Lumbale Spinalkanalstenose

"Inside Disc Out" Discectomy for the Treatment of Discogenic Lumbar Spinal Canal Stenosis under the Intervertebral Foramen Endoscope

OBJECTIVE

Conventional posterior-approach decompression surgeries have a higher risk of nerve root injury and dura laceration. We explore the therapeutic strategy and effect of "inside disc out" discectomy under intervertebral foramen endoscope technique for discogenic lumbar spinal canal stenosis (DLSS) treatment.

METHODS

Twenty-nine patients with DLSS in the responsible segment were treated with "inside disc out" discectomy under intervertebral foramen endoscope technique between October 2017 to October 2019. Lower limb and back pain were recorded before operation, and visual analogue scale (VAS) score and Oswestry disability index (ODI) were recorded for lower limb and back pain at 1, 3, 6, and 12 months postoperatively. The postoperative effects were evaluated using the modified MacNab method for all the patients.

RESULTS

All 29 patients successfully completed the operation. The operation time was 75-120 min, with an average of 90 ± 17 min. Postoperative lumbar CT examinations of all the patients showed full decompression of the spinal cord with no residual pressure. The average follow-up time for all the patients was 13 ± 3.5 months (12-18 months). The VAS score for lower back and lower limb pain was 7.52 ± 1.25 before the operation, and 1.80 ± 0.63, 1.33 ± 0.88, 1.07 ± 0.89, and 0.81 ± 0.51 at 1, 3, 6, and 12 months after the surgery, respectively. The Oswestry dysfunction index was 59.43 ± 10.04 before surgery and 29.67 ± 10.35, 21.13 ± 9.32, 14.52 ± 5.98, and 9.84 ± 4.68 at 1, 3, 6, and 12 months after the surgery, respectively. The VAS score and ODI index of low back and lower limb pain at different time points after the surgery were significantly improved compared to those before the surgery (P < 0.01). The effect of the modified MacNab was excellent in 26 patients, good in two patients, and fair in one patient. The excellent and good rates were 91.4%. Among them, one patient had symptoms of hyperesthesia in the anterior aspect of the thigh and decreased quadriceps muscle strength after lumbar 4/5 segment endoscopic surgery. After symptomatic and conservative treatment, the symptoms disappeared 4 weeks postoperatively, and there were no other serious surgical complications.

CONCLUSIONS

Following the "inside disc out" discectomy under intervertebral foramen endoscope protocols, the risk of nerve injury can greatly be reduced, with good postoperative efficacy. Overall, the procedure is safe and feasible for DLSS treatment.

Outcome of Percutaneous Transforaminal Endoscopic Lumbar Decompression for Multisegment Lumbar Spinal Stenosis and the Effect on VAS Scores

Purpose

To investigate the efficacy of percutaneous transforaminal endoscopic lumbar decompression (PTED) in the treatment of multisegment lumbar spinal stenosis (LSS) and its effect on VAS scores.

Methods

126 patients with multisegment LSS admitted between August 2017 and August 2021 were selected and divided into the PTED group and the traditional open surgery group (TOS group) according to the different treatment methods. There were 70 cases in the PTED group, treated with PTED, and 56 cases in the TOS group, treated with traditional open surgery. The clinical outcomes, the preoperative and postoperative pain visual analogue scale (VAS), the Oswestry disability index (ODI), the SF-36 quality of life questionnaire scores, the perioperative indicators (operative time, days in hospital, intraoperative blood loss), the postoperative complications, and imaging data were compared between the two groups.

Results

After the operation, the excellent and good rate in the PTED group (91.43%) was significantly higher than that in the TOS group (75.00%) (P < 0.05). At each time after the operation, the VAS and ODI scores of the two groups were lower than those before the operation, and the VAS scores of the PTED group at 1 day and 3 months after operation were lower than those of the TOS group, and the ODI scores of the PTED group at 3 months after operation were lower than those of the TOS group (P < 0.05). 3 months after the operation, the SF-36 scores in both groups were higher than those before the operation, and those in the PTED group were higher than those in the TOS group (P < 0.05). The operation time and days in hospital in the PTED group were shorter than those in the TOS group, and the intraoperative dominant blood loss and recessive blood loss were less than those in the TOS group (P < 0.05). The total incidence of complications in the PTED group (15.71%) was significantly lower than that in the TOS group (32.14%) (P < 0.05).

Conclusion

Both PTED and traditional open surgery are effective in treating patients with multisegmental LSS, and both show positive postoperative changes in all indicators, but the former has more promising near -term results in improving lumbar spine pain, function and quality of life than the latter, and has the advantages of less trauma, less bleeding, and fewer complications.

Hospital frailty risk score predicts adverse events in spine surgery

PURPOSE

The Hospital Frailty Risk Score (HFRS) is derived from routinely collected data and validated as a geriatric risk stratification tool. This study aimed to evaluate the utility of the HFRS as a predictor for postoperative adverse events in spine surgery.

METHODS

In this retrospective analysis of 2042 patients undergoing spine surgery at a university spine center between 2011 and 2019, HFRS was calculated for each patient. Multivariable logistic regression models were used to assess the relationship between the HFRS and postoperative adverse events. Adverse events were compared between patients with high or low frailty risk.

RESULTS

Patients with intermediate or high frailty risk showed a higher rate of reoperation (19.7% vs. 12.2%, p < 0.01), surgical site infection (3.4% vs. 0.4%, p < 0.001), internal complications (4.1% vs. 1.1%, p < 0.01), Clavien-Dindo IV complications (8.8% vs. 3.4%, p < 0.001) and transfusion (10.9% vs. 1.5%, p < 0.001). Multivariable logistic regression analyses revealed a high HFRS as independent risk factor for reoperation [odds ratio (OR) = 1.1; 95% confidence interval (CI) 1.0-1.2], transfusion (OR = 1.3; 95% CI 1.2-1.4), internal complications (OR = 1.2; 95% CI 1.1-1.3), surgical site infections (OR = 1.3; 95% CI 1.2-1.5) and other complications (OR = 1.3; 95% CI 1.2-1.4).

CONCLUSION

The HFRS can predict adverse events and is an easy instrument, fed from routine hospital data. By identifying risk patients at an early stage, the individual patient risk could be minimized, which leads to less complications and lower costs.

LEVEL OF EVIDENCE

Level III - retrospective cohort study TRIAL REGISTRATION: The study was approved by the local ethics committee (20-1821-104) of the University of Regensburg in February 2020.

Endoscopic modified total laminoplasty for symptomatic lumbar spinal stenosis

Context/objective: At present, there is no consensus on the most effective surgical method for treating symptomatic lumbar spinal stenosis (LSS). Total laminectomy, which is frequently used at this time, destroys the posterior midline structure, causing many postoperative complications. We have designed a new surgical approach instead of total laminectomy. In this paper, we aimed to describe the surgical method of endoscopic modified total laminectomy for lumbar spinal stenosis as well as to explore its early efficacy.Participants: Patients with symptomatic LSS who underwent endoscopic modified total laminoplasty between August 2016 and August 2017 were eligible for our study.Outcome measures: Before surgery and one year after surgery, we measured lower limb pain and back pain by visual analog scale (VAS), disability via Oswestry Disability Index (ODI), and severity of back pain according to the Japanese Orthopedic Association Score for Back Pain (JOA), while any complications were also assessed.Results: Endoscopic modified total laminoplasty was performed on 22 LSS patients, including eight males and 14 females(mean age = 59.3 ± 9.6 years). We found statistically significant differences before and one year after surgery for VAS lower limb pain and back pain, ODI and JOA scores(P < 0.001). Complications included intraoperative dural tears(n = 1),and weak fusion between the lamina and the vertebral body (n = 1).Conclusion: Endoscopic modified total laminectomy is a promising surgical approach which reduces patient suffering and improves patient quality of life.

Gait analysis in the elderly patients with lumbar spinal stenosis

PURPOSE

This study aims to analyze the gait characteristics of the elderly patients with lumbar spinal stenosis by an intelligent device for energy expenditure and activity (IDEEA) to assist clinical work.

METHODS

A total of 98 subjects were included in this study from January 2017 to December 2018. A total of 49 elderly outpatients with symptomatic lumbar spinal stenosis in unilateral lower extremity were included as the experimental group, and another 49 healthy subjects matched with gender, age, and body mass index (BMI) were analyzed as the control group. The gait data of the subjects (including single support, double support, SLS/DLS, swing duration, step duration, cycle duration, pulling accel, swing power, ground impact, foot fall, foot off, push off, speed, cadence, step length, and stride length) were collected to compare between the experience group and control group, the affected leg and the healthy leg in experimental group.

RESULTS

The results of this study presented that small intermittent claudication occurred in all patients. The time of single support was significantly increased (p < 0.05). Double support, step duration, and pulling accel were increased (p < 0.05), and the Push off, speed, step length, and Stride length were decreased (p < 0.05) in the experimental group compared with the control group.

CONCLUSION

Small intermittent claudication was the basic gait composition of the elderly patients with lumbar spinal stenosis that can reflect the abnormal gait characteristics by IDEEA.

Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function

Background

Management of lumbar canal stenosis should be started with conservative treatment and preferably with a multimodal approach, but in cases of severe pain with extensive neurogenic claudication symptoms, surgical intervention is indicated. This retrospective study targets to evaluate the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function.

Methods

Data of 184 patients of the study groups were divided into group A (data from patients who underwent laminectomy and foraminotomy only) and group B (data from patients who underwent laminectomy and foraminotomy with spinal fixation). Preoperative, operative, postoperative (PO), and follow-up data were extracted and analyzed from files of patients fulfilling the inclusion criteria.

Results

Primary outcome was at least 50% improvement of pain severity regarding numeric rating scale (NRS) and Oswestry disability index (ODI) score at 6-months PO compared to preoperative scores. Operative time was significantly longer in group B than group A. Immediate PO data regarding PO analgesic requirement, amount of wound drainage, and PO hospital stay showed non-significant difference between both groups. There was a statically significant improvement of EHL muscle strength regarding Odom’s scoring in group B in which the success rate for pain improvement was 81.8% and for disability was 66.8%. There were insignificant differences in patient’s satisfaction to surgery with variable ages, a significant outcome in females and in patients with fewer levels of affection of both groups.

Conclusion

The present study reported the efficacy and safety of the laminectomy, foraminotomy, discectomy, and medial facetectomy with spinal fixation using trans-pedicular screws for management of patients with spinal canal stenosis.