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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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Rangwalla K, Filley A, El Naga A, Gendelberg D, Baldwin A, Maziad A, Arora A, Wague A, O'Donnell J, Chryssikos T, Kasir R, Shah J, Theologis A, Tan L, Mummaneni P, Alamin T, Berven SH. Degenerative lumbar spondylolisthesis: review of current classifications and proposal of a novel classification system. 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; 33:1762-1772. [PMID: 37543967 DOI: 10.1007/s00586-023-07818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/27/2023] [Accepted: 06/04/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To review existing classification systems for degenerative spondylolisthesis (DS), propose a novel classification designed to better address clinically relevant radiographic and clinical features of disease, and determine the inter- and intraobserver reliability of this new system for classifying DS. METHODS The proposed classification system includes four components: 1) segmental dynamic instability, 2) location of spinal stenosis, 3) sagittal alignment, and 4) primary clinical presentation. To establish the reliability of this system, 12 observers graded 10 premarked test cases twice each. Kappa values were calculated to assess the inter- and intraobserver reliability for each of the four components separately. RESULTS Interobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation was 0.94, 0.80, 0.87, and 1.00, respectively. Intraobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation were 0.91, 0.88, 0.87, and 0.97, respectively. CONCLUSION The UCSF DS classification system provides a novel framework for assessing DS based on radiographic and clinical parameters with established implications for surgical treatment. The almost perfect interobserver and intraobserver reliability observed for all components of this system demonstrates that it is simple and easy to use. In clinical practice, this classification may allow subclassification of similar patients into groups that may benefit from distinct treatment strategies, leading to the development of algorithms to help guide selection of an optimal surgical approach. Future work will focus on the clinical validation of this system, with the goal of providing for more evidence-based, standardized approaches to treatment and improved outcomes for patients with DS.
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Affiliation(s)
- Khuzaima Rangwalla
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anna Filley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ashraf El Naga
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - David Gendelberg
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Avionna Baldwin
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ali Maziad
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ayush Arora
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Aboubacar Wague
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer O'Donnell
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Rafid Kasir
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jay Shah
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alekos Theologis
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lee Tan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Todd Alamin
- Department of Orthopaedic Spine Surgery, Stanford University, Redwood City, California, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Mannion AF, Mariaux F, Werth PM, Pearson AM, Lurie JD, Fekete TF, Kohler M, Haschtmann D, Kleinstueck FS, Jeszenszky D, Loibl M, Otten P, Norberg M, Porchet F. Evaluation of "appropriate use criteria" for surgical decision-making in lumbar degenerative spondylolisthesis. A controlled, multicentre, prospective observational study. 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; 33:1773-1785. [PMID: 38416192 DOI: 10.1007/s00586-024-08157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Selecting patients with lumbar degenerative spondylolisthesis (LDS) for surgery is difficult. Appropriate use criteria (AUC) have been developed to clarify the indications for LDS surgery but have not been evaluated in controlled studies. METHODS This prospective, controlled, multicentre study involved 908 patients (561 surgical and 347 non-surgical controls; 69.5 ± 9.7y; 69% female), treated as per normal clinical practice. Their appropriateness for surgery was afterwards determined using the AUC. They completed the Core Outcome Measures Index (COMI) at baseline and 12 months' follow-up. Multiple regression adjusting for confounders evaluated the influence of appropriateness designation and treatment received on the 12-month COMI and achievement of MCIC (≥ 2.2-point-reduction). RESULTS As per convention, appropriate (A) and uncertain (U) groups were combined for comparison with the inappropriate (I) group. For the adjusted 12-month COMI, the benefit of surgery relative to non-surgical care was not significantly greater for the A/U than the I group (p = 0.189). There was, however, a greater treatment effect of surgery for those with higher baseline COMI (p = 0.035). The groups' adjusted probabilities of achieving MCIC were: 83% (A/U, receiving surgery), 71% (I, receiving surgery), 50% (A/U, receiving non-surgical care), and 32% (I, receiving non-surgical care). CONCLUSIONS A/U patients receiving surgery had the highest chances of achieving MCIC, but the AUC were not able to identify which patients had a greater treatment effect of surgery relative to non-surgical care. The identification of other characteristics that predict a greater treatment effect of surgery, in addition to baseline COMI, is required to improve decision-making.
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Affiliation(s)
- Anne F Mannion
- Spine Centre Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Francine Mariaux
- Spine Centre Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Paul M Werth
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Jon D Lurie
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | | | | | | - Markus Loibl
- Spine Centre, Schulthess Klinik, Zurich, Switzerland
| | | | - Michael Norberg
- Centre Médical de Lavey-les-Bains, Lavey-les-Bains, Switzerland
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van Grafhorst JMP, Dijkerman ML, Peul WC, Vleggeert-Lankamp CLA. Symptomatic lumbar stenosis due to low-grade degenerative spondylolisthesis can effectively be treated with mere decompression. Acta Neurochir (Wien) 2023; 165:2145-2151. [PMID: 37410183 PMCID: PMC10409655 DOI: 10.1007/s00701-023-05667-7] [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: 04/18/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine. We aim to establish the incidence of degenerative spondylolisthesis in spinal stenosis surgical candidates and to evaluate the incidence of failure of decompressive surgery without concomitant spondylodesis as initial treatment. METHODS Medical files of all operated patients for spinal stenosis between 2007 and 2013 were evaluated. Demographic characteristics, pre-operative radiological characteristics (level of stenosis, presence, and grade of spondylolisthesis), surgical technique, incidence, and indication for reoperation were summarised, as well as the type of reoperation. Patient satisfaction was classified as 'satisfied' or 'unsatisfied' after initial and secondary surgery. The follow-up was 6 to 12 years. RESULTS Nine hundred thirty-four patients were included, and 253 (27%) had a spondylolisthesis. Seventeen percent of the spondylolisthesis patients receiving decompression were reoperated versus 12% of the stenosis patients (p=.059). Reoperation in the spondylolisthesis group concerned instrumented spondylodesis in 38 versus 10% in the stenosis group. The satisfaction percentage was comparable in the stenosis and the spondylolisthesis group two months after surgery (80 vs. 74%). Of the 253 spondylolisthesis patients, 1% initially received instrumented spondylodesis and 6% in a second operation. CONCLUSION Lumbar stenosis with and without (low-grade) degenerative spondylolisthesis can usually effectively be treated with mere decompression. Instrumented surgery in a second surgical procedure does not lead to less satisfaction with surgical outcomes.
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Affiliation(s)
| | - Manon L Dijkerman
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
| | - Carmen L A Vleggeert-Lankamp
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
- Department of Neurosurgery, Spaarne Gasthuis, Haarlem/Hoofddorp, Netherlands
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Kaiser R, Kantorová L, Langaufová A, Slezáková S, Tučková D, Klugar M, Klézl Z, Barsa P, Cienciala J, Hajdúk R, Hrabálek L, Kučera R, Netuka D, Prýmek M, Repko M, Smrčka M, Štulík J. Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry 2023; 94:657-666. [PMID: 36849239 PMCID: PMC10359551 DOI: 10.1136/jnnp-2022-330158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). RESULTS We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). CONCLUSIONS Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO REGISTRATION NUMBER CRD42022308267.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Lucia Kantorová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Alena Langaufová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Simona Slezáková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Dagmar Tučková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Zdeněk Klézl
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Pavel Barsa
- Department of Neurosurgery, Regional Hospital Liberec, Liberec, Czech Republic
| | - Jan Cienciala
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Richard Hajdúk
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Lumír Hrabálek
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- University Hospital Olomouc, Olomouc, Czech Republic
| | - Roman Kučera
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Martin Prýmek
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Repko
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Smrčka
- University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Štulík
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
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Li Y, Cheng X, Chen B. Comparison of 270-degree percutaneous transforaminal endoscopic decompression under local anesthesia and minimally invasive transforaminal lumbar interbody fusion in the treatment of geriatric lateral recess stenosis associated with degenerative lumbar spondylolisthesis. J Orthop Surg Res 2023; 18:183. [PMID: 36895012 PMCID: PMC9996849 DOI: 10.1186/s13018-023-03676-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE Various lumbar decompression techniques have been used for the treatment of degenerative lumbar spondylolisthesis (DLS). Few studies have compared the clinical efficacy of percutaneous transforaminal endoscopic decompression (PTED) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lateral recess stenosis associated with DLS (LRS-DLS) in geriatric patients. The objective of the study was to compare the safety and short-term clinical efficacy of 270-degree PTED under local anesthesia and MIS-TLIF in the treatment of LRS-DLS in Chinese geriatric patients over 60 years old. MATERIALS AND METHODS From January 2017 to August 2019, the data of 90 consecutive geriatric patients with single-level L4-5 LRS-DLS were retrospectively reviewed, including those in the PTED group (n = 44) and MIS-TLIF group (n = 46). The patients were followed up for at least 1 year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. X-ray examinations were performed 1 year after surgery to assess the progression of spondylolisthesis in the PTED group and bone fusion in the MIS-TLIF group. RESULTS The mean patient ages in the PTED and MIS-TLIF groups were 70.3 years and 68.6 years, respectively. Both the PTED and MIS-TLIF groups demonstrated significant improvements in the VAS score for leg pain and ODI score, and no significant differences were found between the groups at any time point (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the PTED group was similar to that in the MIS-TLIF group (90.9% vs. 91.3%, P > 0.05), PTED was advantageous in terms of the operative time, estimated blood loss, incision length, drainage time, drainage volume, length of hospital stay, and complications. CONCLUSIONS Both PTED and MIS-TLIF led to favorable outcomes in geriatric patients with LRS-DLS. In addition, PTED caused less severe trauma and fewer complications. In terms of perioperative quality-of-life and clinical outcomes, PTED could supplement MIS-TLIF in geriatric patients with LRS-DLS.
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Affiliation(s)
- Yubo Li
- Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China
| | - Xiaokang Cheng
- Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China.,Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Bin Chen
- Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China.
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Ricciardi L, Piazza A, Capobianco M, Della Pepa GM, Miscusi M, Raco A, Scerrati A, Somma T, Lofrese G, Sturiale CL. Lumbar interbody fusion using oblique (OLIF) and lateral (LLIF) approaches for degenerative spine disorders: a meta-analysis of the comparative studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1-7. [PMID: 34825987 DOI: 10.1007/s00590-021-03172-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Historically, posterior approaches to the lumbar spine have allowed surgeons to manage degenerative conditions affecting the lumbar spine. However, spinal muscles injury, post-surgical vertebral instability, cerebrospinal fluid (CSF) leakage, and failed back surgery syndrome (FBSS) represent severe complications that may occur after these surgeries. Lumbar interbody fusion using anterior (ALIF), oblique (OLIF), or lateral (LLIF) approaches may represent valuable surgical alternatives, in case fusion is indicated on single or multiple levels. METHODS The present study is a systematic review, conducted according to the PRISMA statement, of comparative studies on OLIF, and LLIF for degenerative spine disorders, and a meta-analysis of their clinical-radiological outcomes and complications. RESULTS After screening 1472 papers on PubMed, Scopus, and Cochrane Library, only 3 papers were included in the present study. 318 patients were included for data meta-analysis, 128 in OLIF group, and 190 in LLIF group. There were no significative differences in terms of surgical (intraoperative blood loss and surgical duration) and clinical (VAS-back, VAS-leg, and ODI scores) outcomes, or fusion rates at last follow-up (> 2 years). Significantly higher rates of abdominal complications, system failure, and vascular injuries were recorded in the OLIF group. Conversely, postoperative neurological symptoms and psoas weakness were significatively more common in LLIF group. CONCLUSIONS The meta-analysis suggests that OLIF and LLIF are both effective for lumbar degenerative disorders, although each of them presents specific complications and this should represent a relevant element in the surgical planning.
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Affiliation(s)
- Luca Ricciardi
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Amedeo Piazza
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Mattia Capobianco
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | | | - Massimo Miscusi
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Antonino Raco
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Alba Scerrati
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giorgio Lofrese
- Division of Neurosurgery, Ospedale Bufalini, Cesena, Italy. .,Dipartimento Neuroscienze, Unità Operativa Complessa di Neurochirurgia, Ospedale "M.Bufalini", Viale Ghirotti 286, 47521, Cesena, Italy.
| | - Carmelo Lucio Sturiale
- Operative Unit of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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8
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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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9
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Contraindications and Complications of Full Endoscopic Lumbar Decompression for Lumbar Spinal Stenosis: A Systematic Review. World Neurosurg 2022; 168:398-410. [DOI: 10.1016/j.wneu.2022.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
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10
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Morse KW, Steinhaus M, Bovonratwet P, Kazarian G, Gang CH, Vaishnav AS, Lafage V, Lafage R, Iyer S, Qureshi S. Current treatment and decision-making factors leading to fusion vs decompression for one-level degenerative spondylolisthesis: survey results from members of the Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery. Spine J 2022; 22:1778-1787. [PMID: 35878759 DOI: 10.1016/j.spinee.2022.07.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Degenerative spondylolisthesis (DS) is one of the most common pathologies spine surgeons treat. While a number of potential factors have been identified, there is no current consensus on which variables most impact the decision to fuse vs. decompress alone in this population. PURPOSE The purpose of this study was to describe current DS treatment practices and identify both the radiographic and clinical factors leading to the decision to fuse segments for one level DS. STUDY DESIGN/SETTING Descriptive cross-sectional survey. PATIENT SAMPLE Surveys were administered to members of Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery. OUTCOME MEASURES Surgeon demographics and treatment practices were reported. Radiographic and clinical parameters were ranked by each surgeon with regards to their importance. METHODS The primary analysis was limited to completed surveys. Baseline characteristics were summarized. Clinical and radiographic parameters were ranked and compared. Ranking of each clinical and radiographic parameters was reported using best and worst rank, mean rank position, and percentiles. The most important, top 3 most important, and top 5 most important parameters were ordered given each parameter's ranking frequency. RESULTS 381 surveys were returned completed. With regards to fusion vs. decompression, 19.9% fuse all cases, 39.1% fuse > 75%, 17.8% fuse 50%-75%, and 23.2% fuse <25%. The most common decompressive technique was a partial laminotomy (51.4%), followed by full laminectomy (28.9%). 82.2% of respondents instrument all fusion cases. Instability (93.2%), spondylolisthesis grade (59.8%), and laterolisthesis (37.3%) were the most common radiographic factors impacting the decision to fuse. With regards to the clinical factors leading to fusion, mechanical low back pain (83.2%), activity level (58.3%), and neurogenic claudication (42.8%) were the top 3 clinical parameters. CONCLUSIONS There is little consensus on the treatment of DS, with society members showing substantial variation in treatment patterns with the majority utilizing fusion for treatment. The most common radiographic parameters impacting treatment are instability, spondylolisthesis grade, and laterolisthesis while mechanical low back pain, activity level, and neurogenic claudication are the most common clinical parameters.
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Affiliation(s)
- Kyle W Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Michael Steinhaus
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA; Intermountain Spine Institute, Murray, UT, USA
| | - Patawut Bovonratwet
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Gregory Kazarian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Catherine Himo Gang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avani S Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA; Department of Orthopaedic Surgery, Boston University, Boston, MA, USA
| | - Virginie Lafage
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA; Department of Spine Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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11
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Wei FL, Zhou CP, Gao QY, Du MR, Gao HR, Zhu KL, Li T, Qian JX, Yan XD. Decompression alone or decompression and fusion in degenerative lumbar spondylolisthesis. EClinicalMedicine 2022; 51:101559. [PMID: 35865739 PMCID: PMC9294267 DOI: 10.1016/j.eclinm.2022.101559] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clinically, there are substantive practice variations in surgical management of degenerative lumbar spondylolisthesis. We aimed at evaluating whether decompression alone outcomes for patients with degenerative lumbar spondylolisthesis are comparable to those of decompression with fusion. METHODS In this meta-analysis, the Embase, PubMed, and Cochrane Library databases were searched from inception to February 16th, 2022. Randomised controlled trials (RCTs) and cohort studies comparing decompression alone with decompression and fusion for patients with degenerative lumbar spondylolisthesis were included in this study. There were no language limitations. Odds ratio (OR), mean difference (MD) and 95% confidence interval (CI) were used to report results in the random-effects model. Main outcomes included Oswestry disability index (ODI), pain, clinical satisfaction, complication and reoperation rates. The study protocol was published in PROSPERO (CRD42022310645). FINDINGS Thirty-three studies (6 RCTs and 27 cohort studies) involving 94 953 participants were included. Differences in post-operative ODI between decompression alone and decompression with fusion were not significant. A small difference for back (MD, 0.13; [95% CI, 0.08 to 0.18]; I 2:0.00%) and leg pain (MD, 0.30; [95% CI, 0.09 to 0.51]; I 2:48.35%) was observed on the 3rd post-operative month. The results did not reveal significant differences in leg pain and back pain between decompression alone and fusion groups on the 6th, 12th, and 24th post-operative months. Difference in clinical satisfaction between decompression alone and decompression with fusion were not significant from RCTs (OR, 0.26; [95% CI, 0.03 to 1.92]; I 2:83.27%). Complications (OR, 1.54; [95% CI, 1.16 to 2.05]; I 2:48.88%), operation time (MD, 83.39; [95% CI, 55.93 to 110.85]; I 2:98.75%), intra-operative blood loss (MD, 264.58; [95% CI, 174.99 to 354.16]; I 2:95.61%) and length of hospital stay (MD, 2.85; [95% CI, 1.60 to 4.10]; I 2:99.49%) were higher with fusion. INTERPRETATION Clinical effectiveness of decompression alone was comparable to that of decompression with fusion for degenerative lumbar spondylolisthesis. Decompression alone is recommended for patients with degenerative lumbar spondylolisthesis. FUNDING This work was supported by grants from the National Natural Science Foundation of China (No. 81871818), Tangdu Hospital Seed Talent Program (Fei-Long Wei), Natural Science Basic Research Plan in Shaanxi Province of China (No.2019JM-265) and Social Talent Fund of Tangdu Hospital (No.2021SHRC034).
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Quan-You Gao
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, 710032, Xi'an, China
- Corresponding author at: School of Basic Medicine, Fourth Military Medical University, No. 169 Changle Rd, Xi'an 710032, China.
| | - Ji-Xian Qian
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
- Corresponding author at: Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, China.
| | - Xiao-Dong Yan
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
- Corresponding author at: Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, China.
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12
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Mimura T, Tsutsumimoto T, Yui M, Misawa H. Does fusion status following posterolateral lumbar fusion in the treatment for stable lumbar degenerative spondylolisthesis affect the long-term surgical outcomes? A propensity score-weighted analysis of consecutive patients. J Orthop Sci 2022; 27:990-994. [PMID: 34364757 DOI: 10.1016/j.jos.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/12/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The surgical strategy of lumbar degenerative spondylolisthesis (LDS) is controversial, especially regarding whether or not fusion should be used. Although some reports have indicated that decompression combined with fusion may be better than decompression alone in the treatment of LDS, the effect of fusion status after uninstrumented posterolateral lumbar fusion (PLF) on the outcomes of patients with stable LDS remains unknown. This study aimed to evaluate the surgical outcomes of uninstrumented PLF for stable LDS and clarify whether radiographic fusion status could affect surgical outcomes. METHODS A total of 93 consecutive patients who had undergone single-level uninstrumented PLF for Meyerding grade I LDS without preoperative dynamic instability with a minimum follow-up period of 5 years were retrospectively studied. Patients were divided into two groups: nonunion (52 patients) and union (41 patients). The primary outcomes were the 5-year percent recovery of postoperative Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI), Visual analog scale (VAS) scores, and reoperation rate. The outcome scores were compared between the groups using the inverse probability weighting method using propensity scores. RESULTS The union and nonunion groups had comparable weighted means of the 5-year postoperative clinical score for the percent recovery of the JOA score (70.2% vs. 71.1%, P = 0.86), ODI (14.5 vs.14.6, P = 0.98), VAS of low back pain (20.3 vs. 18.7 mm, P = 0.72), and VAS of leg pain (24.0 vs. 19.4 mm, P = 0.43). The reoperation rate was 2.4% (one case of adjacent segment pathology) in the union group and 0% in the nonunion group (P = 0.44). CONCLUSION The fusion status following uninstrumented PLF had no significant effect on the 5-year postoperative clinical outcomes and reoperation rate in patients with Meyerding grade I LDS without dynamic instability.
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Affiliation(s)
- Tetsuhiko Mimura
- Spine Center, Yodakubo Hospital, 2857 Furumachi, Nagawa, Nagano, 386-0603, Japan
| | | | - Mutsuki Yui
- Spine Center, Yodakubo Hospital, 2857 Furumachi, Nagawa, Nagano, 386-0603, Japan
| | - Hiromichi Misawa
- Spine Center, Yodakubo Hospital, 2857 Furumachi, Nagawa, Nagano, 386-0603, Japan
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13
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Louie PK. In Spinal Stenosis with Degenerative Spondylolisthesis, Decompression Surgery Alone Was Noninferior to Decompression Surgery with Instrumented Fusion for Reducing Impairment at 2 Years. J Bone Joint Surg Am 2022; 104:943. [PMID: 35383632 DOI: 10.2106/jbjs.22.00307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Philip K Louie
- Department of Neurosurgery, Medical Director of Research and Academics, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington
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14
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Mid-term changes in spinopelvic sagittal alignment in lumbar spinal stenosis with coexisting degenerative spondylolisthesis or scoliosis after minimally invasive lumbar decompression surgery: minimum five-year follow-up. Spine J 2022; 22:819-826. [PMID: 34813957 DOI: 10.1016/j.spinee.2021.11.012] [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: 05/13/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Recently, the number of patients with lumbar spinal stenosis (LSS) who present with a coexisting spinal deformity such as degenerative spondylolisthesis (DS) and scoliosis (DLS) has been increasing. Lumbar decompression without fusion can lead to a reactive improvement in the lumbar and sagittal spinopelvic alignment, even if a sagittal imbalance exists preoperatively. However, the mid- to long-term impact of the coexistence of DS and DLS on the change in sagittal spinopelvic alignment and clinical outcomes after decompression surgery remains unknown. PURPOSE This study aimed to investigate whether the coexistence of DS or DLS in patients with LSS is associated with differences in radiological and clinical outcomes after minimally invasive lumbar decompression surgery. STUDY DESIGN/SETTING A retrospective analysis of prospectively collected data. PATIENT SAMPLE A total of 169 patients who underwent minimally invasive lumbar decompression surgery and follow-up >5 years postoperatively. OUTCOME MEASURES Self-report measures: Low back pain (LBP) and/or leg pain and/or leg numbness visual analog scale (VAS) scores and the Japanese Orthopedic Association scores. PHYSIOLOGIC MEASURES Standing sagittal spinopelvic alignment. METHODS In total, 81 patients with LSS, 50 patients with LSS and DS (≥3 mm anterior slippage), and 38 patients with LSS and DLS (≥15° coronal Cobb angle) were included in the current study. Clinical and radiological outcome results before surgery and at 2 and 5 years after surgery were compared among the groups. RESULTS In patients with LSS with coexisting DS, the clinical outcomes at 2, and 5 years after surgery were similar to those of patients with only LSS. In patients with LSS with coexisting DLS, the VAS LBP and leg pain at 2 years after surgery was significantly higher (34.7 vs. 27.8, p=0.014; 27.8 vs. 14.7, p=0.028) and the achievement rate of the minimal clinically important difference in VAS LBP and leg pain was significantly lower than that of the LSS group (36.1% vs. 54.2%, p=0.036; 58.3% vs. 69.9%, p=0.10). The clinical outcomes except VAS leg numbness at 5 years after surgery were similar to those of patients with only LSS. The reoperation rate of the DS group was significantly lower than that of the LSS group (4.0% vs. 14.8%; p=0.01); however, the reoperation rate of the DLS group was comparable to that of the LSS group (15.8% vs. 14.8%; p=0.493). Lumbar lordosis (LL), sacral slope, pelvic tilt, and pelvic incidence-LL had significantly improved and been maintained for 5 years after the surgery in both the DS and the DLS groups. The sagittal vertical axis had improved at two-year follow-up; however, no significant difference was observed at the 5-year follow-up in both the DS, and the DLS groups. CONCLUSIONS Mid-term clinical outcomes in patients with LSS with and without deformity were comparable. Lumbar decompression without fusion can result in a reactive improvement in the lumbar and sagittal spinopelvic alignment, even with coexisting DS or DLS. Minimally invasive surgery could be considered for most patients with LSS.
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15
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Pazarlis K, Frost A, Försth P. Lumbar Spinal Stenosis with Degenerative Spondylolisthesis Treated with Decompression Alone. A Cohort of 346 Patients at a Large Spine Unit. Clinical Outcome, Complications and Subsequent Surgery. Spine (Phila Pa 1976) 2022; 47:470-475. [PMID: 35213524 DOI: 10.1097/brs.0000000000004291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVE To study the clinical outcome, complications and subsequent surgery rate of DA for lumbar spinal stenosis (LSS) with DS. SUMMARY OF BACKGROUND DATA There is still no consensus regarding the treatment approach for LSS with DS. METHODS We performed a retrospectively designed cohort study on prospectively collected data from a single high productive spine surgical center. Results from the Swedish Spine Registry and a local register for complications were used for the analyses. Patients with LSS and DS (>3 mm) who underwent DA during January 2012 to August 2017 were included. Patient reported outcome measures at baseline and 2 years after surgery were analyzed. Complications within 30 days of surgery and all subsequent surgery in the lumbar spine were registered. RESULTS We identified and included 346 patients with completed 2-year follow-up registration. At 2-year follow-up there was a significant improvement in all outcome measures. The global assessment success rate for back and leg pain was 68.3% and 67.6% respectively. Forty-one patients had at least 1 intra- or postoperative complication (11.9%). Nine patients (2.6%), underwent subsequent surgery within 2 years of the primary surgery whereof 2 underwent fusion. During the whole period of data collection, that is, as of June 2020, 28 patients had undergone subsequent surgery (8.1%) whereas 8 of them had had 2 surgeries. Fifteen patients underwent fusion. CONCLUSION DA provides good clinical outcome at 2-year follow-up in patients with LSS and DS with low rate of intra- and postoperative complications and subsequent surgery. Our data supports the evidence that DA is effective and safe for LSS with DS.Level of Evidence: 3.
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Affiliation(s)
- Konstantinos Pazarlis
- Stockholm Spine Center, Upplands Väsby, Sweden
- Department of Surgical Sciences, Division of Orthopaedics, Uppsala University, Uppsala, Sweden
| | | | - Peter Försth
- Department of Surgical Sciences, Division of Orthopaedics, Uppsala University, Uppsala, Sweden
- Spine Surgery Unit, Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
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16
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Chen M, Jia P, Feng F, Tang H. A novel minimally invasive technique of inter-spinal distraction fusion surgery for single-level lumbar spinal stenosis in octogenarians: a retrospective cohort study. J Orthop Surg Res 2022; 17:100. [PMID: 35172868 PMCID: PMC8848666 DOI: 10.1186/s13018-022-03004-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/09/2022] [Indexed: 11/14/2022] Open
Abstract
Objective Surgical treatment of lumbar spinal stenosis (LSS) in octogenarians (patients aged ≥ 80 years) has been a challenge. Inter-spinal distraction fusion (ISDF)—a minimally invasive procedure—was used for treating LSS in octogenarians. This retrospective cohort study aimed to investigate the clinical efficacy and safety of a minimally invasive ISDF technique for LSS in octogenarian patients. Methods From April 2015 to April 2019, octogenarian patients who underwent lumbar fusion surgery due to single-segment LSS were included. The patients were grouped into the ISDF group and posterior lumbar interbody fusion (PLIF) group based on the type of surgery. Clinical outcomes were evaluated using scores of the visual analog pain scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedics Association (JOA) scale. Radiographs were assessed for the intervertebral angle (IA), lumbar lordosis (LL), and posterior disc height (PDH). After 2 years postoperatively, all patients underwent computed tomography (CT) to evaluate the fusion condition. Perioperative data and related complications were recorded. Results Sixty-two patients were included (mean age: 82.22 ± 1.95 years). The ISDF and the PLIF groups had 34 and 28 patients, respectively. The average follow-up time was 2.1 ± 0.25 years. There was no significant difference in VAS, ODI, JOA, and PDH scores between both groups preoperatively and at each postoperative time-point. The IA and LL showed significant differences between both groups after surgery (p < 0.05). The postoperative IA in the ISDF group were significantly lower than the preoperative values, while that in the PLIF group were markedly increased. The PLIF group had an increased LL compared with that preoperatively (p < 0.05), while the LL in the ISDF did not significantly change. The operative time, blood loss, hospital stay time, and the rate of perioperative complications of the ISDF group were significantly lower than those of the PLIF group (p < 0.05). There was no significant difference in the fusion rates between both groups. Conclusion ISDF surgery is a viable method for octogenarian patients with LSS that provides a similar clinical efficacy, shorter operative time, less blood loss, shorter hospital stay time, and fewer complications, compared to the PLIF surgery.
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Affiliation(s)
- Mengmeng Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, No. 95, Yong An Road, Xi Cheng District, Beijing, 100050, People's Republic of China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, No. 95, Yong An Road, Xi Cheng District, Beijing, 100050, People's Republic of China
| | - Fei Feng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, No. 95, Yong An Road, Xi Cheng District, Beijing, 100050, People's Republic of China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, No. 95, Yong An Road, Xi Cheng District, Beijing, 100050, People's Republic of China.
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Koduri S, Saadeh YS, Strong MJ, Muhlestein WE, Oppenlander ME. Commentary: Transforaminal Lumbar Interbody Fusion With Double Cages: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e108-e109. [PMID: 35007271 DOI: 10.1227/ons.0000000000000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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18
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Han X, Chen X, Li K, Li Z, Li S. Finite analysis of stability between modified articular fusion technique, posterior lumbar interbody fusion and posteriorlateral lumbar fusion. BMC Musculoskelet Disord 2021; 22:1015. [PMID: 34863121 PMCID: PMC8645152 DOI: 10.1186/s12891-021-04899-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background It is not clear whether modified facet fusion (MFF) is biomechanically different from traditional fusion techniques such as posterior lateral lumbar fusion (PLF) and posterior lumbar interbody fusion (PLIF). Methods In this study, a healthy adult Chinese male volunteer was selected to perform 3D reconstruction of CT image data and simulate the successful fusion of L4–5 MFF, PLF and PLIF, respectively. The motion range of L4–5 segments of the model was simulated under 6 working conditions, including forward flexion, extension, lateral flexion and rotation under normal physiological conditions, and the stability of the three fusion procedures in the pathological segments of the lumbar spine was compared. Results There was no difference in range of motion between MFF model and PLF or PLIF model (P < 0.05). Also, the stiffness of the PLFand the MFF model were comparable (P > 0.05), but were smaller than the PLIF model (P < 0.05). Conclusions MFF provides reliable stability at the lumbar fixation fusion level and does not differ significantly from PLF and PLIF in terms of range of motion.
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Affiliation(s)
- Xiao Han
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Xin Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Kuan Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China.
| | - Shugang Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China.
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Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T, Rekeland F, Franssen E, Weber C, Brisby H, Grundnes O, Algaard KRH, Böker T, Banitalebi H, Indrekvam K, Hellum C. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. N Engl J Med 2021; 385:526-538. [PMID: 34347953 DOI: 10.1056/nejmoa2100990] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In patients with lumbar spinal stenosis and degenerative spondylolisthesis, it is uncertain whether decompression surgery alone is noninferior to decompression with instrumented fusion. METHODS We conducted an open-label, multicenter, noninferiority trial involving patients with symptomatic lumbar stenosis that had not responded to conservative management and who had single-level spondylolisthesis of 3 mm or more. Patients were randomly assigned in a 1:1 ratio to undergo decompression surgery (decompression-alone group) or decompression surgery with instrumented fusion (fusion group). The primary outcome was a reduction of at least 30% in the score on the Oswestry Disability Index (ODI; range, 0 to 100, with higher scores indicating more impairment) during the 2 years after surgery, with a noninferiority margin of -15 percentage points. Secondary outcomes included the mean change in the ODI score as well as scores on the Zurich Claudication Questionnaire, leg and back pain, the duration of surgery and length of hospital stay, and reoperation within 2 years. RESULTS The mean age of patients was approximately 66 years. Approximately 75% of the patients had leg pain for more than a year, and more than 80% had back pain for more than a year. The mean change from baseline to 2 years in the ODI score was -20.6 in the decompression-alone group and -21.3 in the fusion group (mean difference, 0.7; 95% confidence interval [CI], -2.8 to 4.3). In the modified intention-to-treat analysis, 95 of 133 patients (71.4%) in the decompression-alone group and 94 of 129 patients (72.9%) in the fusion group had a reduction of at least 30% in the ODI score (difference, -1.4 percentage points; 95% CI, -12.2 to 9.4), showing the noninferiority of decompression alone. In the per-protocol analysis, 80 of 106 patients (75.5%) and 83 of 110 patients (75.5%), respectively, had a reduction of at least 30% in the ODI score (difference, 0.0 percentage points; 95% CI, -11.4 to 11.4), showing noninferiority. The results for the secondary outcomes were generally in the same direction as those for the primary outcome. Successful fusion was achieved with certainty in 86 of 100 patients (86.0%) who had imaging available at 2 years. Reoperation was performed in 15 of 120 patients (12.5%) in the decompression-alone group and in 11 of 121 patients (9.1%) in the fusion group. CONCLUSIONS In this trial involving patients who underwent surgery for degenerative lumbar spondylolisthesis, most of whom had symptoms for more than a year, decompression alone was noninferior to decompression with instrumented fusion over a period of 2 years. Reoperation occurred somewhat more often in the decompression-alone group than in the fusion group. (NORDSTEN-DS ClinicalTrials.gov number, NCT02051374.).
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Affiliation(s)
- Ivar M Austevoll
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Erland Hermansen
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Morten W Fagerland
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Kjersti Storheim
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Jens I Brox
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Tore Solberg
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Frode Rekeland
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Eric Franssen
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Clemens Weber
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Helena Brisby
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Oliver Grundnes
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Knut R H Algaard
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Tordis Böker
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Hasan Banitalebi
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Kari Indrekvam
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
| | - Christian Hellum
- From Kysthospitalet in Hagevik, Orthopedic Department, Haukeland University Hospital (I.M.A., E.H., F.R., K.I.), and the Department of Clinical Medicine, University of Bergen (E.H., F.R., K.I.), Bergen, Møre and Romsdal Hospital Trust, Ålesund Hospital, Orthopedic Department, Ålesund (E.H.), the Oslo Center for Biostatistics and Epidemiology, Research Support Services (M.W.F.), the Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience (K.S.), and the Department of Physical Medicine and Rehabilitation (J.I.B.), Oslo University Hospital, the Department of Physiotherapy, Oslo Metropolitan University (K.S.), the Medical Faculty (J.I.B.), the Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine (T.B.), and the Institute of Clinical Medicine (H. Banitalebi), University of Oslo, Akershus University Hospital, Orthopedic Department (O.G.), Radiology, Unilabs Radiology (K.R.H.A.), and the Department of Radiology and Nuclear Medicine (T.B.) and the Division of Orthopedic Surgery (C.H.), Oslo University Hospital Ullevål, Oslo, the Institute of Clinical Medicine, University of Tromsø-the Arctic University of Norway, and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø (T.S.), the Orthopedic Department (E.F.) and the Department of Neurosurgery (C.W.), Stavanger University Hospital, and the Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger (C.W.), Stavanger, and the Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog (H. Banitalebi) - all in Norway; and the Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (H. Brisby)
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Toyoda H, Yamada K, Terai H, Hoshino M, Suzuki A, Takahashi S, Tamai K, Ohyama S, Hori Y, Yabu A, Salimi H, Nakamura H. Classification and prognostic factors of residual symptoms after minimally invasive lumbar decompression surgery using a cluster analysis: a 5-year follow-up cohort study. 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 2021; 30:918-927. [PMID: 33555366 DOI: 10.1007/s00586-021-06754-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Residual symptoms indicating incomplete remission of lower leg numbness or low back pain may occur after spine surgery. The purpose was to elucidate the pattern of residual symptoms 5 years after minimally invasive lumbar decompression surgery using a cluster analysis. METHODS The study comprised 193 patients with lumbar spinal stenosis (LSS) (108 men, 85 women) ranging in age from 40 to 86 years (mean, 67.9 years). Each patient underwent 5-year follow-up. The Japanese Orthopedic Association score and visual analog scale scores for low back pain, leg pain, and leg numbness at 5 years were entered into the cluster analysis to characterize postoperative residual symptoms. Other clinical data were analyzed to detect the factors significantly related to each cluster. RESULTS The analysis yielded four clusters representing different patterns of residual symptoms. Patients in cluster 1 (57.0%) were substantially improved and had few residual symptoms of LSS. Patients in cluster 2 (11.4%) were poorly improved and had major residual symptoms. Patients in cluster 3 (17.6%) were greatly improved but had mild residual low back pain. Patients in cluster 4 (14.0%) were improved but had severe residual leg numbness. Prognostic factors of cluster 2 were a short maximum walking distance, motor weakness, resting lower leg numbness, cofounding scoliosis, and high sagittal vertical axis. CONCLUSIONS This is the first study to identify specific patterns of residual symptoms of LSS after decompression surgery. Our results will contribute to acquisition of preoperative informed consent and identification of patients with the best chance of postoperative improvement.
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Affiliation(s)
- Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.
| | - Kentaro Yamada
- Department of Orthopaedic Surgery, Fuchu Hospital, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Shoichiro Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Hamidullah Salimi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
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Oikonomidis S, Meyer C, Scheyerer MJ, Grevenstein D, Eysel P, Bredow J. Lumbar spinal fusion of low-grade degenerative spondylolisthesis (Meyerding grade I and II): Do reduction and correction of the radiological sagittal parameters correlate with better clinical outcome? Arch Orthop Trauma Surg 2020; 140:1155-1162. [PMID: 31734732 DOI: 10.1007/s00402-019-03282-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Lumbar and lumbosacral spinal fusion is an established procedure for the treatment of degenerative spondylolisthesis. However, the impact of reduction in the affected segment and of improvement in the radiological sagittal parameters on the clinical outcome remains unclear. Purpose of the study is to analyze the correlation between the radiological sagittal parameters and clinical outcome after lumbar spinal fusion in low-grade degenerative spondylolisthesis. MATERIALS AND METHODS In a monocentric prospective, clinical study, patients with low-grade degenerative spondylolisthesis of a single lumbar segment have been included. All patients received a lumbar spinal fusion according to the pathology of the treated segment. Patients attended clinical and radiological follow-up examination 1 and 2 years postoperatively. Clinical outcome was assessed using the Core Outcome Measurement Index (COMI), the Oswestry Disability Index (ODI) and the EuroQol 5D. The sagittal spinopelvic radiological parameters, sagittal rotation and anterior displacement of the affected segment and lumbar lordosis were assessed. The correlation between the sagittal radiological parameters and clinical outcome was analyzed using Spearman-Rho bi-serial test. RESULTS Sixty-two patients (35 female and 27 male) with an average age of 59.3 years were included in the study. All patients completed the follow-up examinations. Significant improvement in COMI, ODI and EuroQol 5D scores was shown in all follow-up examinations. Significant reduction in the anterior displacement was measured postoperatively, which was preserved during the follow-up. However, no correlation could be demonstrated between reduction in anterior displacement and improvement in clinical outcome. Nonetheless, correlation between correction of sagittal rotation and clinical outcome was shown. CONCLUSIONS Reduction in anterior displacement of the affected segment in the surgical treatment of low-grade degenerative spondylolisthesis does not have an impact on the clinical outcome.
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Affiliation(s)
- Stavros Oikonomidis
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Carolin Meyer
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Max Joseph Scheyerer
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - David Grevenstein
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Austevoll IM, Gjestad R, Solberg T, Storheim K, Brox JI, Hermansen E, Rekeland F, Indrekvam K, Hellum C. Comparative Effectiveness of Microdecompression Alone vs Decompression Plus Instrumented Fusion in Lumbar Degenerative Spondylolisthesis. JAMA Netw Open 2020; 3:e2015015. [PMID: 32910195 PMCID: PMC7489859 DOI: 10.1001/jamanetworkopen.2020.15015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Conflicting evidence and large practice variation are present in the surgical treatment of degenerative spondylolisthesis. More than 90% of surgical procedures in the United States include instrumented fusion compared with 50% or less in other countries. OBJECTIVE To evaluate whether the effectiveness of microdecompression alone is noninferior to decompression with instrumented fusion in a real-world setting. DESIGN, SETTING, AND PARTICIPANTS This multicenter comparative effectiveness study with a noninferiority design assessed prospective data from the Norwegian Registry for Spine Surgery. From September 19, 2007, to December 21, 2015, 1376 patients at 35 Norwegian orthopedic and neurosurgical departments underwent surgery for lumbar spinal stenosis with degenerative spondylolisthesis without scoliosis. After excluding patients undergoing laminectomy alone, fusion without instrumentation, or surgery in more than 2 levels and those with a former operation at the index level, 794 patients were included in the analyses, regardless of missing or incomplete follow-up data, before propensity score matching. Data were analyzed from March 20 to October 30, 2018. EXPOSURES Microdecompression alone or decompression with instrumented fusion. MAIN OUTCOMES AND MEASURES A reduction from baseline of 30% or greater in the Oswestry Disability Index at 12-month follow-up. RESULTS After propensity score matching, 570 patients (413 female [72%]; mean [SD] age, 64.7 [9.5] years) were included for comparison, with 285 undergoing microdecompression (mean [SD] age, 64.6 [9.8] years; 205 female [72%]) and 285 undergoing decompression with instrumented fusion (mean [SD] age, 64.8 [9.2] years; 208 female [73%]). The proportion of each type of procedure varied between departments. However, changes in outcome scores varied within patients but not between departments. The proportion of patients with improvement in the Oswestry Disability Index of at least 30% was 150 of 219 (68%) in the microdecompression group and 155 of 215 (72%) in the instrumentation group. The 95% CI (-12% to 5%) for the difference of -4% was above the predefined margin of noninferiority (-15%). Microdecompression alone was associated with shorter operation time (mean [SD], 89 [44] vs 180 [65] minutes; P < .001) and shorter hospital stay (mean [SD], 2.5 [2.4] vs 6.4 [3.0] days; P < .001). CONCLUSIONS AND RELEVANCE Among patients with degenerative spondylolisthesis, the clinical effectiveness of microdecompression alone was noninferior to that of decompression with instrumented fusion. Microdecompression alone was also associated with shorter durations of surgery and hospital stay, supporting the suggestion that the less invasive procedure should be considered for most patients.
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Affiliation(s)
- Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tore Solberg
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - Jens Ivar Brox
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
- Department of Physical Medicine and Rehabilitation, Oslo, University Hospital, Oslo, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Xie P, Feng F, Chen Z, He L, Yang B, Chen R, Wu W, Liu B, Dong J, Shu T, Zhang L, Chen CM, Rong L. Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:546. [PMID: 32799839 PMCID: PMC7429717 DOI: 10.1186/s12891-020-03566-x] [Citation(s) in RCA: 9] [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] [Received: 02/09/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). Methods This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. Results The most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery. Conclusion The PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.
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Affiliation(s)
- Peigen Xie
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Feng Feng
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Zihao Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Lei He
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bu Yang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Ruiqiang Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Wenbin Wu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bin Liu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Jianwen Dong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Tao Shu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Liangming Zhang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Chien-Min Chen
- Minimally Invasive Spine Center, Changhua Christian Hospital, No.135, Nansiao St., Changhua city, Changhua county, Taiwan.
| | - Limin Rong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China.
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Dettori JR, Skelly AC, Brodt ED. Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals. Global Spine J 2020; 10:667-673. [PMID: 32677574 PMCID: PMC7359690 DOI: 10.1177/2192568220917926] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN A systematic cross-sectional survey of systematic reviews (SRs). OBJECTIVE To evaluate the methodological quality of spine surgery SRs published in 2018 using the updated AMSTAR 2 critical appraisal instrument. METHODS We identified the PubMed indexed journals devoted to spine surgery research in 2018. All SRs of spine surgical interventions from those journals were critically appraised for quality independently by 2 reviewers using the AMSTAR 2 instrument. We calculated the percentage of SRs achieving a positive response for each AMSTAR 2 domain item and assessed the levels of confidence in the results of each SR. RESULTS We identified 28 SRs from 4 journals that met our criteria for inclusion. Only 49.5% of the AMSTAR 2 domain items satisfied the AMSTAR 2 criteria. Critical domain items were satisfied less often (39.1%) compared with noncritical domain items (57.3%). Domain items most poorly reported include accounting for individual study risk of bias when interpreting results (14%), list and justification of excluded articles (18%), and an a priori establishment of methods prior to the review or registered protocol (18%). The overall confidence in the results was rated "low" in 2 SRs and "critically low" in 26. CONCLUSIONS The credibility of a SR and its value to clinicians and policy makers are dependent on its methodological quality. This appraisal found significant methodological limitations in several critical domains, such that the confidence in the findings of these reviews is "critically low."
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Affiliation(s)
- Joseph R. Dettori
- Spectrum Research, Inc, Steilacoom, WA, USA,Joseph R. Dettori, Spectrum Research, Inc, Steilacoom, WA, USA.
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Cheng XK, Cheng YP, Liu ZY, Bian FC, Yang FK, Yang N, Zhang LX, Chen B. Percutaneous transforaminal endoscopic decompression for lumbar spinal stenosis with degenerative spondylolisthesis in the elderly. Clin Neurol Neurosurg 2020; 194:105918. [PMID: 32446122 DOI: 10.1016/j.clineuro.2020.105918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Percutaneous transforaminal endoscopic decompression (PTED) under local anesthesia is rarely performed for lumbar spinal stenosis (LSS) with degenerative lumbar spondylolisthesis (DLS) because of the limited field of vision, inherent instability, etc. The objective of this study was to describe the procedure of the PTED technique and to demonstrate the early clinical outcomes. PATIENTS AND METHODS From January 2017 to January 2019, 40 consecutive patients aged 60 and older were diagnosed with LSS with DLS in our institution and underwent PTED. All patient were followed up to 1 year postoperatively. The clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. RESULTS The mean age was 70.2 ± 7.1 years. Follow-up ranged from 12 to 24 months. The mean ± SD values of the preoperative VAS leg pain and ODI scores were 7.5 ± 1.1 and 67.3 ± 9.3, respectively. The scores improved to 2.2 ± 1.1 and 20.7 ± 8.1 at 12 months postoperatively. The outcomes of the modified MacNab criteria showed that 87.5 % of patients obtained a good-to-excellent rate. The percent slippage of spondylolisthesis before surgery (10.8 ± 2.6 %) and at the end of follow-up (11.0 ± 2.4 %) was not significantly different. One patient had a dural tear and intracranial hypertension, and one patient had tibialis anterior weakness. CONCLUSION PTED under local anesthesia could be an effective treatment method for LSS with DLS in elderly patients. However, potential complications still require further evaluation.
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Affiliation(s)
- Xiao-Kang Cheng
- Chengde Medical University, Chengde 067000, Hebei, China; Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, China
| | - Yuan-Pei Cheng
- Orthopaedic Department, China-Japan Union Hospital of Jilin University, Changchun 130000, Jilin, China
| | - Zhao-Yu Liu
- Chengde Medical University, Chengde 067000, Hebei, China; Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, China
| | - Fu-Cheng Bian
- Chengde Medical University, Chengde 067000, Hebei, China; Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, China
| | - Feng-Kai Yang
- Chengde Medical University, Chengde 067000, Hebei, China; Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, China
| | - Ning Yang
- Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, China
| | - Lin-Xia Zhang
- School of Culture and Media, Xinjiang University of Finance & Economics, Urumqi 830012, Xinjiang, China
| | - Bin Chen
- Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, China.
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Clinical outcomes of lumbar spinal surgery in patients 80 years or older with lumbar stenosis or spondylolisthesis: a systematic review and meta-analysis. 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 2020; 29:2129-2142. [PMID: 31912292 DOI: 10.1007/s00586-019-06261-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/02/2019] [Accepted: 12/16/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE This systematic review and meta-analysis of all available evidence was performed to assess the safety and efficacy of surgery for lumbar stenosis and spondylolisthesis in patients 80 years or older versus those younger than 80 years. METHODS A search of the literature was conducted in PubMed/MEDLINE, EMBASE and the Cochrane Collaboration Library. Relevant studies comparing the clinical outcomes of lumbar surgery in octogenarians and younger patients were selected according to the eligibility criteria. The predefined endpoints were extracted and meta-analysed from the identified studies. RESULTS Data from 16 observational studies including 374,197 patients were included in the final analysis. The pooled data revealed that patients 80 years or older had a significantly higher incidence of overall complication, mortality, readmission and longer length of hospital stay than younger patients. There was a similar improvement in the clinical symptoms (Oswestry Disability Index and pain) of patients in the two groups. No significant differences in overall wound complication, reoperation rate, operative time and intraoperative blood loss were found between the groups. CONCLUSIONS Our results revealed that the clinical improvement in pain and disability did not significantly differ according to age, although the patients aged 80 years or older had increased incidences of mortality and complication than younger patients. Age alone is not a contraindication for lumbar surgery in very old patients. A careful preoperative evaluation, proper patient selection and appropriate surgical approach are important to achieve successful surgical outcomes. These slides can be retrieved under Electronic Supplementary Material.
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Li XF, Jin LY, Lv ZD, Su XJ, Wang K, Shen HX, Song XX. Efficacy of percutaneous transforaminal endoscopic decompression treatment for degenerative lumbar spondylolisthesis with spinal stenosis in elderly patients. Exp Ther Med 2019; 19:1417-1424. [PMID: 32010317 DOI: 10.3892/etm.2019.8337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
The efficacy of fusion combined with decompression for the treatment of spinal stenosis with degenerative lumbar spondylolisthesis (DLS) has been debated. Percutaneous transforaminal endoscopic decompression (PTED) under local anesthesia is an ultra-minimally invasive procedure. The present study aimed to evaluate whether PTED is an effective alternative therapy for spinal stenosis associated with DLS in elderly patients. PTED was performed in elderly patients exhibiting lumbar stenosis and low-grade (Meyerding grades I and II) DLS; these patients also exhibited leg-dominant symptoms and had tolerable or absent mechanical back pain. Administration of general anesthesia may be considerably hazardous in patients when combined with comorbid conditions that result from aging. Therefore, the present procedure was performed under local anesthesia. No obvious radiographic lumbar intervertebral instability was identified prior to surgery. Pre- and post-operative visual analogue scale (VAS) score, Oswestry Disability Index (ODI) and walking distance data were collected. The clinical global outcomes following surgery were evaluated using modified MacNab criteria. A total of 18 elderly patients underwent surgery using PTED techniques. The mean follow-up time was 27.7 months (range, 24-33 months) and the mean estimated blood loss was 18.33 ml (range, 10-35 ml). The mean pre-operative ODI, VAS score of the back and VAS score of the leg were 68.2±6.5, 2.8±1.4 and 6.6±1.2, respectively. All average scores improved post-operatively to 31.7±5.2, 1.5±0.6 and 1.7±0.8, respectively, at the latest follow-up. A statistically significant improvement was observed for all scores at 1 month and that the scores remained relatively stable after that. According to modified MacNab criteria, the good-to-excellent rate was 83.3%. Only 1 patient required micro-decompression surgery due to poor rating. The present study indicated that PTED may be an effective alternative therapeutic option for elderly patients with low-grade DLS associated with spinal stenosis. However, PTED techniques continue to evolve and further follow-up studies are required to determine the long-term outcomes of this treatment technique.
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Affiliation(s)
- Xin-Feng Li
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200444, P.R. China.,Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Lin-Yu Jin
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Zhen-Dong Lv
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Xin-Jin Su
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Kun Wang
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Hong-Xing Shen
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Xiao-Xing Song
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
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Sun K, Liang L, Yin H, Yu J, Feng M, Zhan J, Jin Z, Yin X, Wei X, Zhu L. Manipulation for treatment of degenerative lumbar spondylolisthesis: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18135. [PMID: 31804324 PMCID: PMC6919453 DOI: 10.1097/md.0000000000018135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Degenerative lumbar spondylolisthesis (DLS) is one of the common orthopedic diseases which causes low back pain in patients, which seriously affects people's daily life and work. As a method of conservative treatment of this disease, manipulation is widely used in clinical practice. We will summarize the current published evidence of manipulation in the treatment of DLS, and evaluate the effectiveness and safety of manipulation through systematic review and meta-analysis, so as to provide more reliable evidence for future clinical practice. METHODS We will conduct a comprehensive search of the following 9 databases until January 2019: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, Wan Fang Database, and Chinese Biomedical Database. The 2 researchers will independently search, screen, extract data, and evaluate the quality of the literatures. The primary outcomes include clinical effectiveness, Japanese Orthopaedic Association scores, and the secondary outcomes include visual analog scale scores, symptom scores, and adverse events. Bias risk tools provided by Cochrane Collaboration will be used for literature quality assessment, and RevMan 5.3 software will be used for meta-analysis. RESULTS The results of this study will systematically evaluate the effectiveness and safety of manipulation intervention for people with DLS, especially in improving lumbar function scores and pain scores. CONCLUSION The systematic review of this study will summarize the current published evidence of manipulation for the treatment of DLS, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION This study does not require ethical approval and the results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019139933.
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Affiliation(s)
- Kai Sun
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Long Liang
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - He Yin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Jie Yu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Minshan Feng
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine
| | | | - Zhefeng Jin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Xunlu Yin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Xu Wei
- Office of Academic Research, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine
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History of degenerative spondylolisthesis: From anatomical description to surgical management. Neurochirurgie 2019; 65:75-82. [DOI: 10.1016/j.neuchi.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/26/2019] [Accepted: 03/20/2019] [Indexed: 01/01/2023]
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Li XF, Jin LY, Lv ZD, Su XJ, Wang K, Song XX, Shen HX. Endoscopic Ventral Decompression for Spinal Stenosis with Degenerative Spondylolisthesis by Partially Removing Posterosuperior Margin Underneath the Slipping Vertebral Body: Technical Note and Outcome Evaluation. World Neurosurg 2019; 126:e517-e525. [PMID: 30825627 DOI: 10.1016/j.wneu.2019.02.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Decompression alone is a treatment option in patients with lumbar spinal stenosis (LSS) and degenerative lumbar spondylolisthesis (DLS). This study aims to describe the procedure of percutaneous transforaminal endoscopic ventral decompression technique and to demonstrate the clinical outcomes. METHODS Two years of retrospective data were collected from 26 patients with predominant unilateral leg pain caused by LSS and low-grade DLS (Meyerding grades I and Ⅱ). All patients underwent endoscopic ventral decompression by removing the posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression without excessive resection of facet joints. The surgical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), modified MacNab criteria, and walking distance improvement evaluation. RESULTS The mean age of the 18 women and 8 men was 69.2 years. The mean preoperative ODI and VAS of the leg and the back scores were 64.7 ± 8.1, 7.0 ± 1.4, and 3.0 ± 1.2, respectively. All mean scores improved postoperatively to 31.4 ± 5.6, 2.4 ± 1.1, and 1.7 ± 1.1 at the final follow-up. In 88.5% of cases, patients' estimated walking distance improved. The outcomes of the modified MacNab criteria showed that 81.3% of patients obtained good-to-excellent rate. There were no statistically significant differences between the percent slip of spondylolisthesis before surgery and at the end of follow-up. CONCLUSIONS Based on the initial short-term follow-up results, transforaminal endoscopic ventral decompression by partially removing the posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression, might be an efficient alternative treatment for leg dominant symptoms in patients with LSS and low-grade DLS.
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Affiliation(s)
- Xin-Feng Li
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin-Yu Jin
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen-Dong Lv
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Jin Su
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Wang
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Xing Song
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-Xing Shen
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "surgical and research" articles in the European Spine Journal, 2018. 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 2019; 28:1-9. [PMID: 30604293 DOI: 10.1007/s00586-018-5856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Benoist M. The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: A survey of the "medical" articles in the European Spine Journal, 2018. 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 2019; 28:10-20. [PMID: 30604295 DOI: 10.1007/s00586-018-5857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
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Abstract
Degenerative low-grade lumbar spondylolisthesis is the most common form of spondylolisthesis. The majority of patients are asymptomatic and do not require surgical intervention. Symptomatic patients present with a combination of lower back pain, radiculopathy and/or neurogenic claudication and may warrant surgery if non-operative measures fail. There is widespread controversy regarding the indications for surgery and appropriate treatment strategies for patients with this type of spondylolisthesis. This article provides a comprehensive evidence-based review of the available literature to support the management of degenerative low-grade spondylolisthesis.
Cite this article: EFORT Open Rev 2018;3:620-631. DOI: 10.1302/2058-5241.3.180020.
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Affiliation(s)
- Nick Evans
- University Hospital of Wales, Cardiff, UK
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Does Concomitant Degenerative Spondylolisthesis Influence the Outcome of Decompression Alone in Degenerative Lumbar Spinal Stenosis? A Meta-Analysis of Comparative Studies. World Neurosurg 2018; 123:226-238. [PMID: 30576810 DOI: 10.1016/j.wneu.2018.11.246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate whether the preoperative presence of degenerative spondylolisthesis (DS) worsens the outcome of patients undergoing decompression alone for degenerative lumbar stenosis. METHODS We conducted a comprehensive search in the PubMed, Embase, and Cochrane Library databases. All comparative studies were included in this meta-analysis. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The functional outcomes were clinical scores and reoperation rate. The radiologic outcomes were slippage rate and postoperative instability rate. RESULTS A total of 11 studies with 1081 cases, including 469 cases of degenerative lumbar stenosis with DS (DS group) and 612 degenerative lumbar stenosis without spondylolisthesis (noDS group), were enrolled in our meta-analysis. There were no significant differences between the 2 groups for functional outcomes in terms of Japanese Orthopedic Association score, Japanese Orthopedic Association recovery rate, Oswestry Disability Index score, visual analog scale back/leg, and reoperation rate after decompression alone. For the radiologic outcomes, slippage rate was found not changed significantly before and after minimally invasive decompression alone in the DS group and the postoperative instability rate did not differ significantly between the 2 groups after decompression alone by a minimally invasive method. CONCLUSIONS Our meta-analysis revealed that concomitant DS (Meyerding grade I-II) does not influence the outcome of decompression alone in degenerative lumbar spinal stenosis, especially when a minimally invasive procedure was performed and patients did not have predominant symptoms of mechanical back pain. The presence of DS should not be an indication for fusion surgery in degenerative lumbar spinal stenosis.
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Minimally invasive decompression in patients with degenerative spondylolisthesis associated with lumbar spinal stenosis. Report of a surgical series and review of the literature. Neurol Neurochir Pol 2018; 52:448-458. [PMID: 30025719 DOI: 10.1016/j.pjnns.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/14/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022]
Abstract
We reported the results of minimally invasive spinal decompression (MISD) in patients with degenerative spondylolisthesis (DS) associated with lumbar spinal stenosis (LSS) and performed a literature review in order to evaluate the clinical and radiological outcomes, the complications and reoperation rate of MISD procedures in these patients. Data of 28 patients submitted to MISD for DS associated to LSS were reviewed. We evaluated the Visual Analogue Scale (VAS) both for low back pain (LBP) and legs pain, the Oswestry Disability Index (ODI) and the degree of the slippage. A PubMed search of the English literature was conducted. Only papers with more than 10 patients and reporting explicitly data of patients with DS were included in the analysis. We found a statistically significant improvement of LBP, legs pain and ODI in our series. The degree of slippage was stable at follow-up (FU) with no need of reoperation. No major complications occurred. In our literature review, we were able to analyze the differences in ODI in 156 patients and the differences in Japanese Orthopedic Association (JOA) score in 218 patients. We observed a statistically significant improvement of ODI and JOA score at FU compared to pre-operative. The percentage of slippage, evaluated in 283 patients, was unchanged at FU compared to pre-operative. The overall complication rate was 1.6%. The overall reoperation rate was 4.5%. MISD procedures are safe and effective in patients with DS associated to LSS and are associated to low morbidity and significant improvement of disability without progression of slippage.
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