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Heard JC, Lee Y, Ezeonu T, Lambrechts MJ, Issa TZ, Yalla GR, Tran K, Singh A, Purtill C, Somers S, Becsey A, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. Does the Severity of Foraminal Stenosis Impact Outcomes of Lumbar Decompression Surgery? World Neurosurg 2023; 179:e296-e304. [PMID: 37633493 DOI: 10.1016/j.wneu.2023.08.081] [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: 06/20/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To establish the relationship between the magnitude of foraminal stenosis and 1) improvement in patient-reported outcomes, 2) improvement in motor function after lumbar decompression surgery, and 3) difference in surgical outcomes. METHODS Patients who underwent one-level posterior lumbar decompression for radiculopathy were retrospectively identified. Patient demographics and surgical characteristics were collected through a query search and manual chart review of the electronic medical records. Foraminal stenosis was determined on magnetic resonance imaging and graded using Lee et al.'s validated methodology as none, mild, moderate, or severe. Surgical outcomes, motor function, and patient-reported outcome measures (PROMs) were compared based on the amount of stenosis (mild vs. moderate vs. severe). Bivariant and multivariant analyses were performed. RESULTS Severe stenosis demonstrated more 90-day readmissions (0.00% vs. 0.00% vs. 8.57%, respectively, P = 0.019), though this effect did not remain significant on multivariate analysis (P = 0.068). There was no association between stenosis severity and the degree of functional impairment or PROMs preoperatively. Patients with moderate or severe preoperative foraminal stenosis showed improvement in all PROMs after surgery (P < 0.05) except the mental component of the Short Form 12 survey. Notably, central stenosis grade was insignificantly different between groups (P = 0.358). Multivariable logistic regression analysis did not identify any significant independent predictors of surgical outcomes or changes in PROMs. CONCLUSIONS We demonstrated that regardless of foraminal stenosis severity preoperatively, patients have a similar improvement in PROMs, surgical outcomes, and restoration of motor function after lumbar decompression surgery for radiculopathy.
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Affiliation(s)
- Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Teeto Ezeonu
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Goutham R Yalla
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Khoa Tran
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Akash Singh
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Caroline Purtill
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sydney Somers
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander Becsey
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wang T, Wang A, Zang L, Fan N, Wu Q, Lu X, Yuan S. Reoperations After Percutaneous Endoscopic Transforaminal Decompression for Treating Lumbar Spinal Stenosis: Incidence and Predictors. Global Spine J 2023; 13:2327-2335. [PMID: 35225015 PMCID: PMC10538338 DOI: 10.1177/21925682221081030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The main purpose of the present study was to report the incidence and identify predictors of reoperation in patients with lumbar spinal stenosis (LSS) treated with percutaneous endoscopic transforaminal decompression (PETD). METHODS This study retrospectively reviewed consecutive patients with LSS who underwent PETD at our center between January 2016 and July 2020. The incidence of reoperations was calculated. We then designed a surgical period-matched case-control study to identify predictors among demographic data, clinical baseline data, and imaging parameters. RESULTS This study identified 496 eligible patients. 33 (6.7%) patients underwent reoperation with a mean follow-up of 3 years, consisting 22 (4.4%) at the index level and 11 (2.2%) at the adjacent levels. There were significant differences in age and age-adjusted Charlson comorbidity index (AACCI) between the two groups, with younger age (P = .004) and lower AACCI (P = .019) in reoperation group. Age was identified as the sole independent predictor (P = .006). The duration of symptoms ≥12 months (P = .034) and the presence of heart problems (P = .012) were recognized as specific predictors among patients younger than 65 years. CONCLUSIONS In a mean follow-up of 3 years, the incidence of reoperation in LSS treated with PETD was 6.7%. A younger age was the independent predictor for reoperation. Younger patients with the duration of symptoms ≥12 months or without heart problems were more likely to undergo a second operation. Prospective randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xuanyu Lu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Son HJ, Chang BS, Chang SY, Gimm G, Kim H. Midterm Outcomes of Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process: Minimum 5-Year Follow-up. Clin Orthop Surg 2023; 15:800-808. [PMID: 37811507 PMCID: PMC10551678 DOI: 10.4055/cios22362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 10/10/2023] Open
Abstract
Background To overcome several disadvantages of conventional laminectomy for degenerative lumbar spinal stenosis (DLSS), several types of minimally invasive surgery have been developed. The purpose of the present study was to report the clinical and radiological mid-term outcomes of spinous process-splitting decompression (SPSD) for DLSS. Methods Seventy-three consecutive patients underwent SPSD between September 2014 and March 2016. Of these, 42 (70 segments) who had at least 5 years of follow-up were analyzed retrospectively. The visual analog scale for back pain and leg pain, Oswestry disability index, and walking distance without resting were scored to assess clinical outcomes at the preoperative and final follow-up. A subgroup analysis was performed according to the union status of the split spinous processes (SPs). For radiological outcomes, slip in the neutral position as a static parameter, anterior flexion-neutral translation, and posterior extension-neutral translation as a dynamic parameter were measured before and at the final follow-up after surgery. Spinopelvic parameters were also measured. Reoperation rate at the index levels was investigated, and predictive risk factors for reoperation were evaluated using multivariate logistic regression. Survival analysis was performed with reoperation as the endpoint to estimate the longevity of the SPSD for DLSS. Results All clinical outcomes improved significantly at the final follow-up compared to those at the initial visit (p < 0.05). The clinical outcomes did not differ according to the union status of the split SP. There were no cases of definite segmental instability and no significant changes in the static or dynamic parameters after surgery. Sacral slope and lumbar lordosis increased, and pelvic tilt decreased significantly at the follow-up (p < 0.05), despite no significant change in the sagittal vertical axis. The mean longevity of the procedure before the reoperation was 82.9 months. Five patients (11.9%) underwent reoperation at a mean of 52.2 months after the SPSD. There were no significant risk factors for reoperation; however, the preoperative severity of foraminal stenosis had an odds ratio of 7.556 (p = 0.064). Conclusions SPSD for DLSS showed favorable clinical and radiological outcomes at the mid-term follow-up. SPSD could be a good surgical option for treating DLSS.
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Affiliation(s)
- Hee Jung Son
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Geunwu Gimm
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Sekiguchi M. The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 5. Postoperative Prognosis. Spine Surg Relat Res 2023; 7:314-318. [PMID: 37636153 PMCID: PMC10447196 DOI: 10.22603/ssrr.2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 08/29/2023] Open
Affiliation(s)
- Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Toyoda H, Terai H, Yamada K, Kato M, Suzuki A, Takahashi S, Tamai K, Yabu A, Iwamae M, Sawada Y, Nakamura H. A decision tree analysis to predict clinical outcome of minimally invasive lumbar decompression surgery for lumbar spinal stenosis with and without coexisting spondylolisthesis and scoliosis. Spine J 2023; 23:973-981. [PMID: 36739978 DOI: 10.1016/j.spinee.2023.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Implementing machine learning techniques, such as decision trees, known as prediction models that use logical construction diagrams, are rarely used to predict clinical outcomes. PURPOSE To develop a clinical prediction rule to predict clinical outcomes in patients who undergo minimally invasive lumbar decompression surgery for lumbar spinal stenosis with and without coexisting spondylolisthesis and scoliosis using a decision tree model. STUDY DESIGN/SETTING A retrospective analysis of prospectively collected data. PATIENT SAMPLE This study included 331 patients who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥2 years at 1 institution. OUTCOME MEASURES Self-report measures: The Japanese Orthopedic Association (JOA) scores and low back pain (LBP)/leg pain/leg numbness visual analog scale (VAS) scores. Physiologic measures: Standing sagittal spinopelvic alignment, computed tomography, and magnetic resonance imaging results. METHODS Low achievement in clinical outcomes were defined as the postoperative JOA score at the 2-year follow-up <25 points. Univariate and multiple logistic regression analysis and chi-square automatic interaction detection (CHAID) were used for analysis. RESULTS The CHAID model for JOA score <25 points showed spontaneous numbness/pain as the first decision node. For the presence of spontaneous numbness/pain, sagittal vertical axis ≥70 mm was selected as the second decision node. Then lateral wedging, ≥6° and pelvic incidence minus lumbar lordosis (PI-LL) ≥30° followed as the third decision node. For the absence of spontaneous numbness/pain, sex and lateral olisthesis, ≥3mm and American Society of Anesthesiologists physical status classification system score were selected as the second and third decision nodes. The sensitivity, specificity, and the positive predictive value of this CHAID model was 65.1, 69.8, and 64.7% respectively. CONCLUSIONS The CHAID model incorporating basic information and functional and radiologic factors is useful for predicting surgical outcomes.
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Affiliation(s)
- Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan.
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Kentaro Yamada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Yuta Sawada
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Wang A, Wang T, Zang L, Fan N, Yuan S, Si F, Du P. Identification of preoperative radiological risk factors for reoperation following percutaneous endoscopic lumbar decompression to treat degenerative lumbar spinal stenosis. Front Surg 2023; 9:1054760. [PMID: 36684204 PMCID: PMC9852717 DOI: 10.3389/fsurg.2022.1054760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/24/2022] [Indexed: 01/07/2023] Open
Abstract
Background This study aimed to identify radiological risk factors associated with reoperation after percutaneous transforaminal endoscopic decompression (PTED) for degenerative lumbar spinal stenosis (DLSS). Methods The preoperative clinical data of 527 consecutive patients with DLSS who underwent PTED were retrospectively reviewed. Overall, 44 patients who underwent reoperation were matched for age, sex, body mass index, and surgical segment to 132 control patients with excellent or good clinical outcomes. Radiological characteristics were compared between the groups using independent sample t-tests and Pearson's chi-square tests. A predictive model was established based on multivariate logistic regression analysis. Results The analyses revealed significant differences in the presence of lumbosacral transitional vertebra (LSTV, 43.2% vs. 17.4%, p = 0.001), the number of levels with senior-grade disc degeneration (2.57 vs. 1.96, p = 0.018) and facet degeneration (1.91 vs. 1.25 p = 0.002), and the skeletal muscle index (SMI, 849.7 mm2/m2 vs. 1008.7 mm2/m2, p < 0.001) between patients in the reoperation and control groups. The results of the logistic analysis demonstrated that LSTV (odds ratio [OR] = 2.734, 95% confidence interval [CI]:1.222-6.117, p < 0.014), number of levels with senior-grade facet degeneration (OR = 1.622, 95% CI:1.137-2.315, p = 0.008), and SMI (OR = 0.997, 95% CI:0.995-0.999, p = 0.001) were associated with reoperation after PTED. The application of the nomogram based on these three factors showed good discrimination (area under the receiver operating characteristic curve 0.754, 95% CI 0.670-0.837) and good calibration. Conclusion LSTV, more levels with senior-grade facet degeneration, and severe paraspinal muscle atrophy are independent risk factors for reoperation after PTED. These factors can thus be used to predict reoperation risk and to help tailor treatment plans for patients with DLSS.
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Kawakami M, Takeshita K, Inoue G, Sekiguchi M, Fujiwara Y, Hoshino M, Kaito T, Kawaguchi Y, Minetama M, Orita S, Takahata M, Tsuchiya K, Tsuji T, Yamada H, Watanabe K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication. J Orthop Sci 2023; 28:46-91. [PMID: 35597732 DOI: 10.1016/j.jos.2022.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine. METHODS The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members. RESULTS Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided. CONCLUSIONS The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.
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Affiliation(s)
| | | | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | - Yasushi Fujiwara
- Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Japan
| | | | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Japan
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Tanaka S, Wada K, Kumagai G, Asari T, Aburakawa S, Yamasaki Y, Yokoyama T, Takeuchi K, Ishibashi Y. Comparison of Short-Term Clinical Results and Radiologic Changes Between Two Different Minimally Invasive Decompressive Surgical Methods for Lumbar Canal Stenosis: Lumbar Spinous Process Splitting Laminectomy and Trans-Interspinous Lumbar Decompression. Spine (Phila Pa 1976) 2021; 46:E1136-E1145. [PMID: 33813582 DOI: 10.1097/brs.0000000000004052] [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: 02/01/2023]
Abstract
STUDY DESIGN A multicenter, retrospective study. OBJECTIVE To clarify the clinical and radiological effects of removing interspinous contextures in lumbar decompression surgery for patients with lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA There have seldom been reports that have compared both clinical results and radiological changes among minimally invasive decompression methods. METHODS Consecutive 52 patients underwent lumbar spinous process-splitting laminectomy (LSPSL), following which 50 patients underwent trans-interspinous lumbar decompression (TISLD). All patients presented with cauda equina type of lumbar spinal stenosis and underwent a minimum 1-year follow-up. The Japanese Orthopaedic Association (JOA) score and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score were evaluated to determine the extent of daily living activities. Propensity score (PS)-matched analysis was used to match patients' age and preoperative JOA scores between the two groups. Lumbar lordosis (LL), disc height (DH), segmental range of motion (ROM), and vertebral anterior translation were measured by functional lumbar lateral x-ray, and changes between preoperative and 1-year postoperative values were evaluated. RESULTS Twenty-nine pairs of patients were selected by PS-matching. Mean JOA scores increased from 14.4 to 23.5 (mean recovery rate was 62.3%) in the LSPSL group and from 14.0 to 23.2 (61.3%) in the TISLD group at preoperative and 1-year follow-up, respectively. There were no significant differences in clinical results and changes in LL, ROM, and vertebral anterior translation in each group. The DH at L4/5 level at 1-year after surgery revealed significant decrease in the TISLD group compared with the LSPSL group. There was a correlation between preoperative DH and DH decrease in the LSPSL group, but not in TISLD group. CONCLUSION Removal of interspinous contextures did not influence clinical outcomes at 1 year after surgery, but it may be likely to cause disc height loss when it applied at the L4/5 level.Level of Evidence: 3.
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Affiliation(s)
- Sunao Tanaka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shuichi Aburakawa
- Department of Orthopaedic Surgery, Aomori Rosai Hospital, Aomori, Japan
| | | | - Toru Yokoyama
- Department of Orthopaedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Kazunari Takeuchi
- Department of Orthopaedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Le Huec JC, Seresti S, Bourret S, Cloche T, Monteiro J, Cirullo A, Roussouly P. Revision after spinal stenosis surgery. 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; 29:22-38. [PMID: 31997016 DOI: 10.1007/s00586-020-06314-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To make a literature review on spinal stenosis recurrence after a first surgery and edit rules to avoid this complication. METHODS We conducted two separate PUBMED searches to evaluate the revision post-stenosis and degenerative scoliosis surgery using the terms: lumbar vertebrae/surgery, spinal stenosis, spine, scoliosis and reoperation. The resulting papers were categorized into three groups: (1) those that evaluated reoperation post-simple decompression; (2) those that evaluated spinal decompression and fusion for short (3 levels or less) or long (more than 3 levels) segment spinal fusion; and (3) those diagnosing the stenosis during the surgery. RESULTS (1) We found 11 relevant papers that only looked at revision spine surgery post-laminectomy for spinal stenosis. (2) We found 20 papers looked at reoperation post-laminectomy and fusion amongst which there were two papers specifically comparing long-segment (> 3 level) and short-segment (3 or less levels) fusions. (3) In the unspecified group, we found only one article. Fifteen articles were excluded as they were not specifically looking at our objective criteria for revision surgery. In regard to revision post-adult deformity surgery, we found 18 relevant articles. CONCLUSIONS After this literature review and analysis of post-operative stenosis, it seems important to provide some advice to avoid revision surgeries more or less induced by the surgery. It looks interesting when performing simple decompression without fusion in the lumbar spine to analyse the risk of instability induced by the decompression and facet resection but also by a global balance analysis. Regarding pre-operative stenosis in a previously operated area, different causes may be evocated, like screw or cage malpositionning but also insufficient decompression which is a common cause. Intraoperatively, the use of neuromonitoring and intraoperative CT scan with navigation are useful tool in complex cases to avoid persisting stenosis. Pre-op analysis and planning are key parameters to decrease post-op problems. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- J C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France.
| | - S Seresti
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - S Bourret
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - T Cloche
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - J Monteiro
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - A Cirullo
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - P Roussouly
- Centre Des Massues, Croix Rouge, 92 Rue Dr Ed Locard, 69005, Lyon, France
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