-5 was the most common level decompressed using the interlaminar and contralateral approaches, whereas L5-S1 was the most common level decompressed using the paraspinal approach. All three approaches provided favorable clinical outcomes at the final follow-up, with considerable improvements in patients’ VAS scores for leg pain (63.6–73.5%) and ODI scores (67.2–71%). The overall complication rate was <6%. Conclusions: The three approaches of UBE surgery are effective and safe for the decompression of various types of DLSS. In the future, long-term prospective studies and randomized control trials are warranted to explore this new technique further and to compare it with conventional surgical techniques.
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Evaluating 5-year outcomes of interlaminar devices as an adjunct to decompression for symptomatic lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1367-1374. [PMID: 36840820 DOI: 10.1007/s00586-023-07610-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE To assess and compare 5-year outcomes following uninstrumented spinal decompression and decompression with interlaminar device (ILD). To determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied. This is because comparative literature between the above two procedures is limited past the 2-year timeframe. METHODS We conducted a retrospective review of prospectively collected data from a single surgeon across 116-patients who underwent spinal decompression with or without ILD insertion between 2007 and 2015. Patients with symptomatic LSS who met the study criteria were offered spinal decompression with ILD insertion. Patients who accepted ILD were placed in the D + ILD group (n = 61); while those opting for decompression alone were placed in the DA group (n = 55). Clinical outcomes were assessed preoperatively and up to 5-years postoperatively using the ODI, Eq. 5d, VAS back and leg pain, and SF-36. Radiological indices were assessed preoperatively and up to 5-years postoperatively. RESULTS Both groups showed statistically significant (p < 0.001) improvement in all clinical outcome indicators at all timepoints as compared to their preoperative status. The D + ILD group achieved significant improvement in radiological parameters namely foraminal height and posterior disc height in the immediate postoperative period that was maintained while the DA group did not. CONCLUSION Our study found that in the management of LSS, clinical outcomes between those patients undergoing decompression alone compared to decompression with ILD showed statistically significant improvement in VAS back pain and radiological parameters namely foraminal height and posterior disc height at the 5-year mark. ILD does not predispose to increased reoperation rates.
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Sudo H, Miyakoshi T, Watanabe Y, Ito YM, Kahata K, Tha KK, Yokota N, Kato H, Terada T, Iwasaki N, Arato T, Sato N, Isoe T. Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial. BMJ Open 2023; 13:e065476. [PMID: 36731929 PMCID: PMC9896178 DOI: 10.1136/bmjopen-2022-065476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In patients with combined lumbar spinal canal stenosis (LSCS), a herniated intervertebral disc (IVD) that compresses the dura mater and nerve roots is surgically treated with discectomy after laminoplasty. However, defects in the IVD after discectomy may lead to inadequate tissue healing and predispose patients to the development of IVD degeneration. Ultrapurified stem cells (rapidly expanding clones (RECs)), combined with an in situ-forming bioresorbable gel (dMD-001), have been developed to fill IVD defects and prevent IVD degeneration after discectomy. We aim to investigate the safety and efficacy of a new treatment method in which a combination of REC and dMD-001 is implanted into the IVD of patients with combined LSCS. METHODS AND ANALYSIS This is a multicentre, prospective, double-blind randomised controlled trial. Forty-five participants aged 20-75 years diagnosed with combined LSCS will be assessed for eligibility. After performing laminoplasty and discectomy, participants will be randomised 1:1:1 into the combination of REC and dMD-001 (REC-dMD-001) group, the dMD-001 group or the laminoplasty and discectomy alone (control) group. The primary outcomes of the trial will be the safety and effectiveness of the procedure. The effectiveness will be assessed using visual analogue scale scores of back pain and leg pain as well as MRI-based estimations of morphological and compositional quality of the IVD tissue. Secondary outcomes will include self-assessed clinical scores and other MRI-based estimations of compositional quality of the IVD tissue. All evaluations will be performed at baseline and at 1, 4, 12, 24 and 48 weeks after surgery. ETHICS AND DISSEMINATION This study was approved by the ethics committees of the institutions involved. We plan to conduct dissemination of the outcome data by presenting our data at national and international conferences, as well as through formal publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER jRCT2013210076.
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Affiliation(s)
- Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Takashi Miyakoshi
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yudai Watanabe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Kaoru Kahata
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Khin Khin Tha
- Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Nozomi Yokota
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroe Kato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Tomoko Terada
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Teruyo Arato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiyuki Isoe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
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Coenen P, de Wind A, van de Ven P, de Maaker-Berkhof M, Koes B, Buchbinder R, Hartvigsen J, Anema JHR. The slow de-implementation of non-evidence-based treatments in low back pain hospital care-Trends in treatments using Dutch hospital register data from 1991 to 2018. Eur J Pain 2023; 27:212-222. [PMID: 36317649 PMCID: PMC10099564 DOI: 10.1002/ejp.2052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/13/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability worldwide and has an excessive societal burden. Accumulating evidence has shown that some medical approaches such as imaging in absence of clear indications, medication and some invasive treatments may contribute to the problem rather than alleviating it. OBJECTIVES To determine the extent of de-implementation of non-evidence-based hospital treatments for LBP care in the Netherlands in the last three decades. METHODS Using a register-based population-level observational study with Dutch hospital data, providing a nearly complete coverage of hospital admissions in the Netherlands in 1991-2018, we assessed five frequently applied non-evidence-based hospital treatments for LBP. Time trends in treatment use (absolute and per 100,000 inhabitants) were plotted and analysed using Poisson regression. RESULTS The use of bed rest for non-specific LBP and hernia nuclei pulposi, and discectomy for spinal stenosis decreased 91%, 81% and 86% since the availability of evidence/guidelines, respectively. De-implementation, beyond 84%, was reached after 18 and 17 years for bed rest for non-specific LBP and discectomy respectively, while it was not reached after 28 years for bed rest for hernia nuclei pulposi. For spinal fusion and invasive pain treatment, there was an initial increase followed by a reduction. Overall, these treatments reduced by 85% and 75%, respectively. CONCLUSIONS In the Netherlands, de-implementation of five non-recommended hospital LBP treatments, if at all, took several decades. Although de-implementation was substantial, slow de-implementation has likely resulted in considerable waste of resources and avoidable harm to many patients in Dutch hospitals. SIGNIFICANCE Medically intensive approaches to low-back pain care contribute to the high societal burden of this disease. There have been calls to avoid such care. Using Dutch hospital data, we showed that de-implementation of five non-recommended hospital low-back pain treatments, if at all, took several decades (i.e. ≥17 years) after availability of evidence and guidelines. Slow de-implementation has likely resulted in considerable waste of resources and avoidable harm to hospital patients; better ways for de-implementation of non-evidence-based care are needed.
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Affiliation(s)
- Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Astrid de Wind
- Department of Public and Occupational Health, Amsterdam UMC, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marianne de Maaker-Berkhof
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bart Koes
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash Department of Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Johannes Han R Anema
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Validity of outcome measures used in randomized clinical trials and observational studies in degenerative lumbar spinal stenosis. Sci Rep 2023; 13:1068. [PMID: 36658179 PMCID: PMC9852241 DOI: 10.1038/s41598-022-27218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
It is unclear whether outcome measures used in degenerative lumbar spinal stenosis (DLSS) have been validated for this condition. Cross-sectional analysis of studies for DLSS included in systematic reviews (SA) and meta-analyses (MA) indexed in the Cochrane Library. We extracted all outcome measures for pain and disability. We assessed whether the studies provided external references for the validity of the outcome measures and the quality of the validation studies. Out of 20 SA/MA, 95 primary studies used 242 outcome measures for pain and/or disability. Most commonly used were the VAS (n = 69), the Oswestry Disability Index (n = 53) and the Zurich Claudication Questionnaire (n = 22). Although validation references were provided in 45 (47.3%) primary studies, only 14 validation studies for 9 measures (disability n = 7, pain and disability combined n = 2) were specifically validated in a DLSS population. The quality of the validation studies was mainly poor. The Zurich Claudication Questionnaire was the only disease specific tool with adequate validation for assessing treatment response in DLSS. To compare results from clinical studies, outcome measures need to be validated in a disease specific population. The quality of validation studies need to be improved and the validity in studies adequately cited.
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Yang J, Yang Y, Wang G, Xu S, Li G, Zhang S, Yang C, Wang S, Wang Q. Is local autogenous morselized bone harvested from decompression through a posterior-transforaminal approach sufficient for single-level interbody fusion in the lower lumbar spine? BMC Musculoskelet Disord 2023; 24:12. [PMID: 36609247 PMCID: PMC9817406 DOI: 10.1186/s12891-023-06131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To determine the volume and applicability of local autogenous morselized bone (LAMB) harvested and used during posterior-transforaminal lumbar interbody fusion (P-TLIF) in the lower lumbar spine. METHODS Clinical and radiographic data of 147 patients (87 males) undergoing P-TLIF from January 2017 to December 2019 for lumbar degenerative diseases were retrospectively analyzed. Computed tomography was used to assess the fusion status (at 6 months, 1 year, and the last follow-up postoperatively), restored disc height, graft fusion area and volume, and the minimum required bone volume (MRBV). Clinical outcomes of P-TLIF were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for low back pain (LBP) and leg pain (LP). RESULTS The mean follow-up period was 28.4 ± 4.49 months. The patient's age and diagnosis were correlated to the volume and weight of LAMB (mean volume and weight: 3.50 ± 0.45 mL and 3.88 ± 0.47 g, respectively). The ratio of actual fusion area to the total disc endplate and the ratio of actual fusion volume to the total volume of the disc space were > 40%. MRBV ranged from 1.83 ± 0.48 cm3 to 2.97 ± 0.68 cm3. The proportion of grade 4 or 5 fusions increased from 60.6% at 6 months to 96.6% at the last follow-up. The ODI, VAS-LP, and VAS-LBP scores significantly improved after surgery and remained unchanged during the follow-up. CONCLUSION When combined with a cage, the volume of LAMB harvested from decompression through the unilateral approach at a single-level is sufficient to achieve a solid interbody fusion in the lower lumbar spine with excellent clinical and radiographic outcomes.
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Affiliation(s)
- Jin Yang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Yong Yang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China ,Department of Orthopedics Surgery, Chengdu Yumei Hospital, 269 Xiajiancao Road, Chengdu, 610051 Sichuan China
| | - Gaoju Wang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Shuang Xu
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Guangzhou Li
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Shuai Zhang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Chaohua Yang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Song Wang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Qing Wang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
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Analysis of complications and unsatisfactory results of surgical treatment of degenerative lumbar spinal stenosis in the elderly patients. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.6.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background. The results of treatment of the elderly patients operated for spinal stenosis allow us to suggest that a cascade of degenerative changes in the spinal motion segments causes the formation of an adjacent level syndrome, pseudarthrosis, and in some cases – the instability in the fixing structure.The aim of the study. To determine the prognostic factors for the adjacent level syndrome in patients after decompressive and stabilizing spinal surgeries.Methods. We carried out a retrospective cohort study of the surgical treatment of 129 elderly patients (over 60 years of age) for the period from January 2018 to March 2022, who underwent surgery at the lumbosacral level of spine for degenerative spinal stenosis.Results. The outcomes of surgical treatment of 129 patients and the results of discriminant analysis of morphometric studies of computed tomography data indicate that the most significant indicators for the development of the adjacent level syndrome are the lordosis angle in the segment adjacent to the operated one (the mean value in the analyzed group is 12.87 ± 2.22°; in the control group – 11.92 ± 2.97°); the anterior height of the adjacent intervertebral disc (the mean value in the analyzed group is 12.70 ± 2.44 mm; in the control group – 11.46 ± 3.58 mm) and the difference of anterior and posterior disc heights at the adjacent level (the mean value in the analyzed group is 5.48 ± 2.84 mm; in the control group – 6.27 ± 2.71 mm).Conclusion. When analyzing the treatment outcomes of 129 elderly patients operated for degenerative spinal stenosis using instrumented spinal fusion, we revealed that in 16 patients, the adjacent level syndrome developed with an increase in the lordosis angle at the level adjacent to the operated segment. An increase in the anterior height of the adjacent intervertebral disc and the decrease in the difference of anterior and posterior disc heights at the adjacent level can be considered as unfavorable prognostic factors (p = 0.83).
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Karlsson T, Försth P, Skorpil M, Pazarlis K, Öhagen P, Michaëlsson K, Sandén B. Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up. Bone Joint J 2022; 104-B:1343-1351. [PMID: 36453045 PMCID: PMC9680197 DOI: 10.1302/0301-620x.104b12.bjj-2022-0340.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
AIMS The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. METHODS The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis). RESULTS A total of 211 patients underwent surgery at a mean age of 66 years (69% female): 103 were treated by decompression with fusion and 108 by decompression alone. A two-year MRI was available for 176 (90%) of the eligible patients. A new stenosis at the operated and/or adjacent level occurred more frequently after decompression and fusion than after decompression alone (47% vs 29%; p = 0.020). The difference remained in the subgroup with a preoperative spondylolisthesis, (48% vs 24%; p = 0.020), but did not reach significance for those without (45% vs 35%; p = 0.488). Proximal adjacent level stenosis was more common after fusion than after decompression alone (44% vs 17%; p < 0.001). Restenosis at the operated level was less frequent after fusion than decompression alone (4% vs 14%; p = 0.036). Vertebral slip increased by 1.1 mm after decompression alone, regardless of whether a preoperative spondylolisthesis was present or not. CONCLUSION Adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively. This supports decompression alone as the preferred method of surgery for spinal stenosis, whether or not a degenerative spondylolisthesis is present preoperatively.Cite this article: Bone Joint J 2022;104-B(12):1343-1351.
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Affiliation(s)
- Thomas Karlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden,Correspondence should be sent to Thomas Karlsson. E-mail:
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
| | - Mikael Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Konstantinos Pazarlis
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Stockholm Spine Center, Upplands Väsby, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Sandén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
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Yang Z, Wang H, Li W, Hu W. Comparative Effects and Safety of Full-Endoscopic Versus Microscopic Spinal Decompression for Lumbar Spinal Stenosis: A Meta-Analysis and Statistical Power Analysis of 6 Randomized Controlled Trials. Neurospine 2022; 19:996-1005. [PMID: 36597637 PMCID: PMC9816578 DOI: 10.14245/ns.2244600.300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/05/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE This meta-analysis with statistical power analysis aimed to evaluate the difference between full-endoscopic and microscopic spinal decompression in treating spinal stenosis. METHODS We searched PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure) for relevant randomized controlled trials (RCTs) regarding the comparison of full-endoscopic versus microscopic spinal decompression in treating lumbar spinal stenosis through February 28, 2022. Two independent investigators selected studies, extracted information, and appraised methodological quality. Meta-analysis was conducted using RevMan 5.4 and STATA 14.0, and statistical power analysis was performed using G*Power 3.1. RESULTS Six RCTs involving 646 patients met selection criteria. Meta-analysis suggested that, compared with microscopic decompression, full-endoscopic spinal decompression achieved more leg pain improvement (mean difference [MD], -0.20; 95% confidence interval [CI], -0.30 to -0.10; p = 0.001), shortened operative time (MD, -12.71; 95% CI, -18.27 to -7.15; p < 0.001), and decreased the incidence of complications (risk ratio, 0.43; 95% CI, 0.22-0.82; p = 0.01), which was supported by a statistical power of 98.57%, 99.97%, and 81.88%, respectively. CONCLUSION Full-endoscopic spinal decompression is a better treatment for lumbar spinal stenosis, showing more effective leg pain improvement, shorter operative time, and fewer complications than microscopic decompression.
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Affiliation(s)
- Zechuan Yang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenkai Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Hu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Corresponding Author Weihua Hu Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Simon L, Millot F, Hoarau X, Buttin R, Srour R. Comparison of the Biomechanical Effect of the FFX Device Compared With Other Lumbar Fusion Devices: A Finite Element Study. Int J Spine Surg 2022; 16:935-943. [PMID: 35940636 PMCID: PMC9746444 DOI: 10.14444/8355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lumbar decompression can result in postsurgical instability and spondylolisthesis in patients with lumbar spinal stenosis (LSS). While pedicle screw (PS) constructs improve stability and support fusion, their use can lead to adjacent level degeneration due to rigidity and resultant overload of anatomical structures. The FFX device is a facet spacer designed to be a less invasive alternative for obtaining fusion compared with PS. OBJECTIVE The present study aimed to compare biomechanical performance of the FFX device to different lumbar spine procedures using the finite element (FE) method. STUDY DESIGN Comparative biomechanical study by FE method. METHODS An FE model for the lumbar spine was developed and validated to assess vertebral displacement and stress variations in the facet joints and discs following surgery. Modeled scenarios included a healthy spine as a reference model, laminectomy (LAM), and prior to/following L4-L5 fusion for LAM + FFX and LAM + PS. RESULTS LAM increased displacement compared with the healthy spine and both instrumented spine procedures. Facet joint stress at adjacent levels for LAM + PS was significantly higher than with LAM + FFX prior to fusion (+13.5% for L3-L4; +15.7% for L5-S1). Adjacent level disc stress at L5-S1 was 7.7% higher for LAM + PS vs LAM + FFX. Adjacent level facet joint and disc stresses for LAM + FFX were equivalent to LAM + PS once fusion occurred. CONCLUSIONS Instrumented spine fixation prevents the risk of lumbar instability associated with LAM alone. Compared with PS, the FFX device is a less invasive alternative for the treatment of LSS, which potentially lowers the risk of adjacent segment degeneration prior to fusion that provides equivalent stability once fusion is achieved. LEVEL OF EVIDENCE: 5
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Krakowiak M, Rulewska N, Rudaś M, Broda M, Sabramowicz M, Jaremko A, Leki K, Sokal P. Interspinous Process Devices Do Not Reduce Intervertebral Foramina and Discs Heights on Adjacent Segments. J Pain Res 2022; 15:1971-1982. [PMID: 35860418 PMCID: PMC9292060 DOI: 10.2147/jpr.s356898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Interspinous process device (IPD) placement is an attractive treatment option for lumbar spinal and foraminal stenosis. The goal of the treatment is to release the stress on facets joints as well as decompress the nerve roots by enlarging the intervertebral foramina and narrowed canal recesses. Purpose To evaluate possible structural changes in the lumbar spine after implantation of an IPD on operated and adjacent segments. Patients and Methods Twenty-two patients were enrolled in the study. Preoperative MRI scans of the lumbar spine evaluated recess and foraminal stenosis prior to the application of an IPD. CT exams were performed and morphometric measurements were made to assess the size of intervertebral foramina after implantation on the operated and adjacent segments. Results Statistically significant enlargements in diameter and surface area of the intervertebral foramen were seen at the operating level. On the right and left sides, foraminal enlargement after the procedure was 1 mm in diameter. The average enlargement of the foramina surface area at the level of implantation was 10 mm2. The median interspinous distance was significantly enlarged by 3.5 mm. No significant changes in adjacent segments were observed. Clinical improvement was confirmed by the Oswestry Disability Index (ODI) and visual analog scale (VAS). Preoperative disability was reduced (mean ODI from 70.5 (12.25) to 49.5 (23.75)), as well as back pain (mean VAS from 8.0 (1.7) to 4.4 (2.6)) and pain in lower limbs (mean VAS from 7.4 (1.9) to 3.8 (2.9)). Conclusion Decompression surgery using an IPD is effective in the treatment of lumbar foraminal and canal stenosis. It provides relief of symptoms in short-term observation through enlargement of intervertebral foramina and decompression of neural roots. It reduces overload of facet joints of the operated segment and does not decrease the size of the intervertebral foramina and disc heights of adjacent segments.
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Affiliation(s)
- Mateusz Krakowiak
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Natalia Rulewska
- Students' Scientific Circle at the Department of Neurosurgery, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marcin Rudaś
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maciej Broda
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Michał Sabramowicz
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Andrzej Jaremko
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krzysztof Leki
- Centre for Statistical Analysis, Nicolaus Copernicus University, Toruń, Poland
| | - Paweł Sokal
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Comer C, Ammendolia C, Battié MC, Bussières A, Fairbank J, Haig A, Melloh M, Redmond A, Schneider MJ, Standaert CJ, Tomkins-Lane C, Williamson E, Wong AY. Consensus on a standardised treatment pathway algorithm for lumbar spinal stenosis: an international Delphi study. BMC Musculoskelet Disord 2022; 23:550. [PMID: 35676677 PMCID: PMC9175311 DOI: 10.1186/s12891-022-05485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/27/2022] [Indexed: 12/29/2022] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a common degenerative spinal condition in older adults associated with disability, diminished quality of life, and substantial healthcare costs. Individual symptoms and needs vary. With sparse and sometimes inconsistent evidence to guide clinical decision-making, variable clinical care may lead to unsatisfactory patient outcomes and inefficient use of healthcare resources. Methods A three-phase modified Delphi study comprising four consensus rounds was conducted on behalf of the International Taskforce for the Diagnosis and Management of LSS to develop a treatment algorithm based on multi-professional international expert consensus. Participants with expertise in the assessment and management of people with LSS were invited using an international distribution process used for two previous Delphi studies led by the Taskforce. Separate treatment pathways for patients with different symptom types and severity were developed and incorporated into a proposed treatment algorithm through consensus rounds 1 to 3. Agreement with the proposed algorithm was evaluated in the final consensus round. Results The final algorithm combines stratified and stepped approaches. When indicated, immediate investigation and surgery is advocated. Otherwise, a stepped approach is suggested when self-directed care is unsatisfactory. This starts with tailored rehabilitation, then more complex multidisciplinary care, investigations and surgery options if needed. Treatment options in each step depend on clinical phenotype and symptom severity. Treatment response guides pathway entrance and exit points. Of 397 study participants, 86% rated their agreement ≥ 4 for the proposed algorithm on a 0–6 scale, of which 22% completely agreed. Only 7% disagreed. Over 70% of participants felt that the algorithm would be useful for clinicians in public healthcare (both primary care and specialist settings) and in private healthcare settings, and that a simplified version would help patients in shared decision-making. Conclusions International and multi-professional agreement was achieved for a proposed LSS treatment algorithm developed through expert consensus. The algorithm advocates different pathway options depending on clinical indications. It is not intended as a treatment protocol and will require evaluation against current care for clinical and cost-effectiveness. It may, however, serve as a clinical guide until evidence is sufficient to inform a fully stratified care model. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05485-5.
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Affiliation(s)
- Christine Comer
- Leeds Community Healthcare NHS Trust, Leeds, UK. .,Faculty of Medicine, University of Leeds, Leeds, UK.
| | - Carlo Ammendolia
- Faculty of Medicine, University of Toronto and Mount Sinai Hospital, Toronto, ON, Canada
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone & Joint Institute, Western University, London, ON, Canada
| | - André Bussières
- School of Physical Medicine & Occupational Therapy, McGill University, Montreal, Canada.,Université du Québec À Trois-Rivières, Trois-Rivières, QC, Canada
| | - Jeremy Fairbank
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford Nuffield NHS Trust, Windmill Road, Oxford, UK
| | - Andrew Haig
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA
| | - Markus Melloh
- Faculty of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand.,Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland.,Curtin Medical School, Curtin University and UWA Medical School, University of Western Australia, Bentley, Australia
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Michael J Schneider
- Department of Physical Therapy, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher J Standaert
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Esther Williamson
- Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, Centre for Rehabilitation Research, University of Oxford, Windmill Road, Oxford, UK
| | - Arnold Yl Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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20
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Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1370-1390. [PMID: 35511368 DOI: 10.1007/s00586-022-07222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/15/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the efficacy of physiotherapy approaches used in the treatment of LSS and compare their delivery characteristics. METHODS A systematic search was conducted using MEDLINE/PubMed, EMBASE, Scopus, PEDro, CINAHL and Web of Science databases, from inception until March 2021. Inclusion criteria were clinical diagnosis of LSS confirmed through imaging techniques, RCTs written in English comparing physiotherapy interventions among them or versus placebo or usual care without restrictions on treatment and follow-up duration, outcomes related to pain, physical function, disability and quality of life. Two independent reviewers assessed records for eligibility and methodological quality (PEDro scale) and extracted participants' characteristics, interventions details and outcome measures at each timepoint. Pooled or un-pooled findings were reported as mean difference with 95% confidence interval, depending on heterogeneity. Evidence quality was rated using the GRADE approach. RESULTS Twelve studies (944 patients, mean PEDro score 7.6, range 5-9) were included. Three weeks of weight-supported walking improved pain and disability, while 8 weeks of aquatic exercises improved pain and walking tolerance (very low evidence). Six weeks of cycling reduced disability compared to weight-supported walking (low evidence). Six weeks of manual therapy plus exercise was not superior to supervised exercises (low evidence), but improved pain, walking tolerance, disability and quality of life compared to home/group exercises (moderate to very low evidence). Very low evidence supported 2 weeks of electromagnetic fields, whereas TENS (low evidence) and ultrasounds (very low evidence) revealed no effects. CONCLUSIONS These findings may assist clinicians in delivering effective physiotherapy interventions in LSS patients.
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21
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Srour R. Comparison of Operative Time and Blood Loss With the FFX® Device Versus Pedicle Screw Fixation During Surgery for Lumbar Spinal Stenosis: A Retrospective Cohort Study. Cureus 2022; 14:e22931. [PMID: 35399487 PMCID: PMC8986517 DOI: 10.7759/cureus.22931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background Pedicle screw (PS) placement can be associated with soft tissue damage and blood loss. The study objective was to evaluate differences in operative time and blood loss between PS fixation and an implantable facet fusion device in patients undergoing lumbar fusion surgery. Materials and methods A retrospective analysis was performed on patients undergoing lumbar fusion surgery with PS fixation or the lumbar Facet FiXation (FFX) device. Procedures were performed by the same surgeon at a single institution. The PS group included patients from 2016 and the FFX group included patients from 2018. Variables including age, sex, levels operated on, operative time, and operative blood loss were collected. Results A total of 70 patients were included in the study. Twenty-eight in the PS arm and 42 in the FFX arm. The PS group had a mean age of 67.5 ± 9.3 years compared to 70.4 ± 11.5 years for the FFX group. The PS group had a higher percentage of females (57.1%) versus the FFX group (31.0%); p = 0.025. Mean number of levels operated on were similar between the PS and FFX groups (2.3 ± 1 .1 vs. 2.2 ± 1.0, respectively; p = 0.89). Mean operative time was significantly longer for the PS group versus the FFX group (152.5 ± 39.4 vs. 99.4 ± 44.0 minutes; p < 0.001). Mean operative blood loss was significantly greater for the PS group versus the FFX group (446.5 ± 272.0 vs. 251.0 ± 315.9 mL; p < 0.01). Differences were independent of the number of levels operated on. Conclusion Placement of the FFX device is associated with a significant reduction in operative time and blood loss compared to PS fixation in patients undergoing spinal fusion surgery.
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Affiliation(s)
- Robin Srour
- Neurosurgery, Hôpitaux Civils de Colmar, Colmar, FRA
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22
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Ammendolia C, Hofkirchner C, Plener J, Bussières A, Schneider MJ, Young JJ, Furlan AD, Stuber K, Ahmed A, Cancelliere C, Adeboyejo A, Ornelas J. Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review. BMJ Open 2022; 12:e057724. [PMID: 35046008 PMCID: PMC8772406 DOI: 10.1136/bmjopen-2021-057724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication. DESIGN A systematic review. DATA SOURCES CENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020. ELIGIBILITY CRITERIA We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis. RESULTS Of 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that: Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; manual therapy, education and exercise delivered using a cognitive-behavioural approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. The remaining 20 new trials demonstrated low-quality or very low-quality evidence for all comparisons and outcomes, like the findings of our original review. CONCLUSIONS There is moderate-quality evidence that a multimodal approach which includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness. PROSPERO REGISTRATION NUMBER CRD42020191860.
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Affiliation(s)
- Carlo Ammendolia
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rheumatology, Sinai Health System, Toronto, Ontario, Canada
| | - Corey Hofkirchner
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Joshua Plener
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculy of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, boulevard des Forges, Trois-Rivières Québec, Canada
| | | | - James J Young
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Sports Medicine and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Andrea D Furlan
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Kent Stuber
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Aksa Ahmed
- Rheumatology, Sinai Health System, Toronto, Ontario, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Aleisha Adeboyejo
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Joseph Ornelas
- Health Systems Management, Rush University, Chicago, Illinois, USA
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23
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Onggo JR, Nambiar M, Maingard JT, Phan K, Marcia S, Manfrè L, Hirsch JA, Chandra RV, Buckland AJ. The use of minimally invasive interspinous process devices for the treatment of lumbar canal stenosis: a narrative literature review. JOURNAL OF SPINE SURGERY 2021; 7:394-412. [PMID: 34734144 DOI: 10.21037/jss-21-57] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
Minimally invasive interspinous process devices (IPD), including interspinous distraction devices (IDD) and interspinous stabilizers (ISS), are increasingly utilized for treating symptomatic lumbar canal stenosis (LCS). There is ongoing debate around their efficacy and safety over traditional decompression techniques with and without interbody fusion (IF). This study presents a comprehensive review of IPD and investigates if: (I) minimally invasive IDD can effectively substitute direct neural decompression and (II) ISS are appropriate substitutes for fusion after decompression. Articles published up to 22nd January 2020 were obtained from PubMed search. Relevant articles published in the English language were selected and critically reviewed. Observational studies across different IPD brands consistently show significant improvements in clinical outcomes and patient satisfaction at short-term follow-up. Compared to non-operative treatment, mini-open IDD was had significantly greater quality of life and clinical outcome improvements at 2-year follow-up. Compared to open decompression, mini-open IDD had similar clinical outcomes, but associated with higher complications, reoperation risks and costs. Compared to open decompression with concurrent IF, ISS had comparable clinical outcomes with reduced operative time, blood loss, length of stay and adjacent segment mobility. Mini-open IDD had better outcomes over non-operative treatment in mild-moderate LCS at 2-year follow-up, but had similar outcomes with higher risk of re-operations than open decompression. ISS with open decompression may be a suitable alternative to decompression and IF for stable grade 1 spondylolisthesis and central stenosis. To further characterize this procedure, future studies should focus on examining enhanced new generation IPD devices, longer-term follow-up and careful patient selection.
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Affiliation(s)
- James R Onggo
- Interventional Radiology Service, Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Mithun Nambiar
- Interventional Radiology Service, Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Julian T Maingard
- Interventional Radiology Service, Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - Kevin Phan
- Department of Neurosurgery, NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Stefano Marcia
- Department of Radiology, SS Trinità Hospital ASSL Cagliari ATS Sardegna, Cagliari, Italy
| | - Luigi Manfrè
- Department of Interventional Spine Neuroradiology-Neurosurgery, Mediterranean Institute for Oncology, Viagrande, Italy
| | - Joshua A Hirsch
- Interventional Spine Service, NeuroInterventional Radiology, Massachusetts General Hospital, Boston, USA
| | - Ronil V Chandra
- Interventional Radiology Service, Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Aaron J Buckland
- Spine Research Center, Department of Orthopaedic Surgery, NYU Langone Health, New York, USA.,Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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24
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Anderson DB, Stanford R, Van Gelder JM, Harris IA, Eyles J, Damodaran O, Maher CG, Ferreira ML. How much change in symptoms do spinal surgeons expect following lumbar decompression and microdiscectomy? J Clin Neurosci 2021; 91:243-248. [PMID: 34373035 DOI: 10.1016/j.jocn.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
The study aimed to determine how much change in neurogenic claudication spinal surgeons expect in patients following lumbar decompression for lumbar spine stenosis (LSS), and radicular leg pain following microdiscectomy. Secondary aims were to identify surgeons' preferences regarding surgical techniques for lumbar decompression, and their rating of the quality of current evidence for lumbar decompression. All Australian spine surgeons were invited, of whom 71 completed the survey (31% response rate). Only registered spinal surgeons were included. The online survey, administered using REDCap, included 4 sections: demographics and background; expected change in symptoms on a +/- 100% scale (-100% worst, 0% no change and 100% best possible); surgical preference; and rating of current evidence for lumbar decompression compared with other treatments. There were 71 complete responses, 76% were neurosurgeons (N = 54), predominantly male (96%; N = 68). On average, surgeons expected an 86% (median: 87%, inter-quartile range (IQR): 80%, 91%) improvement in neurogenic claudication following lumbar decompression for LSS and 89% (median: 91%, IQR: 85%, 95%) improvement in radicular pain following microdiscectomy. A multiple linear regression found no surgeon characteristics were associated with expected change following surgery. The preferred surgical technique for LSS was full laminectomy (58%; N = 41). Thirty-five percent of surgeons accurately rated the evidence supporting the superiority of lumbar decompression compared with non-surgical care for LSS as low quality. Spine surgeons expect large symptom improvements following lumbar decompression and microdiscectomy. Understanding of the current evidence was higher for lumbar decompression with fusion, than for decompression alone for LSS.
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Affiliation(s)
- David B Anderson
- Faculty of Medicine and Health, The Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Graduate School of Health, University of Technology Sydney, New South Wales.
| | - Ralph Stanford
- Orthopaedic Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - James M Van Gelder
- Department of Neurosurgery, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia; Sydney Spine Institute, Burwood, New South Wales, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, New South Wales, Australia; Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jillian Eyles
- Faculty of Medicine and Health, The Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Omprakash Damodaran
- Department of Neurosurgery, Concord General Repatriation Hospital, Concord, New South Wales, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, The Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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25
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Kumar CD, Dietz N, Sharma M, Cruz A, Counts CE, Wang D, Ugiliweneza B, Boakye M, Drazin D. Spine Surgery in the Octogenarian Population: A Comparison of Demographics, Surgical Approach, and Healthcare Utilization With the PearlDiver Database. Cureus 2021; 13:e14561. [PMID: 34026377 PMCID: PMC8133513 DOI: 10.7759/cureus.14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background With the recent advances in technology and healthcare, increasing numbers of individuals over the age of 80 will require surgical intervention for spinal pathology. Given the risk of increased complications in the elderly, a limited number of spinal surgeries are performed on octogenarians every year. This makes it difficult to generalize the trends and outcomes of these surgeries to a greater population. This study attempts to understand the trends in the safety profile and healthcare utilization across the United States for octogenarians undergoing spinal fusion and/or decompression surgery for spinal stenosis and/or degenerative disease using the PearlDiver database. Methodology Patients who underwent fusion and/or decompression for stenosis and/or degenerative diseases were extracted using International Classification of Disease ninth and tenth revisions (ICD-9 prior to October 2015, ICD-10 after) from 2007 to 2016 in the PearlDiver database. Three comparative groups were considered: (1) primary fusion without concurrent decompression, (2) primary decompression with concurrent fusion, and (3) fusion with concurrent decompression. Outcomes of interest were patient characteristics, demographics, length of stay, surgery hospitalization payments, and discharge disposition. These outcomes were compared to patients over the age of 20 who also underwent spinal surgery. Results A total of 9,715 patients who underwent spinal surgery were identified in the search. Of the 9,139 patients, 503 were octogenarians and 73 were nonagenarians. Octogenarians and nonagenarians diagnosed with spinal stenosis were more likely to undergo decompression alone rather than fusion or both fusion and decompression (21 for both fusion and decompression; p < 0.0001). Patients diagnosed with both spinal stenosis and degeneration were more likely to undergo both fusion and decompression than fusion or decompression alone (239 for both, 208 for decompression alone, and 23 for fusion alone; p < 0.0001). No statistically significant difference was found in the percentage of patients discharged home following either fusion or decompression or both surgeries (p = 0.0737). The mean length of stay for patients in the 20-79-year age group was 2.79 days, whereas for the octogenarian and nonagenarian cohort it was 3.85 days. The index hospitalization pay for patients in the 20-79-year age group was $19,220, whereas for the octogenarians and nonagenarians cohort it was $15,091. Conclusions Patients over the age of 80 were more likely to undergo either a fusion procedure or a decompression procedure alone rather than both unless they were diagnosed with spinal degeneration. The PearlDiver database analysis indicates that the length of stay for octogenarians and nonagenarians is longer than that for patients in the 20-79-year age group, and that younger patients are more likely to be discharged earlier than patients over the age of 80. Moreover, we observed that the index hospitalization pay was higher for patients over the age of 20 than for octogenarians and nonagenarians in all cases except for a fusion procedure.
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Affiliation(s)
- Chitra D Kumar
- Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Nicholas Dietz
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Mayur Sharma
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Aurora Cruz
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | | | - Dengzhi Wang
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Beatrice Ugiliweneza
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, USA.,Department of Health Management and Systems Science, University of Louisville, Louisville, USA
| | - Maxwell Boakye
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Doniel Drazin
- Medicine, Pacific Northwest University of Health Sciences, Yakima, USA
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26
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Chalmers K, Smith P, Garber J, Gopinath V, Brownlee S, Schwartz AL, Elshaug AG, Saini V. Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims. JAMA Netw Open 2021; 4:e218075. [PMID: 33904912 PMCID: PMC8080218 DOI: 10.1001/jamanetworkopen.2021.8075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022] Open
Abstract
Importance Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services. Objective To describe characteristics of hospitals associated with overuse of health care services in the US. Design, Setting, and Participants This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020. Main Outcomes and Measures Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters. Results The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P < .001), northeast (0.08 [95% CI, 0.06-0.09] points; P < .001), and western hospitals (0.08 [95% CI, 0.07-0.10] points; P < .001). Nonprofit hospitals had a lower adjusted mean score than for-profit hospitals (-0.03 [95% CI, -0.04 to -0.02] points; P < .001). Major teaching hospitals had significantly lower adjusted mean overuse scores vs minor teaching hospitals (difference in means, -0.07 [95% CI, -0.08 to -0.06] points; P < .001) and nonteaching hospitals (-0.10 [95% CI, -0.12 to -0.09] points; P < .001). Of the 4 clusters identified, 1 was characterized by its low counts of overuse in all services except for spinal fusion; the majority of major teaching hospitals were in this cluster (164 of 223 major teaching hospitals [73.5%]). Conclusions and Relevance This cross-sectional study used a novel measurement of hospital-associated overuse; results showed that the highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South.
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Affiliation(s)
- Kelsey Chalmers
- Lown Institute, Brookline, Massachusetts
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | - Aaron L. Schwartz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania
| | - Adam G. Elshaug
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- University of Southern California, Brookings Schaeffer Initiative for Health Policy, The Brookings Institution, Washington, DC
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Sunderland G, Foster M, Dheerendra S, Pillay R. Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases. Global Spine J 2021; 11:172-179. [PMID: 32875849 PMCID: PMC7882820 DOI: 10.1177/2192568219896541] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Despite numerous advances in the technology and techniques available to spinal surgeons, lumbar decompression remains the mainstay of degenerative lumbar spine surgery. It has proven efficacy in trials, but only limited evidence of advantage over conservative management in large scale systematic reviews. We collated data from a large surgically managed cohort to evaluate the patient-reported outcomes. METHODS We performed a retrospective analysis of a prospectively populated database. Patient demographics, surgical details, and patient outcomes (Spine Tango core outcome measures index [COMI]-Low Back) were collected for 2699 lumbar decompression surgeries. RESULTS Lumbar decompression was shown to be successful at improving leg pain (mean improvement in visual analogue scale [VAS] at 3 months = 4) and to a lesser extent, back pain (mean improvement in VAS at 3 months = 2.61). Mean improvement in COMI score was 3.15 for all-comers. Minimal clinically important improvement (MCID) in COMI score (-2 points) was achieved in 73% of patients by 2-year follow-up. Primary surgery was more effective than redo surgery: odds ratio 0.547 (95% CI 0.408-0.733, P < .001). The benefits across all outcomes were maintained for the 2-year follow-up period. Patients can be classified according to their outcome as "early responders"; achieving MCID by 3 months (61% primary vs 41% redo), "late responders"; achieving MCID by 2 years (15% vs 20%) or nonresponders (24% vs 39%). CONCLUSIONS Lumbar decompression is effective in improving quality of life in appropriately selected patients. Patient-reported outcome measures collected routinely and collated within a registry are a powerful tool for assessing the efficacy of lumbar spine interventions and allow accurate counseling of patients perioperatively.
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Affiliation(s)
| | | | - Sujay Dheerendra
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Robin Pillay
- The Walton Centre NHS Foundation Trust, Liverpool, UK
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Welton L, Krieg B, Trivedi D, Netsanet R, Wessell N, Noshchenko A, Patel V. Comparison of Adverse Outcomes Following Placement of Superion Interspinous Spacer Device Versus Laminectomy and Laminotomy. Int J Spine Surg 2021; 15:153-160. [PMID: 33900969 DOI: 10.14444/8020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Current evidence suggests placement of the Superion interspinous spacer (SISS) device compared with laminectomy or laminotomy surgery offers an effective, less invasive treatment option for patients with symptomatic lumbar spinal stenosis. Both SISS placement and laminectomy or laminotomy have risks of complications and a direct comparison of complications between the 2 procedures has not been previously studied. The purpose of this study is to compare the short-term complications of the SISS with laminectomy or laminotomy and highlight device-specific long-term outcomes with SISS. METHODS Via retrospective review, 189 patients who received lumbar level SISSs were compared with 378 matched controls who underwent primary lumbar spine laminectomy or laminotomy; data were collected from the American College of Surgeons National Surgical Quality Improvement Program database. Complications analyzed included rates of wound infection, pulmonary embolism, deep venous thrombosis, urinary tract infection, sepsis, septic shock, cardiac arrest, death, and reoperation within 30 days of index surgery. Differences between groups were analyzed using the χ2test. Device-specific complication (DSC) rates included device malfunction or misplacement (DM), device explantation (DE), spinous process fracture (SPF), and subsequent spinal surgery (SSS). RESULTS No differences in demographics or comorbidities existed between groups. There was no significant difference in rates of complications between groups. A total of 44.4% of patients in the SISS group experienced DSCs with 11.1% of patients experiencing DM, 21.1% experiencing an SPF, 20.1% requiring DE, and 24.3% requiring SSS. Having at least 1 DSC significantly increased odds of SSS, odds ratio >120, P < .0001. CONCLUSION Rates of 30-day complications in the SISS group were not significantly different from patients undergoing laminectomy or laminotomy. Rates of 2-year DSC within SISS and cumulative risk associated with these complications should be considered further as they likely represent need for additional procedures for patients and substantial cost to the healthcare system. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE Having no differences in adverse events between laminectomies or laminotomies and SISS plus evidence of substantial device-specific long-term adverse outcomes and reoperation should be given consideration when deciding on surgical intervention of 1-2 level lumbar spinal stenosis.
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Affiliation(s)
- Lindsay Welton
- University of Minnesota School of Medicine Department of Surgery, Division of General Surgery, Minneapolis, Minnesota
| | - Brandi Krieg
- University of Colorado School of Medicine, Aurora, Colorado
| | - Deepa Trivedi
- University of Colorado School of Public Health, Aurora, Colorado
| | - Rahwa Netsanet
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
| | - Nolan Wessell
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
| | - Andriy Noshchenko
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
| | - Vikas Patel
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
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Jang SW, Yang HS, Kim YB, Yang JC, Kang KB, Kim TW, Park KH, Jeon KS, Shin HD, Kim YE, Cho HN, Lee YK, Lee Y, Lee SBN, Ahn DY, Sim WS, Jo M, Jo GJ, Park DB, Park GS. Comparison of the Effectiveness of Three Lumbosacral Orthoses on Early Spine Surgery Patients: A Prospective Cohort Study. Ann Rehabil Med 2021; 45:24-32. [PMID: 33557479 PMCID: PMC7960949 DOI: 10.5535/arm.20158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data. Methods This prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted. Results No significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003). Conclusion The newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.
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Affiliation(s)
- Soo Woong Jang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee Seung Yang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Bae Kim
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Joo Chul Yang
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kyu Bok Kang
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kwan Ho Park
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kyung Soo Jeon
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee Dong Shin
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Ye Eun Kim
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Han Na Cho
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Kyung Lee
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea
| | - Seul Bin Na Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong Young Ahn
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Woo Sob Sim
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Min Jo
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Gyu Jik Jo
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong Bum Park
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Gwan Su Park
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
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Vishwanathan K, Braithwaite I. Construct validity and responsiveness of commonly used patient reported outcome instruments in decompression for lumbar spinal stenosis. J Clin Orthop Trauma 2021; 16:125-131. [PMID: 33717946 PMCID: PMC7920003 DOI: 10.1016/j.jcot.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/07/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Validity and responsiveness of Oswestry disability index (ODI), Roland Morris disability questionnaires (RMDQ), Short Form-12 Physical Component Score (SF-12 PCS) and Short Form-12 Mental Component Score (SF-12 MCS) in patients undergoing open decompression for lumbar canal stenosis has not been previously reported. METHODS Outcome assessment was prospectively evaluated using the ODI, RMDQ, SF-12 PCS and SF-12 MCS pre-intervention and at average follow-up of three months post-intervention. Pearson correlation coefficient was used to evaluate the association between change in values of ODI, RMDQ, SF-12 PCS and SF-12 MCS. Distribution based methods (Effect size [ES], standardised response mean [SRM]) and anchor based method (Area under the curve [AUC] of receiver operating curve [ROC]) were used to determine responsiveness. AUC value ≥ 0.70 is considered as adequate level of responsiveness and the outcome instrument with the largest AUC is considered to be the most responsive outcome instrument. RESULTS This study included 77 participants. Responsiveness was assessed at a mean follow-up of 12 weeks postoperatively. There was significant strong correlation between ODI and RMDQ (r = 0.65, p < 0.0001). The ES of ODI, RMDQ, SF-12 PCS and SF-12 MCS were 1.54, 1.48, 1.85 and 0.51 respectively. The SRM of RMDQ, ODI, SF-12 PCS and SF-12 MCS were 1.22, 1.17, 1.0 and 0.47 respectively. AUC of ODI, RMDQ, SF-12 PCS and SF-12 MCS were 0.83-0.88, 0.82 to 0.86, 0.78 to 0.81 and 0.69 to 0.70 respectively. CONCLUSION It is recommended to use either ODI or RMDQ as region specific patient reported outcome instrument and SF-12 PCS as a health related quality of life outcome instrument to evaluate outcome after decompressive laminectomy for lumbar canal stenosis.
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Key Words
- AUC, Area under the curve
- ES, Effect Size
- HRQoL, Health Related Quality of Life
- Lumbar stenosis
- MCID, Minimal Clinically Important Difference
- NRS, Numerical Rating Scale
- ODI, Oswestry Disability Index
- Oswestry disability index
- RMDQ, Roland Morris disability questionnaires
- ROC, Receiver Operating Curve
- Responsiveness
- Roland morris disability questionnaire
- SF-12
- SF-12 PCS, Short Form-12 Physical Component Score
- SF12-MCS, Short Form-12 Mental Component Score
- SRM, Standardised Response Mean
- VAS, Visual Analogue Scale
- Validity
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Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Waghodia, Vadodara, India,Corresponding author. Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Faculty of Medicine, Parul University, P.O Limda, Waghodia, Vadodara, 391760, India.
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Tu P, Cao S, Jiang C, Yan CC. A comparative study of Lumbar Decompression and Fusion with Internal Fixation versus Simple Decompression in elderly patients with two-segment Lumbar Spinal Stenosis. Pak J Med Sci 2021; 37:256-260. [PMID: 33437287 PMCID: PMC7794151 DOI: 10.12669/pjms.37.1.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/11/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate and compare the effect of decompression and fusion with internal fixation vs. simple decompression in the treatment of elderly patients with two-segment lumbar spinal stenosis (LSS) in perioperative and postoperative follow-up periods. METHODS Twenty-eight elderly patients with two-segment LSS admitted in Baoding First Hospital between Mar. 2017 and Jan. 2018 were retrospectively analyzed. Fifteen patients who underwent simple decompression were included in the simple decompression group, and 13 who underwent decompression and fusion with internal fixation were included in the decompression-fixation group. The general data and perioperative conditions including wound complications, operation time, blood loss, and VAS (legs) and JOA score were analyzed and compared between the two groups. RESULTS There was no significant difference in postoperative leg pain (VAS) between the two groups, and a statistically significant difference in JOA score was found between the two groups one month after the operation. The operation time, length of stay, and blood loss in the decompression-fixation group were significantly different from those in the simple decompression group and no significant difference in wound complications was observed between the two groups. CONCLUSION There is no significant difference in leg pain relief in elderly patients with two-segment LSS when treated with decompression and fusion with internal fixation or simple decompression. Simple decompression is associated with less intraoperative injuries, better postoperative functional recovery, and reduced hospital stay.
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Affiliation(s)
- Pengfa Tu
- Pengfa Tu, Department of Orthopaedics, Baoding First Hospital, Baoding, Hebei, 071000, P.R. China
| | - Shuo Cao
- Shuo Cao, Color Doppler Ultrasound Room, Baoding First Central Hospital, Baoding, Hebei, 071000, P.R. China
| | - Chenyang Jiang
- Chenyang Jiang, Department of Orthopaedics, Baoding First Hospital, Baoding, Hebei, 071000, P.R. China
| | - Chong-chao Yan
- Chong-chao Yan, Department of Orthopaedics, Baoding First Hospital, Baoding, Hebei, 071000, P.R. China
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Hua W, Wang B, Ke W, Wu X, Zhang Y, Li S, Yang S, Yang C. Comparison of lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive surgery transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:785. [PMID: 33246434 PMCID: PMC7697381 DOI: 10.1186/s12891-020-03820-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of the present study is to compare the clinical outcomes and postoperative complications of lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) to treat one-level lumbar spinal stenosis (LSS) without degenerative spondylolisthesis or deformity. METHODS A retrospective analysis of 112 consecutive patients of one-level LSS undergoing either LE-ULBD or MIS-TLIF was performed. Patient demographics, operation time, estimated blood loss, time to ambulation, length of hospitalization, intraoperative and postoperative complications were recorded. The visual analog scale (VAS) score for leg and back pain, the Oswestry Disability Index (ODI) score, and the Macnab criteria were used to evaluate the clinical outcomes. The healthcare cost was also recorded. RESULTS The operation time, estimated blood loss, time to ambulation and length of hospitalization of LE-ULBD group were shorter than MIS-TLIF group. The postoperative mean VAS and ODI scores decreased significantly in both groups. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 90.6 and 93.8% in the two groups. The mean VAS scores, ODI scores and outcomes of the modified Macnab criteria of both groups were of no significant difference. The healthcare cost of LE-ULBD group was lower than MIS-TLIF group. Two cases of intraoperative epineurium injury were observed in the LE-ULBD group. One case of cauda equina injury was observed in the LE-ULBD group. No nerve injury, dural injury or cauda equina syndrome was observed in MIS-TLIF group. However, one case with transient urinary retention, one case with pleural effusion, one case with incision infection and one case with implant dislodgement were observed in MIS-TLIF group. CONCLUSIONS Both LE-ULBD and MIS-TLIF are safe and effective to treat one-level LSS without degenerative spondylolisthesis or deformity. LE-ULBD is a more minimally invasive option and of less economic burden compared with MIS-TLIF. Decompression plus instrumented fusion may be not necessary for one-level LSS without degenerative spondylolisthesis or deformity.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuhua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Wu J, Ao S, Liu H, Wang W, Zheng W, Li C, Zhang C, Zhou Y. Novel electromagnetic-based navigation for percutaneous transforaminal endoscopic lumbar decompression in patients with lumbar spinal stenosis reduces radiation exposure and enhances surgical efficiency compared to fluoroscopy: a randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1215. [PMID: 33178747 PMCID: PMC7607128 DOI: 10.21037/atm-20-1877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Percutaneous transforaminal endoscopic lumbar decompression (PTELD) is an emerging surgical alternative for treating lumbar spinal stenosis (LSS). However, the foraminoplasty procedure often requires repeated fluoroscopy, and endoscopy just offers a local view. No studies have focused on decreasing radiation exposure with electromagnetic navigation assistance. This study introduces a novel electromagnetic-based navigation (EMN) endoscopic system for PTELD in patients with LSS and compares the results in navigation and fluoroscopy groups. Methods Eighty-eight patients with LSS were randomized into either a navigation (44 patients) or fluoroscopy group. Duration of surgery, cannula placement time, radiation dose, blood loss, intraoperative pain assessment, and postoperative hospitalization stay were evaluated. The clinical outcomes were evaluated using a visual analogue scale (VAS), the Oswestry Disability Index (ODI), 6-minute walk test, and modified Macnab criteria. Results Eighty-five patients were followed-up for at least 12 months. The duration of surgery and cannula placement time were significantly more efficient in the navigation group (P=0.03 and P<0.001). Intraoperative pain assessment showed significantly less pain in the navigation group (P=0.038). The radiation dose was significantly higher in the fluoroscopy group than the navigation group (P<0.001). The VAS scores for back (P<0.001) and leg (P<0.001) pain improved significantly in both groups after surgery, as did the ODI (P<0.001) scores. Improvements in walking ability and Macnab criteria assessments at the 12-month follow-up, assessed subjective by patient assessments did not differ between the two groups. Conclusions The EMN system used in PTELD for patients with LSS compared to fluoroscopy enhances efficiency for foraminoplasty, reduces intraoperative pain and levels of radiation exposure. It results in outcomes comparable with results using fluoroscopy.
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Affiliation(s)
- Junlong Wu
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China.,Department of Orthopaedics, the 941 Hospital of Chinese People Liberation Army, Xining, China
| | - Shengxiang Ao
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China
| | - Huan Liu
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China
| | - Wenkai Wang
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China
| | - Wenjie Zheng
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China
| | - Chao Zhang
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China
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Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK. A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis. PAIN MEDICINE 2020; 20:S32-S44. [PMID: 31808530 PMCID: PMC7101166 DOI: 10.1093/pm/pnz161] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present and summarize the current data on how LSS presents in various populations, how it is diagnosed, and current therapeutic strategies. Properly understanding the prevalence, presentation, and treatment options for individuals suffering from LSS is critical to providing patients the best possible care. Results The occurrence of LSS is associated with advanced age. In elderly patients, LSS can be challenging to identify due to the wide variety of presentation subtleties and common comorbidities such as degenerative disc disease. Recent developments in imaging techniques can be useful in accurately identifying the precise location of the spinal compression. Treatment options can range from conservative to surgical, with the latter being reserved for when patients have neurological compromise or conservative measures have failed. Once warranted, there are several surgical techniques at the physician’s disposal to best treat each individual case.
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Affiliation(s)
- Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, Kansas
| | | | | | - Sean Li
- Premier Pain Centers, Shrewsbury, New Jersey
| | - Aaron K Calodney
- Precision Spine Care, Texas Spine and Joint Hospital, Tyler, Texas, USA
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Ekström L, Zhang Q, Abrahamson J, Beck J, Johansson C, Westin O, Todd C, Baranto A. A model for evaluation of the electric activity and oxygenation in the erector spinae muscle during isometric loading adapted for spine patients. J Orthop Surg Res 2020; 15:155. [PMID: 32303232 PMCID: PMC7165389 DOI: 10.1186/s13018-020-01652-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery. METHODS Twelve patients with degenerative lumbar spinal stenosis (DLSS) were included. They were subjected to a test protocol before and after surgery. The protocol consisted of two parts, a dynamic and an isometric Ito loading with a time frame of 60 s and accompanying rest of 120 s. The Ito test was repeated three times. EMG was measured bilaterally at the L4 level and L2 and was recorded using surface electrodes and collected (Biopac Systems Inc.). EMG signal was expressed as RMS and median frequency (MF). Muscle tissue oxygen saturation (MrSO2) was monitored using a near-infrared spectroscopy (NIRS) device (INVOS® 5100C Oxymeter). Two NIRS sensors were positioned bilaterally at the L4 level. The intensity of the leg and back pain and perceived exertion before, during, and after the test was evaluated with a visual analogue scale (VAS) and Borg RPE-scale, respectively. RESULTS All patients were able to perform and complete the test protocol pre- and postoperatively. A consistency of lower median and range values was noted in the sensors of EMG1 (15.3 μV, range 4.5-30.7 μV) and EMG2 (13.6 μV, range 4.0-46.5 μV) that were positioned lateral to NIRS sensors at L4 compared with EMG3 (18.9 μV, range 6.5-50.0 μV) and EMG4 (20.4 μV, range 7.5-49.0 μV) at L2. Right and left side of the erector spinae exhibited a similar electrical activity behaviour over time during Ito test (60 s). Regional MrSO2 decreased over time during loading and returned to the baseline level during recovery on both left and right side. Both low back and leg pain was significantly reduced postoperatively. CONCLUSION Simultaneous measurement of surface EMG and NIRS seems to be a promising tool for objective assessment of paraspinal muscle function in terms of muscular activity and local muscle oxygenation changes in response to isometric trunk extension in patients that have undergone laminectomy for spinal stenosis.
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Affiliation(s)
- Lars Ekström
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden.
| | - Qiuxia Zhang
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Josefin Abrahamson
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Joel Beck
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Christer Johansson
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Olof Westin
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Carl Todd
- The Carl Todd Clinic, 5 Pickwick Park, Park Lane, Corsham, SN13 0HN, UK
| | - Adad Baranto
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
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Wipplinger C, Kim E, Lener S, Navarro-Ramirez R, Kirnaz S, Hernandez RN, Melcher C, Paolicelli M, Maryam F, Schmidt FA, Härtl R. Tandem Microscopic Slalom Technique: The Use of 2 Microscopes Simultaneously Performing Unilateral Laminotomy for Bilateral Decompression in Multilevel Lumbar Spinal Stenosis. Global Spine J 2020; 10:88S-93S. [PMID: 32528812 PMCID: PMC7263332 DOI: 10.1177/2192568219871918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Technical note, retrospective case series. OBJECTIVE Lumbar stenosis can be effectively treated using tubular unilateral laminotomy for bilateral decompression (ULBD). For multilevel stenosis, a multilevel ULBD through separate, alternating crossover approaches has been described as the "slalom technique." To increase efficacy, we introduced this approach with 2 microscopes simultaneously. METHODS We collected data on 13 patients, with multilevel lumbar stenosis, operated at our institution between 2015 and 2016 by the aforementioned technique. We assessed surgical time (ST), estimated blood loss (EBL), complications, and revision surgeries. Furthermore, we provide a stepwise instruction for performing the tandem microscopic slalom technique in a safe and efficient manner. RESULTS The mean age of the patients was 68 ± 8 years. The ST per level was 68 ± 19 minutes with an EBL per level of 39 ± 30 mL. We had no intraoperative complications and none of our patients required a revision surgery during a mean follow-up of 12 months. CONCLUSIONS We have shown that this technique is feasible and can be performed safely for multisegmental lumbar spinal stenosis with minimal tissue trauma and low EBL. Furthermore, randomized controlled studies with a larger sample size may be necessary to drive any final conclusions.
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Affiliation(s)
- Christoph Wipplinger
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
- Christoph Wipplinger and Eliana Kim contributed equally to the work
| | - Eliana Kim
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
- Christoph Wipplinger and Eliana Kim contributed equally to the work
| | - Sara Lener
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | | | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - R. Nick Hernandez
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Carolin Melcher
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Michelle Paolicelli
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Farah Maryam
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
| | | | - Roger Härtl
- Weill Cornell Brain and Spine Center, New York–Presbyterian Hospital, New York, NY, USA
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Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. Int J Mol Sci 2020; 21:ijms21062135. [PMID: 32244936 PMCID: PMC7139690 DOI: 10.3390/ijms21062135] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022] Open
Abstract
With an aging population, there is a proportional increase in the prevalence of intervertebral disc diseases. Intervertebral disc diseases are the leading cause of lower back pain and disability. With a high prevalence of asymptomatic intervertebral disc diseases, there is a need for accurate diagnosis, which is key to management. A thorough understanding of the pathophysiology and clinical manifestation aids in understanding the natural history of these conditions. Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram. There is a large volume of literature on the management of intervertebral disc diseases, which we categorized into five headings: (a) Relief of pain by conservative management, (b) restorative treatment by molecular therapy, (c) reconstructive treatment by percutaneous intervertebral disc techniques, (d) relieving compression and replacement surgery, and (e) rigid fusion surgery. This review article aims to provide an overview on various current diagnostic and treatment options and discuss the interplay between each arms of these scientific and treatment advancements, hence providing an outlook of their potential future developments and collaborations in the management of intervertebral disc diseases.
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Bitenc-Jasiejko A, Konior K, Lietz-Kijak D. Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics. Pain Res Manag 2020; 2020:3967414. [PMID: 32256908 PMCID: PMC7109562 DOI: 10.1155/2020/3967414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Introduction. Lower back pain (LBP) is almost a problem of civilizations. Quite often, it is a consequence of many years of disturbed distribution of tension within the human body caused by local conditions (injuries, hernias, stenoses, spondylolisthesis, cancer, etc.), global factors (postural defects, structural integration disorders, lifestyle, type of activity, etc.), or systemic diseases (connective tissue, inflammation, tumours, abdominal aneurysm, and kidney diseases, including urolithiasis, endometriosis, and prostatitis). Therefore, LBP rehabilitation requires the use of integrated therapeutic methods, combining the competences of interdisciplinary teams, both in the process of diagnosis and treatment. Aim of the Study. Given the above, the authors of the article conducted meta-analysis of the literature in terms of integrated therapeutic methods, indicating the techniques focused on a holistic approach to the patient. The aim of the article is to provide the reader with comprehensive knowledge about treating LBP using noninterventional methods. Material and Methods. An extensive search for the materials was conducted online using PubMed, the Cochrane database, and Embase. The most common noninterventional methods have been described, as well as the most relevantly updated and previously referenced treatment of LBP. The authors also proposed noninvasive (measurable) diagnostic procedures for the functional assessment of the musculoskeletal system, including initial, systematic, and cross-sectional control. All figures and images have been prepared by the authors and are their property. Results This review article goes beyond combining a detailed description of each procedure with full references, as well as a comprehensive discussion of this very complex and troublesome problem. Conclusions Lower back pain is a serious health problem, and this review article will help educate physicians and physiotherapists dealing with LBP in the options of evidence-based treatment. Ultimately, the article introduces and postulates the need to systematize therapeutic procedures in LBP therapy, with a long-term perspective.
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Affiliation(s)
- Aleksandra Bitenc-Jasiejko
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Danuta Lietz-Kijak
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Merkow J, Varhabhatla N, Manchikanti L, Kaye AD, Urman RD, Yong RJ. Minimally Invasive Lumbar Decompression and Interspinous Process Device for the Management of Symptomatic Lumbar Spinal Stenosis: a Literature Review. Curr Pain Headache Rep 2020; 24:13. [PMID: 32072362 DOI: 10.1007/s11916-020-0845-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Symptomatic lumbar spinal stenosis (LSS) is a condition affecting a growing number of individuals resulting in significant disability and pain. Traditionally, treatment options have consisted of conservative measures such as physical therapy, medication management, epidural injections and percutaneous adhesiolysis, or surgery. There exists a treatment gap for patients failing conservative measures who are not candidates for surgery. Minimally invasive lumbar decompression (MILD®) and interspinous process device (IPD) with Superion® represent minimally invasive novel treatment options that may help fill this gap in management. We performed a literature review to separately evaluate these procedures and assess the effectiveness and safety. RECENT FINDINGS The available evidence for MILD and Superion has been continuously debated. Overall, it is considered that while the procedures are safe, there is only modest evidence for effectiveness. For both procedures, we have reviewed 13 studies. Based on the available evidence, MILD and Superion are safe and modestly effective minimally invasive procedures for patients with symptomatic LSS. It is our recommendation that these procedures may be incorporated as part of the continuum of treatment options for patients meeting clinical criteria.
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Affiliation(s)
- Justin Merkow
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Narayana Varhabhatla
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Alan D Kaye
- Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - R Jason Yong
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
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Wu PH, Kim HS, Jang IT. How I do it? Uniportal full endoscopic contralateral approach for lumbar foraminal stenosis with double crush syndrome. Acta Neurochir (Wien) 2020; 162:305-310. [PMID: 31823118 PMCID: PMC6982631 DOI: 10.1007/s00701-019-04157-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
Abstract
Background Evolution of endoscopic surgery provides equivalent results to open surgery with advantages of minimal invasive surgery. The literature on technique Uniportal Full endoscopic contralateral approach is scarce. Methods The endoscopic contralateral approach technique applies for patients presenting with double crush syndrome with foraminal and extraforminal stenosis. The key steps focus on contralateral ventral overriding superior articular process decompression, foraminal and extraforaminal discectomy, and lateral vertebral syndesmophyte decompression leading to enlargement of the contralateral foramen and extraforamen size. Conclusion The Uniportal Full endoscopic contralateral approach is a good alternative to open surgery or minimally invasive microscopic surgery through direct endoscopic visualization of the entire route of exiting nerve with no neural retraction allowing both lateral recess and foraminal and extraforaminal decompression all in one approach. Electronic supplementary material The online version of this article (10.1007/s00701-019-04157-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pang Hung Wu
- Department of Neurosurgery, Nanoori Gangnam Hospital, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of South Korea
- JurongHealth Campus, Orthopaedic Surgery, National University Health Systems, Singapore, Singapore
| | - Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of South Korea.
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of South Korea
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Abstract
STUDY DESIGN Surgeon survey. OBJECTIVE To examine factors influencing surgeons' definition of instability in grade 1 degenerative spondylolisthesis (DS) and assess treatment preferences for both stable and unstable DS. SUMMARY OF BACKGROUND DATA DS treatment options are broadly classified as decompression with or without fusion. In surgical decision-making, "instability" is frequently considered as a key factor. However, no consensus on the definition of instability exists. METHODS A survey was conducted to ascertain the minimum amounts of static translation, dynamic translation, and angulation change that surgeons considered significant for determining instability. The importance of other clinical and radiographic features were also assessed, and respondents' standard treatment for stable and unstable DS. RESULTS Out of 226 respondents, 99% deemed dynamic translation moderately to extremely influential for determining instability, whereas only 55% found static translation as important. The most prevalent cut-off values for dynamic (57%) and static translation (32%) were at least 2-4 mm and for angulation change at least 10-15 degrees (43%). Facet angulation was considered moderately to extremely important to determine instability by 69% of the surgeons, disk height by 67%, patient age by 64%, severity of stenosis by 55%, severity of back pain by 50%, patient-reported function by 49%, pelvic incidence by 47%, and severity of neurogenic claudication by 42%.Decompression with fusion was the preferred treatment method for unstable DS in 99% of the respondents. For stable DS, 40% would still perform fusion, whereas 60% preferred treatment with decompression-alone. Those who preferred fusion for stable DS reported significantly lower thresholds for static (P<0.001) and dynamic translation (P=0.004) for their determination of instability. CONCLUSIONS Clear consensus regarding the definition of instability does not exist. Dynamic translation is the most agreed-upon parameter of influence. Treatment preferences vary for stable DS, but for unstable cases there is broad consensus to perform fusion. LEVEL OF EVIDENCE Level II.
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Hebert JJ, Abraham E, Wedderkopp N, Bigney E, Richardson E, Darling M, Hall H, Fisher CG, Rampersaud YR, Thomas KC, Jacobs B, Johnson M, Paquet J, Attabib N, Jarzem P, Wai EK, Rasoulinejad P, Ahn H, Nataraj A, Stratton A, Manson N. Patients undergoing surgery for lumbar spinal stenosis experience unique courses of pain and disability: A group-based trajectory analysis. PLoS One 2019; 14:e0224200. [PMID: 31697714 PMCID: PMC6837529 DOI: 10.1371/journal.pone.0224200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/08/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Identify patient subgroups defined by trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis, and investigate the construct validity of the subgroups by evaluating for meaningful differences in clinical outcomes. Methods We recruited patients with degenerative lumbar spinal stenosis from 13 surgical spine centers who were deemed to be surgical candidates. Study outcomes (leg and back pain numeric rating scales, modified Oswestry disability index) were measured before surgery, and after 3, 12, and 24 months. Group-based trajectory models were developed to identify trajectory subgroups for leg pain, back pain, and pain-related disability. We examined for differences in the proportion of patients achieving minimum clinically important change in pain and disability (30%) and clinical success (50% reduction in disability or Oswestry score ≤22) 12 months from surgery. Results Data from 548 patients (mean[SD] age = 66.7[9.1] years; 46% female) were included. The models estimated 3 unique trajectories for leg pain (excellent outcome = 14.4%, good outcome = 49.5%, poor outcome = 36.1%), back pain (excellent outcome = 13.1%, good outcome = 45.0%, poor outcome = 41.9%), and disability (excellent outcome = 30.8%, fair outcome = 40.1%, poor outcome = 29.1%). The construct validity of the trajectory subgroups was confirmed by between-trajectory group differences in the proportion of patients meeting thresholds for minimum clinically important change and clinical success after 12 postoperative months (p < .001). Conclusion Subgroups of patients with degenerative lumbar spinal stenosis can be identified by their trajectories of pain and disability following surgery. Although most patients experienced important reductions in pain and disability, 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. These findings may inform appropriate expectation setting for patients and clinicians and highlight the need for better methods of treatment selection for patients with degenerative lumbar spinal stenosis.
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Affiliation(s)
- Jeffrey J. Hebert
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
- School of Psychology and Exercise Science, Murdoch University, Perth, Australia
- * E-mail:
| | - Edward Abraham
- Canada East Spine Centre, Saint John, New Brunswick, Canada
- Division of Orthopaedic Surgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- The Orthopedic Department, Hospital of Southwestern Jutland, Esbjerg, Denmark
| | - Erin Bigney
- Canada East Spine Centre, Saint John, New Brunswick, Canada
| | | | - Mariah Darling
- Canada East Spine Centre, Saint John, New Brunswick, Canada
| | - Hamilton Hall
- University of Toronto, Department of Surgery, Toronto, Canada
| | - Charles G. Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Y. Raja Rampersaud
- University of Toronto, University Health Network, Arthritis Program, Krembil Research Institute, Toronto, Ontario, Canada
| | - Kenneth C. Thomas
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Bradley Jacobs
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Division of Neurosurgery-Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Michael Johnson
- Department of Surgery, Section of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerome Paquet
- Division of Neurosurgery, Department of Surgery, CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Najmedden Attabib
- Canada East Spine Centre, Saint John, New Brunswick, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Peter Jarzem
- McGill Scoliosis and Spine Research Group, Montreal, Quebec, Canada
- Division of Orthopaedics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Eugene K. Wai
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Parham Rasoulinejad
- London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | - Neil Manson
- Canada East Spine Centre, Saint John, New Brunswick, Canada
- Division of Orthopaedic Surgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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Diagnostic performance of the nerve root sedimentation sign in lumbar spinal stenosis: a systematic review and meta-analysis. Neuroradiology 2019; 61:1111-1121. [DOI: 10.1007/s00234-019-02248-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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Anderson DB, Mobbs RJ, Eyles J, Meyer SE, Machado GC, Davis GA, Harris IA, Buchbinder R, Ferreira ML. Barriers to participation in a placebo-surgical trial for lumbar spinal stenosis. Heliyon 2019; 5:e01683. [PMID: 31193403 PMCID: PMC6529717 DOI: 10.1016/j.heliyon.2019.e01683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 03/22/2019] [Accepted: 05/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background Placebo-controlled trials are an important tool when assessing the efficacy of spinal surgical procedures. The most common spinal surgical procedure in older adults is decompression for lumbar spinal stenosis. Before conducting a placebo-surgical trial on decompression surgery, an investigation of patients' willingness to participate in a placebo-controlled trial of decompression surgery and barriers to participation were explored. Materials An online survey. Methods Descriptive analyses of demographic and clinical data, and participants' willingness to participate in a placebo-surgical trial. Logistic regression was used to examine potential predictors of willingness to participate. Two independent researchers performed a coded framework analysis of patients' barriers to participation. Results 68 patients were invited and 63 participants completed the survey (91.3% response, mean (SD) age 69.5 (10.9) years, 52% females), 71% suffered from moderate to very severe pain. Ten participants (15.9%) were willing to participate in a placebo-controlled trial. Being married was associated with decreased odds of participating (OR: 0.2; 95% CI, 0.05 to 0.8; P = 0.03), while the main barriers were a lack of information about the procedure, reassurance of a positive outcome with participation, and concerns about the risks and benefits of placebo surgery. Conclusions A minority of patients with lumbar spinal stenosis were willing to participate in a placebo-controlled trial of surgery. The identified barriers indicate that educating eligible patients about: the need for placebo-surgical trials, the personal risks and benefits of participation, and the importance and potential benefits of placebo trials to others, may be crucial to ensure adequate recruitment into the placebo-controlled surgical trial. Conclusions should be read cautiously however, given the small sample size present in this study.
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Affiliation(s)
- David B Anderson
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Ralph J Mobbs
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney; Neuro Spine Clinic, Randwick; University of New South Wales, Kensington, New South Wales, Australia
| | - Jillian Eyles
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Gustavo C Machado
- Sydney School of Public Health, Sydney Medical School, The University of Sydney; and Institute for Musculoskeletal Health, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gavin A Davis
- Neurosurgery Department, Cabrini and Austin Hospitals, Melbourne, Victoria, Australia
| | - Ian A Harris
- Ingham Institute of Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
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Chen L, H Ferreira P, R Beckenkamp P, L Ferreira M. Comparative efficacy and safety of surgical and invasive treatments for adults with degenerative lumbar spinal stenosis: protocol for a network meta-analysis and systematic review. BMJ Open 2019; 9:e024752. [PMID: 30948574 PMCID: PMC6500367 DOI: 10.1136/bmjopen-2018-024752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Surgical and invasive procedures are widely used in adults with degenerative lumbar spinal stenosis when conservative treatments fail. However, little is known about the comparative efficacy and safety of these interventions. To address this, we will perform a network meta-analysis (NMA) and systematic review to compare the efficacy and safety of surgical and invasive procedures for adults with degenerative lumbar spinal stenosis. METHODS AND ANALYSIS We will include randomised controlled trials assessing surgical and invasive treatments for adults with degenerative lumbar spinal stenosis. We will search AMED, CINAHL, EMBASE, the Cochrane Library and MEDLINE. Only English studies will be included and no restriction will be set for publication status. For efficacy, our primary outcome will be physical function. Secondary outcomes will include pain intensity, health-related quality of life, global impression of recovery, work absenteeism and mobility. For safety, our primary outcome will be all-cause mortality. Secondary outcomes will include adverse events (number of events or number of people with an event) and treatment withdrawal due to adverse effect. Two reviewers will independently select studies, extract data and assess the risk of bias (Revised Cochrane risk-of-bias tool for randomized trials) of included studies. The quality of the evidence will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation framework. Random-effects NMA will be performed to combine all the evidence under the frequentist framework and the ranking results will be presented through the surface under the cumulative ranking curve and mean rank. All analyses will be performed in Stata and R. ETHICS AND DISSEMINATION No ethical approval is required. The research will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018094180.
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Affiliation(s)
- Lingxiao Chen
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H Ferreira
- University of Sydney, Faculty of Health Sciences, Discipline of Physiotherapy, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- University of Sydney, Faculty of Health Sciences, Discipline of Physiotherapy, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Anderson DB, Ferreira ML, Harris IA, Davis GA, Stanford R, Beard D, Li Q, Jan S, Mobbs RJ, Maher CG, Yong R, Zammit T, Latimer J, Buchbinder R. SUcceSS, SUrgery for Spinal Stenosis: protocol of a randomised, placebo-controlled trial. BMJ Open 2019; 9:e024944. [PMID: 30765407 PMCID: PMC6398750 DOI: 10.1136/bmjopen-2018-024944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/12/2018] [Accepted: 12/12/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Central lumbar spinal stenosis (LSS) is a common cause of pain, reduced function and quality of life in older adults. Current management of LSS includes surgery to decompress the spinal canal and alleviate symptoms. However, evidence supporting surgical decompression derives from unblinded randomised trials with high cross-over rates or cohort studies showing modest benefits. This protocol describes the design of the SUrgery for Spinal Stenosis (SUcceSS) trial -the first randomised placebo-controlled trial of decompressive surgery for symptomatic LSS. METHODS AND ANALYSIS SUcceSS will be a prospectively registered, randomised placebo-controlled trial of decompressive spinal surgery. 160 eligible participants (80 participants/group) with symptomatic LSS will be randomised to either surgical spinal decompression or placebo surgical intervention. The placebo surgical intervention is identical to surgical decompression in all other ways with the exception of the removal of any bone or ligament. All participants and assessors will be blinded to treatment allocation. Outcomes will be assessed at baseline and at 3, 6, 12 and 24 months. The coprimary outcomes will be function measured with the Oswestry Disability Index and the proportion of participants who have meaningfully improved their walking capacity at 3 months postrandomisation. Secondary outcomes include back pain intensity, lower limb pain intensity, disability, quality of life, anxiety and depression, neurogenic claudication score, perceived recovery, treatment satisfaction, adverse events, reoperation rate and rehospitalisation rate. Those who decline to be randomised will be invited to participate in a parallel observational cohort. Data analysis will be blinded and by intention to treat. A trial-based cost-effectiveness analysis will determine the potential incremental cost per quality-adjusted life year gained. ETHICS AND DISSEMINATION Ethics approval has been granted by the NSW Health (reference:17/247/POWH/601) and the Monash University (reference: 12371) Human Research Ethics Committees. Dissemination of results will be via journal articles and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12617000884303; Pre-results.
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Affiliation(s)
- David B Anderson
- Insitute of Bone and Joint Research, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Insitute of Bone and Joint Research, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, University of New South Wales, St Leonards, New South Wales, Australia
| | - Gavin A Davis
- Department of Neurosurgery, Austin Health, Heidelberg, New South Wales, Australia
- Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia
| | - Ralph Stanford
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, NIHR Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ralph J Mobbs
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Christopher G Maher
- School of Public Health, The University of Sydney, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Renata Yong
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tara Zammit
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Latimer
- School of Public Health, The University of Sydney, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Volkov IV, Karabaev IS, Ptashnikov DA, Konovalov NA, Khlebov VV. [Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:55-61. [PMID: 30412157 DOI: 10.17116/neiro20188205155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postoperative pain accompanies up to 20% of interventions for degenerative spine diseases (DSDs). The epidemiologic data are contradictory; clinical and radiological diagnostics is often low efficient; capabilities of interventional diagnosis and treatment techniques are poorly understood. PURPOSE The study purpose was to investigate the structure of pain syndromes after surgery for DSDs of the lumbar spine, based on complex diagnostics, as well as to evaluate the capabilities of interventional treatment. MATERIAL AND METHODS We examined 310 patients with postoperative pain syndromes. Patients with obvious indications for repeated surgery were excluded from the analysis; the remaining patients underwent selective diagnostic blockades followed by interventional (puncture) treatment. A positive outcome was defined as a reduction in pain by 50% on the numerical rating scale (NRS-11), by 20% in the Oswestry index (ODI), and by 8 points in the sciatica bothersomeness index (SBI), with the effect lasting for 12 months. Predictive factors for the risk of pain syndromes were analyzed. RESULTS Out of 310 patients, 162 (52.6%) patients had no obvious indications for surgery. Radicular pain was detected in 56 (18.6%) of 310 patients; the positive treatment outcome was achieved in 38 (67.86%) of 56 patients. Facet pain was present in 29 (9.35%) patients; the positive treatment outcome was achieved in 23 (79.31%) patients. Discogenic pain was found in 12 (3.87%) patients; the positive treatment outcome was achieved in 5 (41.63%) patients. sacroiliac joint (SIJ) pain was present in 42 (13.55%) patients; the positive treatment outcome was achieved in 36 (85.71%) patients. Myofascial and competing pain was detected in 12 (3.87%) patients; the causes were not identified in 11 (3.55%) cases. The main risk factors were sagittal balance parameters. CONCLUSION Complex diagnostics revealed postoperative pain not associated with surgical causes in 52.6% of cases; the origin of pain was identified in 49.95% of cases. Interventional treatment was effective in 64.81% of cases; failed back surgery syndrome was diagnosed in 16.13% of patients.
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Affiliation(s)
- I V Volkov
- Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg, Russia; Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia
| | - I Sh Karabaev
- Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia
| | - D A Ptashnikov
- Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg, Russia; Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | | | - V V Khlebov
- Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia
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Tackling low back pain in Brazil: a wake-up call. Braz J Phys Ther 2018; 23:189-195. [PMID: 30337255 DOI: 10.1016/j.bjpt.2018.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Low back pain is the leading cause of years lived with disability in Brazil based upon Global Burden of Disease estimates. Since 1990, the number of years lived with disability has increased by 79.7%, and this number is expected to continue to rise due to population growth and ageing. Yet, similarly to other countries, little attention has been given to it in both the public and private health systems, arguably making it an overlooked epidemic in Brazil. There is evidence that Brazil has adopted unwarranted practices in the management of low back pain in a similar manner to what has been observed in high-income countries. To tackle the burden of low back pain in Brazil, we need highly coordinated efforts from government, the private sector, universities, health workers and civil society. OBJECTIVE This masterclass intends to provide an overview of the challenges faced by Brazil in relation to low back pain management and propose potential solutions that could potentially be implemented based on experiences reported in the literature.
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Poetscher AW, Gentil AF, Ferretti M, Lenza M. Interspinous process devices for treatment of degenerative lumbar spine stenosis: A systematic review and meta-analysis. PLoS One 2018; 13:e0199623. [PMID: 29979691 PMCID: PMC6034833 DOI: 10.1371/journal.pone.0199623] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/03/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Degenerative lumbar spinal stenosis is a condition related to aging in which structural changes cause narrowing of the central canal and intervertebral foramen. It is currently the leading cause for spinal surgery in patients over 65 years. Interspinous process devices (IPDs) were introduced as a less invasive surgical alternative, but questions regarding safety, efficacy, and cost-effectiveness are still unanswered. OBJECTIVES The aim of this study was to provide complete and reliable information regarding benefits and harms of IPDs when compared to conservative treatment or decompression surgery and suggest directions for forthcoming RCTs. METHODS We searched MEDLINE, EMBASE, Cochrane Library, Scopus, and LILACS for randomized and quasi-randomized trials, without language or period restrictions, comparing IPDs to conservative treatment or decompressive surgery in adults with symptomatic degenerative lumbar spine stenosis. Data extraction and analysis were conducted following the Cochrane Handbook. Primary outcomes were pain assessment, functional impairment, Zurich Claudication Questionnaire, and reoperation rates. Secondary outcomes were quality of life, complications, and cost-effectiveness. This systematic review was registered at Prospero (International prospective register of systematic reviews) under number 42015023604. RESULTS The search strategy resulted in 17 potentially eligible reports. At the end, nine reports were included and eight were excluded. Overall quality of evidence was low. One trial compared IPDs to conservative treatment: IPDs presented better pain, functional status, quality of life outcomes, and higher complication risk. Five trials compared IPDs to decompressive surgery: pain, functional status, and quality of life had similar outcomes. IPD implant presented a significantly higher risk of reoperation. We found low-quality evidence that IPDs resulted in similar outcomes when compared to standard decompression surgery. Primary and secondary outcomes were not measured in all studies and were often published in incomplete form. Subgroup analysis was not feasible. Difficulty in contacting authors may have prevented us of including data in quantitative analysis. CONCLUSIONS Patients submitted to IPD implants had significantly higher rates of reoperation, with lower cost-effectiveness. Future trials should improve in design quality and data reporting, with longer follow-up periods.
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Affiliation(s)
| | | | - Mario Ferretti
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mario Lenza
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Filippiadis DK, Marcia S, Ryan A, Beall DP, Masala S, Deschamps F, Kelekis A. New Implant-Based Technologies in the Spine. Cardiovasc Intervent Radiol 2018; 41:1463-1473. [DOI: 10.1007/s00270-018-1987-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
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