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Han B, Chen Y, Liang W, Yang Y, Ding Z, Yin P, Hai Y. Is the interspinous process device safe and effective in elderly patients with lumbar degeneration? A systematic review and meta-analysis of randomized controlled trials. 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; 33:881-891. [PMID: 38342843 DOI: 10.1007/s00586-023-08119-z] [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: 05/23/2023] [Revised: 11/05/2023] [Accepted: 12/22/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways which may cause back pain and neurogenic intermittent claudication in affected patients. Recently, as an alternative treatment between conservative therapy and decompression surgery, interspinous process device (IPD) such as X-stop, Coflex, DIAM, Aperius, Wallis, etc., has gained enough popularity. PURPOSE The purpose of this study was to evaluate the efficacy and safety of IPD in the treatment of degenerative lumbar spinal stenosis compared with decompression surgery. STUDY DESIGN This study was a systematic review and meta-analysis of randomized controlled trials. PATIENT SAMPLE 555 patients' samples were collected for this study. OUTCOME MEASURES The Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire For efficacy evaluation. Complication and reoperation rate was utilized for the assessment of safety. METHODS A comprehensive literature search was performed through Pubmed, EMBASE, Web of Science, and Cochrane Library until October 2023. Among the studies meeting the eligible criteria, any study in which IPD was utilized in the treatment of degenerative lumbar spinal stenosis was included in the current review. For efficacy evaluation, the Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire. Complication and reoperation rates were utilized for the assessment of safety. RESULTS Five randomized controlled trials with 555 patients were included. There were no significant differences in VAS leg pain (SMD - 0.08, 95% CI - 0.32 to 0.15) and back pain (SMD 0.09, 95%CI-0.27 to 0.45), ODI scores (MD 1.08, 95% CI - 11.23 to 13.39) and ZCQ physical function (MD-0.09, 95% CI-0.22 to 0.05) for IPD compared with decompression surgery. In terms of ZCQ symptom severity (MD - 0.22, 95% CI - 0.27 to - 016), decompression surgery showed superior to the IPD. As for complications (RR 1.08, 95% CI 0.36 to 3.27), the IPD had no advantages compared to decompression surgery, whereas inferior to it in reoperation rate (RR 2.58, 95% CI 1.67 to 3.96). CONCLUSIONS This systematic review and meta-analysis indicated no superiority in the clinical outcome for IPD compared with decompression surgery. However, more clinical studies are warranted to determine the efficacy and safety of IPD.
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Affiliation(s)
- Bo Han
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Yuxiang Chen
- Plastic Surgery Hospital, Peking Union Medical. College, Chinese Academy of Medical Sciences, 33 Badachu Road, Beijing, Shijingshan District, China
| | - Weishi Liang
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Yihan Yang
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Zihao Ding
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Peng Yin
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China.
| | - Yong Hai
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China.
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Saravi B, Ülkümen S, Lang G, Couillard-Després S, Hassel F. Case-matched radiological and clinical outcome evaluation of interlaminar versus microsurgical decompression of lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023:10.1007/s00586-023-07551-5. [PMID: 36729245 DOI: 10.1007/s00586-023-07551-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/12/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Endoscopic spine surgery is a globally expanding technique advocated as less invasive for spinal stenosis treatment compared to the microsurgical approach. However, evidence on the efficiency of interlaminar full-endoscopic decompression (FED) vs. conventional microsurgical decompression (MSD) in patients with lumbar spinal stenosis is still scarce. We conducted a case-matched comparison for treatment success with consideration of clinical, laboratory, and radiologic predictors. METHODS We included 88 consecutive patients (FED: 36/88, 40.9%; MSD: 52/88, 59.1%) presenting with lumbar central spinal stenosis. Surgery-related (operation time, complications, length of stay (LOS), American Society of Anesthesiologists physical status (ASA) score, C-reactive protein (CRP), white blood cell count, side of approach (unilateral/bilateral), patient-related outcome measures (PROMs) (Oswestry disability index (ODI), numeric rating scale of pain (NRS; leg-, back pain), EuroQol questionnaire (eQ-5D), core outcome measures index (COMI)), and radiological (dural sack cross-sectional area, Schizas score (SC), left and right lateral recess heights, and facet angles, respectively) parameters were extracted at different time points up to 1-year follow-up. The relationship of PROMs was analyzed using Spearman's rank correlation. Surgery-related outcome parameters were correlated with patient-centered and radiological outcomes utilizing a regression model to determine predictors for propensity score matching. RESULTS Complication (most often residual sensorimotor deficits and restenosis due to hematoma) rates were higher in the FED (33.3%) than MSD (13.5%) group (p < 0.05), while all complications in the FED group were observed within the first 20 FED patients. Operation time was higher in the FED, whereas LOS was higher in the MSD group. Age, SC, CRP revealed significant associations with PROMs. We did not observe significant differences in the endoscopic vs. microsurgical group in PROMs. The correlation between ODI and COMI was significantly high, and both were inversely correlated with eQ-5D, whereas the correlations of these PROMs with NRS findings were less pronounced. CONCLUSIONS Endoscopic treatment of lumbar spinal stenosis was similarly successful as the conventional microsurgical approach. Although FED was associated with higher complication rates in our single-center study experience, the distribution of complications indicated surgical learning curves to be the main factor of these findings. Future long-term prospective studies considering the surgical learning curve are warranted for reliable comparisons of these techniques.
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Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre - Albert-Ludwigs-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany. .,Department of Spine Surgery, Loretto Hospital, Freiburg, Germany.
| | - Sara Ülkümen
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre - Albert-Ludwigs-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Department of Spine Surgery, Loretto Hospital, Freiburg, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre - Albert-Ludwigs-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Department of Spine Surgery, Loretto Hospital, Freiburg, Germany
| | - Sébastien Couillard-Després
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Frank Hassel
- Department of Spine Surgery, Loretto Hospital, Freiburg, Germany
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Jiang L, Luo J, Gong H, Zhang F, Zhang L, Cheng L, Gao X, Zhang D, Liu T, Xiao J. Clinical and Biomechanical Study of Laminoplasty for Thoracic and Lumbar Intradural Tumors. J Clin Med 2023; 12:jcm12010355. [PMID: 36615155 PMCID: PMC9821651 DOI: 10.3390/jcm12010355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
(1) Background: Primary intraspinal tumors account for 2-15% of all central nervous system (CNS) tumors. Most intraspinal tumors are benign, and about 40% of them occur intradurally, for which early surgery is the preferred treatment. Laminectomy with pedicle screw fixation is the conventional surgical treatment. However, laminectomy with pedicle screw fixation is likely to reduce the spinal range of motion (ROM), with many other complications, although it can maintain the stability of the spine. The aim of this study is to determine whether laminoplasty as a new surgical approach for thoracic and lumbar intradural tumors is superior to laminectomy in preserving spinal ROM, maintaining spinal stability and reducing postoperative complications. (2) Methods: We retrospectively analyzed 50 patients who received intradural tumor resection, including 23 who received traditional laminectomy with pedicle screw fixation and 27 who received new laminoplasty. Spinal ROM was evaluated by lumbar flexion/extension radiograph and biomechanical evaluation. Spinal stability was evaluated by imaging observations of the spinal Cobb angle and laminar bone fusion. Postoperative complications were evaluated according to cerebrospinal fluid (CSF) leakage and the length of hospital stay. (3) Results: Compared with the laminectomy group, patients in the laminoplasty group exhibited a better spinal ROM (31.6 ± 12.0° vs. 21.7 ± 11.8°, p = 0.013), a smaller Cobb angle (9.6 ± 4.3 vs. 12.5 ± 5.3, p = 0.034), a lower incidence of CSF leakage (4/14.8% vs. 11/47.8%, p = 0.015), and a shorter length of hospital stay (13.1 ± 1.8 vs. 15.1 ± 2.3 days, p = 0.001). Most patients in the laminoplasty group had satisfactory bone fusion. The biomechanical experiment also demonstrated that spinal ROM in laminoplasty was larger than that in the laminectomy group. (4) Conclusions: Compared with the traditional surgery, the new laminoplasty surgery can better maintain the stability of the spine, preserve spinal ROM, and reduce postoperative complications. It is a surgical method that can be clinically popularized.
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Affiliation(s)
- Lijun Jiang
- School of Medicine, Ningbo University, Ningbo 315211, China
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Jie Luo
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Haiyi Gong
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Fei Zhang
- Department of Orthopedics, Ningbo Beilun Orthopedic Hospital, Ningbo 315899, China
| | - Linxiang Zhang
- School of Medicine, Ningbo University, Ningbo 315211, China
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Linfei Cheng
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Xin Gao
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Dan Zhang
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
| | - Tielong Liu
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
| | - Jianru Xiao
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
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Hiranaka Y, Miyazaki S, Yurube T, Kuroshima K, Ryu M, Inoue S, Kakutani K, Tadokoro K. Influence of the Preoperative Duration of Symptoms on Patients' Clinical Outcomes after Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spinal Diseases. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010022. [PMID: 36676647 PMCID: PMC9867228 DOI: 10.3390/medicina59010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: The impact of the duration of symptoms (DOS) on postoperative clinical outcomes of patients with degenerative lumbar spinal diseases is important for determining the optimal timing of surgical intervention; however, the timing remains controversial. This prospective case−control study aimed to investigate the influence of the preoperative DOS on surgical outcomes in minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF). Materials and Methods: Patients who underwent single-level TLIF for lumbar degenerative diseases between 2017 and 2018 were reviewed. Only patients with full clinical data during the 1-year follow-up period were included. The patients were divided into two groups (DOS < 12 months, group S; DOS ≥ 12 months, group L). The clinical outcomes, including the Oswestry disability index (ODI) and visual analog scale (VAS) for lower back pain, leg pain, and numbness, were investigated preoperatively and at 1, 3, and 6 months, as well as 1 year, after surgery. Furthermore, postoperative patient satisfaction 1 year after surgery was also surveyed. Results: A total of 163 patients were assessed: 60 in group S and 103 in group L. No differences in baseline characteristics and clinical outcomes were found. The ODI and VAS significantly improved from the baseline to each follow-up period (all p < 0.01). Group S had significantly lower ODI scores at 3 months (p = 0.019) and 6 months (p = 0.022). In addition, group S had significantly lower VAS scores for leg pain at 3 months (p = 0.027). In a comparison between both groups, only the patients with cauda equina symptoms showed that ODI and leg pain VAS scores at 3 months after surgery were significantly lower in group S (19.9 ± 9.1 vs. 14.1 ± 12.5; p = 0.037, 7.4 ± 13.9 vs. 14.7 ± 23.1; p = 0.032, respectively). However, the clinical outcomes were not significantly different between both groups 1 year after surgery. Patient satisfaction was also not significantly different between both groups. Conclusions: Patients with a shorter DOS tended to have a significantly slower recovery; however, clinical outcomes 1 year after surgery were good, regardless of the DOS.
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Affiliation(s)
- Yoshiaki Hiranaka
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Shingo Miyazaki
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
- Correspondence: (S.M.); (T.Y.); Tel.: +81-78-382-5985 (S.M.)
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
- Correspondence: (S.M.); (T.Y.); Tel.: +81-78-382-5985 (S.M.)
| | - Kohei Kuroshima
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Shinichi Inoue
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Ko Tadokoro
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
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Ohtomo N, Nakamoto H, Miyahara J, Yoshida Y, Nakarai H, Tozawa K, Fukushima M, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Higashikawa A, Takeshita Y, Kawamura N, Inanami H, Tanaka S, Oshima Y. Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study. BMC Musculoskelet Disord 2021; 22:1053. [PMID: 34930238 PMCID: PMC8690517 DOI: 10.1186/s12891-021-04963-6] [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] [Received: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Microendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy. Methods This is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. Results Of the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). Conclusions MEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.
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Affiliation(s)
- Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yuichi Yoshida
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22Shibuya-Ku, HirooTokyo, 150-8935, Japan
| | - Hiroyuki Nakarai
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa, 211-8510, Japan
| | - Keiichiro Tozawa
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa, 222-0036, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Spine Center, Toranomon Hospital, 2-2-2Minato-Ku, ToranomonTokyo, 105-8470, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa, 211-8510, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa, 222-0036, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22Shibuya-Ku, HirooTokyo, 150-8935, Japan
| | - Hirohiko Inanami
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Inanami Spine and Joint Hospital, 3-17-5Shinagawa-Ku, HigashishinagawaTokyo, 140-0002, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan. .,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.
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Moayeri N, Rampersaud YR. Revision surgery following minimally invasive decompression for lumbar spinal stenosis with and without stable degenerative spondylolisthesis: a 5- to 15-year reoperation survival analysis. J Neurosurg Spine 2021:1-7. [PMID: 34678770 DOI: 10.3171/2021.6.spine2144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive decompression (MID) is an effective procedure for lumbar spinal stenosis (LSS). Long-term follow-up data on reoperation rates are lacking. The objective of this retrospective cohort study was to evaluate reoperation rates in patients with LSS who underwent MID, stratified for degenerative lumbar spondylolisthesis (DLS), with a follow-up between 5 and 15 years. METHODS All consecutive patients with LSS who underwent MID between 2002 and 2011 were included. All patients had neurogenic claudication from central and/or lateral recess stenosis, without or with up to 25% of slippage (grade I spondylolisthesis), and no obvious dynamic instability on imaging (increase in spondylolisthesis by ≥ 5 mm demonstrated on supine-to-standing or flexion-extension imaging). Reoperation rates defined as any operation on the same or adjacent level were assessed. Revision decompression alone was considered if the aforementioned clinical and radiographic criteria were met; otherwise, patients underwent a minimally invasive posterior fusion. RESULTS A total of 246 patients (mean age 66 years) were included. Preoperative spondylolisthesis was present in 56.9%. The mean follow-up period was 8.2 years (range 5.0-14.9 years). The reoperation rates in patients with and without spondylolisthesis were 15.7% and 15.1%, respectively; fusion was required in 7.1% and 7.5%, with no significant difference (redecompression only, p = 0.954; fusion, p = 0.546). For decompression only, the mean times to reoperation were 3.9 years (95% CI 1.8-6.0 years) for patients with DLS and 2.8 years (95% CI 1.3-4.2 years) for patients without DLS; for fusion, the mean times to reoperation were 3.1 years (95% CI 1.0-5.3 years) and 3.1 years (95% CI 1.1-5.1 years), respectively. CONCLUSIONS In highly selected patients with stable DLS and leg-dominant pain from central or lateral recess stenosis, the long-term reoperation rate is similar between DLS and non-DLS patients undergoing MIS decompression.
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Affiliation(s)
- Nizar Moayeri
- 1Department of Neurology and Neurosurgery, University Medical Center Utrecht, The Netherlands
| | - Y Raja Rampersaud
- 2J. Bernard Gosevitz Chair in Arthritis Research at UHN, Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University Health Network (UHN), Toronto; and.,3University of Toronto, Toronto, Ontario, Canada
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Kim HS, Sharma SB, Raorane HD, Kim KR, Jang IT. Early results of full-endoscopic decompression of lumbar central canal stenosis by outside-in technique: A clinical and radiographic study. Medicine (Baltimore) 2021; 100:e27356. [PMID: 34596144 PMCID: PMC8483834 DOI: 10.1097/md.0000000000027356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Retrospective cohort study.Full-endoscopic decompression of lumbar spinal canal stenosis is being performed by endoscopic surgeons as an alternative to micro-lumbar decompression in the recent years. The outcomes of the procedure are reported by few authors only. The aim of this paper is to report the clinical and radiographic outcomes of full endoscopic lumbar decompression of central canal stenosis by outside-in technique at 1-year follow-up.We reviewed patients operated for lumbar central canal stenosis by full endoscopic decompression from May 2018 to November 2018. We analyzed the visual analogue scale scores for back and leg pain and Oswestry disability index at pre-op, post-op, and 1-year follow-up. At the same periods, we also evaluated disc height, segmental lordosis, whole lumbar lordosis on standing X-rays and canal cross sectional area at the affected level and at the adjacent levels on magnetic resonance imaging and the facet length and facet cross-sectional area on computed tomography scans. The degree of stenosis was judged by Schizas grading and the outcome at final follow-up was evaluated by MacNab criteria.We analyzed 32 patients with 43 levels (M:F = 14:18) with an average age of 63 (±11) years. The visual analogue scale back and leg improved from 5.4 (±1.3) and 7.8 (±2.3) to 1.6 (±0.5) and 1.4 (±1.2), respectively, and Oswestry disability index improved from 58.9 (±11.2) to 28 (±5.4) at 1-year follow-up. The average operative time per level was 50 (±16.2) minutes. The canal cross sectional area, on magnetic resonance imaging, improved from 85.78 mm2 (±28.45) to 150.5 mm2 (±38.66). The lumbar lordosis and segmental lordosis also improved significantly. The disc height was maintained in the postoperative period. All the radiographic improvements were maintained at 1-year follow-up. The MacNab criteria was excellent in 18 (56%), good in 11 (34%), and fair in 3 (9%) patients. None of the patients required conversion to open surgery or a revision surgery at follow-up. There was 1 patient with dural tear that was sealed with fibrin sealant patch endoscopically. There were 10 patients who had grade I stable listhesis preoperatively that did not progress at follow-up. No other complications like infection, hematoma formations etc. were observed in any patient.Full endoscopic outside-in decompression method is a safe and effective option for lumbar central canal stenosis with advantages of minimal invasive technique.
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Affiliation(s)
- Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | | | - Harshavardhan D. Raorane
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Kyeong-Rae Kim
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
- Nanoori Gangnam Hospital, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea ZIP-06048
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
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McIlroy S, Walsh E, Sothinathan C, Stovold E, Norwitz D, Norton S, Weinman J, Bearne L. Pre-operative prognostic factors for walking capacity after surgery for lumbar spinal stenosis: a systematic review. Age Ageing 2021; 50:1529-1545. [PMID: 34304266 DOI: 10.1093/ageing/afab150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) reduces walking and quality of life. It is the main indication for spinal surgery in older people yet 40% report walking disability post-operatively. Identifying the prognostic factors of post-operative walking capacity could aid clinical decision-making, guide rehabilitation and optimise health outcomes. OBJECTIVE To synthesise the evidence for pre-operative mutable and immutable prognostic factors for post-operative walking in adults with LSS. DESIGN Systematic review with narrative synthesis. METHODS Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, OpenGrey) were searched for observational studies, evaluating factors associated with walking after surgery in adults receiving surgery for LSS from database inception to January 2020. Two reviewers independently evaluated studies for eligibility, extracted data and assessed risk of bias (Quality in Prognosis Studies). The Grading of Recommendations Assessment, Development and Evaluation method was used to determine level of evidence for each factor. RESULTS 5526 studies were screened for eligibility. Thirty-four studies (20 cohorts, 9,973 participants, 26 high, 2 moderate, 6 low risk of bias) were included. Forty variables (12 mutable) were identified. There was moderate quality of evidence that pre-operative walking capacity was positively associated with post-operative walking capacity. The presence of spondylolisthesis and the severity of stenosis were not associated with post-operative walking capacity. All other factors investigated had low/very low level of evidence. CONCLUSION Greater pre-operative walking is associated with greater post-operative walking capacity but not spondylolisthesis or severity of stenosis. Few studies have investigated mutable prognostic factors that could be potentially targeted to optimise surgical outcomes.
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Affiliation(s)
- Suzanne McIlroy
- Physiotherapy Department, King’s College Hospital NHS Foundation Trust, London, UK
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Edward Walsh
- Physiotherapy Department, King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Elizabeth Stovold
- Population Health Research Institute, St George's University of London, London, UK
| | - Daniel Norwitz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sam Norton
- Health Psychology, King’s College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | - Lindsay Bearne
- School of Population Health and Environmental Sciences, King’s College London, London, UK
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The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 6:100072. [PMID: 35141637 PMCID: PMC8820012 DOI: 10.1016/j.xnsj.2021.100072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) affects mainly elderly patients. To this day, it is unclear whether comorbidities influence treatment success. The aim of this systematic review and meta-analysis was to assess the impact of comorbidities on the treatment effectiveness in symptomatic LSS. METHODS We conducted a systematic review and meta-analysis and reviewed prospective or retrospective studies from Medline, Embase, Cochrane Library and CINAHL from inception to May 2020, including adult patients with LSS undergoing surgical or conservative treatment. Main outcomes were satisfaction, functional and symptoms improvement, and adverse events (AE). Proportions of outcomes within two subgroups of a comorbidity were compared with risk ratio (RR) as summary measure. Availability of ≥3 studies for the same subgroup and outcome was required for meta-analysis. RESULTS Of 72 publications, 51 studies, mostly assessing surgery, there was no evidence reported that patients with comorbidities were less satisfied compared to patients without comorbidities (RR 1.06, 95% confidence interval (CI) 0.77 to 1.45, I 2 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, I 2 72%). A limited number of studies found no influence of comorbidities on functional and symptoms improvement. Older age did not affect satisfaction, symptoms and functional improvement, and AE (age >80 years RR 1.22, 95% CI 0.98 to 1.52, I 2 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, I 2 58%). CONCLUSION In patients with LSS and comorbidities (in particular diabetes), a higher risk for AE should be considered in the treatment decision. Older age alone was not associated with an increased risk for AE, less functional and symptoms improvement, and less treatment satisfaction.
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Martínez-Andrés J, Ayala-Gascón M, Mariscal G, Alfonso-Beltrán J, Barrios C. High Rate of Studies with Level 1 and 2 Evidence among the 100 Most Cited Articles in Lumbar Spinal Stenosis. J Neurol Surg A Cent Eur Neurosurg 2021; 82:453-462. [PMID: 33690879 DOI: 10.1055/s-0040-1720993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND To date, no study has used bibliometric analysis to review the most influential articles in lumbar spinal stenosis. The objective of this study was to identify and analyze the characteristics and the level of evidence of the 100 most cited articles on lumbar spinal stenosis METHODS: The Thomson Reuters Web of Science was accessed to find the 100 most cited articles on lumbar spinal stenosis. For each article, we recorded the number and density of citations, authors, country, journals and years, department, level of evidence, type of study, and if it was part of any multicenter studies. RESULTS Until January 2017, the 100 most cited articles accumulated 11,136 citations (average: 259.05/y), ranging individually between 442 and 50 (average: 111.36). The first reference was published in 1974 in Clinical Orthopaedics and Related Research. Therapeutic studies (n = 40), the 1990s (n = 46), United States as country of origin (n = 51), Harvard University as institution (n = 16), Katz JN as author (n = 10), and Spine as journal (n = 48) have the hegemony. Many were multicenter (n = 42) and using level 2 evidence (n = 49). There is an inverse relationship between citation index and long-standing studies, maintenance of those most cited, and a temporary advance toward better levels of evidence. CONCLUSION This bibliometric analysis reveals a good level of evidence in the published clinical series and includes 100 articles useful for the approach of lumbar spinal stenosis.
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Affiliation(s)
- Juan Martínez-Andrés
- Institute for Research on Musculoskeletal Disorders, Faculty of Medicine and Dentistry, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | - María Ayala-Gascón
- Doctorate School, Faculty of Medicine and Dentistry, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, Faculty of Medicine and Dentistry, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | - Joaquín Alfonso-Beltrán
- Institute for Research on Musculoskeletal Disorders, Faculty of Medicine and Dentistry, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University of Valencia, Valencia, Spain
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Clinical Outcomes of "U" Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy in Chronic Pain Patients with Lumbar Spinal Stenosis Combined with Disc Herniation. Pain Res Manag 2021; 2021:6657463. [PMID: 33532011 PMCID: PMC7837780 DOI: 10.1155/2021/6657463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
Introduction “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD) was introduced for lumbar spinal stenosis (LSS) combined with disc herniation (DH) treatment. This study aims to explore the efficacy and safety of “U” route PELD on chronic pain patients with LSS combined with DH. Methods Degenerative LSS combined with DH patients who underwent “U” route PELD were reexamined, and 80 patients were recruited and followed up for 2 years. The other 80 healthy individuals who were age- and sex-matched to the patients without chronic pain were enrolled as healthy controls. Minimum dura sac cross-sectional area (mDCSA) by MRI, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcomes were assessed. Emotional evaluation of pain catastrophizing and depression was documented with Pain Catastrophizing Scale (PCS) and Beck Depression Inventory (BDI), respectively, for patients before and after surgery and healthy individuals. Results All patients were of the age range from 47 to 85 years, with an average of 59.5 ± 9.76 years. Symptoms duration was 114.6 ± 22.77 months, operation time was 87.7 ± 25.20 minutes, and the average hospital stay was 5.8 ± 2.81 days. Four patients quit, and hence, a total of 76 patients completed the follow-up. The results indicated that mDCSA was improved significantly after operation (p < 0.001), either low back and leg VAS or ODI decreased over time (p < 0.001), and the excellent-to-good rate was improved from 88.75% to 93.42% during postoperative 2 years (p < 0.05). Complications of dural tear, nerve root, or dysesthesia were reported in 5 patients, and all recovered after conservative therapy. The scores of pain catastrophizing were reduced after operation (p < 0.001), but no significance of BDI was found between patients and healthy controls (p > 0.05). Conclusions The “U” route PELD seems an alternative to LSS combined with DH treatment, which might reach a better decompression and effectively improve chronic pain conditions. Still, the complications were potential and required further consideration.
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Daddimani R, Murthy S, Rao S, Patil V. A prospective study analyzing the clinical outcome of degenerative lumbar canal stenosis treated by laminectomy. JOURNAL OF ORTHOPAEDICS AND SPINE 2021. [DOI: 10.4103/joasp.joasp_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Patel JY, Kundnani VG, Chawada B. Is Older Age a Contraindication for Single-Level Transforaminal Lumbar Interbody Fusion? Asian Spine J 2020; 15:447-454. [PMID: 33059435 PMCID: PMC8377219 DOI: 10.31616/asj.2020.0084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/16/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. PURPOSE This study's primary objective was to compare the clinico-radiological outcomes and incidence of perioperative complications of transforaminal lumbar interbody fusion (TLIF) at lower lumbar levels for elderly and younger patients. The secondary objective was to evaluate the effect of age on clinical outcomes and patient satisfaction in the two groups. OVERVIEW OF LITERATURE The lumbar interbody fusion surgery in elder age has been reported to produce a higher complication rate and suboptimal results. Literature evaluating efficacy and safety of TLIF in elderly population is scanty. The effect of age on clinical outcome and the overall patient satisfaction after TLIF has been understudied. METHODS This retrospective study was conducted from 2011 to 2017 with 121 patients, who underwent TLIF and were divided into two cohorts based on age (group A, >65 years and group B, <65 years). Perioperative clinical/radiological parameters, postoperative complications, and satisfactory outcomes were evaluated in both groups. A statistical analysis between two matched groups was performed with logistic regression analysis and Student t-test. RESULTS The mean age was 73.8±4.5 years in group A and 47.3±12.7 years in group B. There was no statistical difference in surgical time (p=0.15), mobilization, or hospital stay (p=0.15) between the two groups. There were no statistically significant differences noted in the Oswestry Disability Index, Visual Analog Scale, or Wang's outcome score between the two groups at final follow-up. Postoperative complications not affecting outcome were common in the elderly group, but there was no statistically significant difference noted among neurological or cardiopulmonary events between the two groups. CONCLUSIONS In judiciously selected patients with proper preoperative risk assessment and optimized medical co-morbidities, TLIF surgery can have successful results, in terms of clinical outcome and satisfaction, in the elderly. Older age should not be a contraindication for TLIF in patients with degenerative lumbar disease.
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Affiliation(s)
- Jwalant Y Patel
- Mumbai Institute of Spine Surgery, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Vishal G Kundnani
- Mumbai Institute of Spine Surgery, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Bansari Chawada
- Department of Preventive and Social Medicine, Medical College Baroda, Vadodara, India
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Molina M. ESTENOSIS LUMBAR DEGENERATIVA: CONCEPTOS BÁSICOS, EVALUACIÓN CLÍNICA Y MANEJO. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Lim KT, Meceda EJA, Park CK. Inside-Out Approach of Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression: A Detailed Technical Description, Rationale and Outcomes. Neurospine 2020; 17:S88-S98. [PMID: 32746522 PMCID: PMC7410386 DOI: 10.14245/ns.2040196.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022] Open
Abstract
Although lumbar stenosis was recognized as a contraindication for endoscopic spine surgery in the past, the advancement in endoscopic system design and development of approach techniques and strategies now enabled the endoscopic spine surgeons to manage all types of lumbar stenosis safely and more effectively. A full-endoscopic lumbar technique for surgical management of spinal canal stenosis is now used today in many advanced spine centers around the world as one of their standard procedures which can be done under general, regional, local anesthesia with sedation. In this technical report, we described in detail the inside-out approach of performing lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) and retrospectively reviewed hospital records of 127 patients who underwent the approach from December 2018 to March 2019 to address 1 level lumbar spinal stenosis and determined its outcome after 12-month follow-up period. Perioperative outcomes, operation time, length of hospital stay, and surgical complications were recorded and analyzed. The cross-sectional area of the thecal sac at the operated level was measured. The visual analogue scale (VAS) was assessed preoperatively, 1 month, and 12 months as well as the Oswestry Disability Index (ODI). The data were statistically analyzed (using SPSS ver. 17.0). The inside-out approach LE-ULBD was shown to effect statistically significant improvement in the VAS of leg and back pain as well as the ODI. It is a familiar, safe, and effective way of performing spinal stenosis decompression with good reproducible outcomes.
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Affiliation(s)
| | - Elmer Jose Arevalo Meceda
- Department of Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, the Philippines.,Department of Surgery, Section of Neurosurgery, Bicol Medical Center, Naga City, the Philippines
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Percutaneous Unilateral Biportal Endoscopic Spine Surgery Using a 30-Degree Arthroscope in Patients With Severe Lumbar Spinal Stenosis: A Technical Note. Clin Spine Surg 2019; 32:324-329. [PMID: 31464695 PMCID: PMC6791497 DOI: 10.1097/bsd.0000000000000876] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unilateral biportal endoscopic surgery (UBESS) for severe lumbar central canal stenosis (LCCS) remains challenging. OBJECTIVE To describe the use of UBESS with a 30-degree arthroscope in patients with severe LCCS. MATERIALS AND METHODS Working and viewing portals were created in each unilateral paravertebral area at the target interlaminar level. After ensuring the visual field with a 30-degree arthroscope, effective tissue removal was possible through safe access to the bilateral hypertrophic yellow ligament with minimal osteotomy. The authors evaluated 58 patients and analyzed the clinical outcomes using the visual analog scale, Macnab criteria, and self-predicted walking distance. RESULTS The visual analog scale scores for low back and leg pains decreased from 7.1 to 1.9 and from 7.9 to 1.6, respectively, at 18 months after the procedure. According to the Macnab criteria, "excellent," "good," and "fair" results were obtained in 51.7%, 41.4%, and 6.9% subjects, respectively. Before surgery, the subjects could walk a mean of 305.8±468.1 m. After surgery, 43.1% of the patients could walk for >1 hour, whereas the remaining patients could walk 1521.8±1831.1 m. CONCLUSION UBESS using a 30-degree arthroscope can be an efficient and safe intervention in patients with severe LCCS.
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Menendez JY, Omar NB, Chagoya G, Tabibian BE, Elsayed GA, Walters BC, Guthrie BL, Hadley MN. Patient Satisfaction in Spine Surgery: A Systematic Review of the Literature. Asian Spine J 2019; 13:1047-1057. [PMID: 31352720 PMCID: PMC6894977 DOI: 10.31616/asj.2019.0032] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/25/2019] [Indexed: 12/03/2022] Open
Abstract
Patient satisfaction reflects the patients’ perception of the outcome of care and is being considered for use in future reimbursement schemes. No consensus exists regarding the best instrument to measure patient satisfaction in the field of spine surgery. This systematic review aimed to determine how patient satisfaction for spine surgery has been measured previously and whether a disease-specific, comprehensive instrument to measure patient satisfaction has been established; we also aimed to define the dimensions of care that determine patient satisfaction in spine surgery. A systematic search of three online databases, unpublished sources, and citations was undertaken to identify 156 empirical studies that reported on patient satisfaction in the field of spine surgery. Manuscripts were reviewed in terms of the patient satisfaction instrument used, and the instruments were categorized as per content and method axes. Taxonomy of patient satisfaction with spine surgery identified the major characteristics of providers and medical care that influenced patient satisfaction and acted as a structure to categorically define the dimensions of patient satisfaction in spine surgery. The reviewed studies predominantly used global (108/156) rather than multidimensional (46/156), instruments. Most studies (96.2%) reported satisfaction with outcome rather than with care, and only 18.5% of the studies (29/156) utilized a disease-specific instrument. The following seven dimensions of patient status, outcome, and care experience that affected patient satisfaction were identified: pain, function, patient expectations/preference, specific patient health characteristics, caregiver interpersonal manner, efficacy/clinical outcomes, and postoperative care/therapy. Currently, no disease-specific instrument that includes all dimensions of patient satisfaction in spine surgery has been developed. Such a patient satisfaction instrument should be designed, tested for reliability and validity, and widely implemented.
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Affiliation(s)
- Joshua York Menendez
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nidal Bassam Omar
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Borna Ethan Tabibian
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Galal Ashraf Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Barton Lucius Guthrie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark Norman Hadley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Takahashi H, Aoki Y, Saito J, Nakajima A, Sonobe M, Akatsu Y, Inoue M, Taniguchi S, Yamada M, Koyama K, Yamamoto K, Shiga Y, Inage K, Orita S, Maki S, Furuya T, Koda M, Yamazaki M, Ohtori S, Nakagawa K. Unilateral laminectomy for bilateral decompression improves low back pain while standing equally on both sides in patients with lumbar canal stenosis: analysis using a detailed visual analogue scale. BMC Musculoskelet Disord 2019; 20:100. [PMID: 30832643 PMCID: PMC6399850 DOI: 10.1186/s12891-019-2475-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/21/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis (LSS) is a less invasive technique compared to conventional laminectomy. Recently, several authors have reported favorable results of low back pain (LBP) in patients of LSS treated with ULBD. However, the detailed changes and localization of LBP before and after ULBD for LSS remain unclear. Furthermore, unsymmetrical invasion to para-spinal muscle and facet joint may result in the residual unsymmetrical symptoms. To clarify these points, we conducted an observational study and used detailed visual analog scale (VAS) scores to evaluate the characteristics and bilateral changes of LBP and lower extremity symptoms. METHODS We included 50 patients with LSS treated with ULBD. A detailed visual analogue scale (VAS; 100 mm) score of LBP in three different postural positions: motion, standing, and sitting, and bilateral VAS score (approached side versus opposite side) of LBP, lower extremity pain (LEP), and lower extremity numbness (LEN) were measured. Oswestry Disability Index (ODI) was used to quantify the clinical improvement. RESULTS Detailed LBP VAS score before surgery was 51.5 ± 32.5 in motion, 63.0 ± 30.1 while standing, and 37.8 ± 31.8 while sitting; and showed LBP while standing was significantly greater than LBP while sitting (p < 0.01). After surgery, LBP while standing was significantly improved relative to that while sitting (p < 0.05), and levels of LBP in the three postures became almost the same with ODI improvement. Bilateral VAS scores showed significant improvement equally on both sides (p < 0.01). CONCLUSIONS ULBD improves LBP while standing equally on both sides in patients with LCS. The improvement of LBP by the ULBD surgery suggests radicular LBP improved because of decompression surgery. Furthermore, the symmetric improvement of LBP by the ULBD surgery suggests unsymmetrical invasion of the paraspinal muscles and facet joints is unrelated to residual LBP.
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Affiliation(s)
- Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Yorikazu Akatsu
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinji Taniguchi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Manabu Yamada
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Keita Koyama
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Keiichiro Yamamoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741 Japan
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Perioperative Effects Associated With the Surgical Treatment of Degenerative Spondylolisthesis: Interbody Versus No Interbody. Clin Spine Surg 2019; 32:E71-E77. [PMID: 30334823 DOI: 10.1097/bsd.0000000000000729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY DESIGN This is a retrospective analysis. OBJECTIVE The purpose of this study was to compare the clinical, radiographic, and perioperative complication profiles of performing an interbody and posterior arthrodesis (CAGE) versus posterolateral lumbar fusion (PLF) alone in patients undergoing surgery for degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA DS is a common disorder that, failing nonoperative treatment, may be managed with surgical decompression and concomitant posterior arthrodesis. At present, the risk/benefit ratio of including an additional interbody arthrodesis has not been clearly delineated in the literature. MATERIALS AND METHODS We reviewed 174 consecutive patients (118 female and 56 male) diagnosed with single-level DS that met the inclusion/exclusion criteria, from January 1, 2000 to August 1, 2011. Clinical outcomes, fusion rates, radiographic outcomes, and complication profiles were recorded. RESULTS We identified 174 patients who received a single-level lumbar interbody fusion with posterolateral fusion (CAGE, n=89) or posterolateral fusion alone (PLF, n=85). No difference in patient-reported outcomes or fusion rate was detected between the 2 groups. We did identify better segmental lordosis increase (4.9±3.2 vs. 0.9±1.9 degrees; P=0.001) and interdiscal height change (2.1±2.4 vs. 0.6±1.6 mm) in the CAGE group. Operative time, 199.8±36.6 versus 142.6±28.5 minutes (P<0.001); blood loss, 355±216.4 versus 269±28.5 mL (P<0.001); and postoperative radiculitis, 28.9% versus 7.0% (P=0.003) were worse in the CAGE group compared with the PLF group. CONCLUSIONS The ideal surgical approach when treating patients with DS remains in question. This study suggests, when comparing PLF with or without additional interbody fusion, that the lack of clinical or fusion-related benefit may not justify the higher risk profile including longer surgery, higher blood loss, and increased risk of postoperative radiculitis. Long-term prospective studies are required to further clarify these findings. LEVEL OF EVIDENCE Level III.
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Long-Term Results of Surgery Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2018; 43:1619-1630. [PMID: 29652786 PMCID: PMC6185822 DOI: 10.1097/brs.0000000000002682] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized trial with a concurrent observational cohort study. OBJECTIVE To compare 8-year outcomes between surgery and nonoperative care and among different fusion techniques for symptomatic lumbar degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA Surgical treatment of DS has been shown to be more effective than nonoperative treatment out to 4 years. This study sought to further determine the long-term (8-year) outcomes. METHODS Surgical candidates with DS from 13 centers with at least 12 weeks of symptoms and confirmatory imaging were offered enrollment in a randomized controlled trial (RCT) or observational cohort study (OBS). Treatment consisted of standard decompressive laminectomy (with or without fusion) versus standard nonoperative care. Primary outcome measures were the Short Form-36 (SF-36) bodily pain and physical function scores and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, and yearly up to 8 years. RESULTS Data were obtained for 69% of the randomized cohort and 57% of the observational cohort at the 8-year follow up. Intent-to-treat analyses of the randomized group were limited by high levels of nonadherence to the randomized treatment. As-treated analyses in the randomized and observational groups showed significantly greater improvement in the surgery group on all primary outcome measures at all time points through 8 years. Outcomes were similar among patients treated with uninstrumented posterolateral fusion, instrumented posterolateral fusion, and 360° fusion. CONCLUSION For patients with symptomatic DS, patients who received surgery had significantly greater improvements in pain and function compared with nonoperative treatment through 8 years of follow-up. Fusion technique did not affect outcomes. LEVEL OF EVIDENCE 1.
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Abou-Al-Shaar H, Adogwa O, Mehta AI. Lumbar Spinal Stenosis: Objective Measurement Scales and Ambulatory Status. Asian Spine J 2018; 12:765-774. [PMID: 30060388 PMCID: PMC6068421 DOI: 10.31616/asj.2018.12.4.765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 11/23/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is one of the most common affecting the elderly population that may lead to loss of function and the inability to execute basic activities of daily living. While surgical decompression remains the standard of care, choosing an optimal management strategy is usually guided by a set of clinical, radiological, and measurement indices. However, to date, there is a major uncertainty and discrepancy regarding the methodology used. There is also inconsistent adoption of outcome measures across studies, which may result in huge limitations in predicting the efficacy and cost-effectiveness of different treatment paradigms. Herein, we review the various measurement indices used for outcome assessment among patients with LSS, and delineate the major advantages and disadvantages of each index. We call for the development of a single objective outcome measure that encompasses and addresses all issues encountered in this heterogeneous group of patients, including monitoring the patient's progression after treatment.
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Affiliation(s)
- Hussam Abou-Al-Shaar
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Masuda K, Higashi T, Yamada K, Sekiya T, Saito T. The surgical outcome of decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis. J Neurosurg Spine 2018; 29:259-264. [PMID: 29856301 DOI: 10.3171/2018.1.spine17879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to assess the usefulness of radiological parameters for surgical decision-making in patients with degenerative lumbar scoliosis (DLS) by comparing the clinical and radiological results after decompression or decompression and fusion surgery. METHODS The authors prospectively planned surgical treatment for 298 patients with degenerative lumbar disease between September 2005 and March 2013. The surgical method used at their institution to address intervertebral instability is precisely defined based on radiological parameters. Among 64 patients with a Cobb angle ranging from 10° to 25°, 57 patients who underwent follow-up for more than 2 years postoperatively were evaluated. These patients were divided into 2 groups: those in the decompression group underwent decompression alone (n = 25), and those in the fusion group underwent decompression and short segmental fusion (n = 32). Surgical outcomes were reviewed, including preoperative and postoperative Cobb angles, lumbar lordosis based on radiological parameters, and Japanese Orthopaedic Association (JOA) scores. RESULTS The JOA scores of the decompression group and fusion group improved from 5.9 ± 1.6 to 10.0 ± 2.8 and from 7.2 ± 2.0 to 11.3 ± 2.8, respectively, which was not significantly different between the groups. At the final follow-up, the postoperative Cobb angle in the decompression group changed from 14° ± 2.9° to 14.3° ± 6.4° and remained stable, while the Cobb angle in the fusion group decreased from 14.8° ± 4.0° to 10.0° ± 8.5° after surgery. CONCLUSIONS The patients in both groups demonstrated improved JOA scores and preserved Cobb angles after surgery. The improvement in JOA scores and preservation of Cobb angles in both groups show that the evaluation of spinal instability using radiological parameters is appropriate for surgical decision-making.
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Mlyavykh S, Ludwig SC, Kepler CK, Anderson DG. Five-year results of a clinical pilot study utilizing a pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis. J Neurosurg Spine 2018; 29:241-249. [PMID: 29856305 DOI: 10.3171/2017.11.spine16664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbar spinal stenosis (LSS) is a common condition that leads to significant disability, particularly in the elderly. Current therapeutic options have certain drawbacks. This study evaluates the 5-year clinical and radiographic results of a minimally invasive pedicle-lengthening osteotomy (PLO) for symptomatic LSS. METHODS A prospective, single-arm, clinical pilot study was conducted involving 20 patients (mean age 61.7 years) with symptomatic LSS treated by a PLO procedure at 1 or 2 lumbar levels. All patients had symptoms of neurogenic claudication or radiculopathy secondary to LSS, and had not improved after a minimum 6-month course of nonoperative treatment. Eleven patients had a Meyerding grade I degenerative spondylolisthesis in addition to LSS. Clinical outcomes were measured using the Oswestry Disability Index, Zürich Claudication Questionnaire, 12-Item Short Form Health Survey, and a visual analog scale for back and leg pain. Procedural variables, neurological outcomes, adverse events, and radiological imaging (plain radiographs and CT scans) were collected at the 1.5-, 3-, 6-, 9-, 12-, 24-, and 60-month time points. RESULTS The PLOs were performed through percutaneous incisions, with minimal blood loss in all cases. There were no operative complications. Four adverse events occurred during the follow-up period. Statistically significant improvement was observed in each of the outcome instruments and maintained over the 5-year follow-up period. Imaging studies, reviewed by an independent radiologist, showed no evidence of device subsidence, migration, breakage, or heterotopic ossification. Thin-slice CT scans documented healing of the osteotomy site in all patients at the 6-month time point and an increase of 115% in the mean cross-sectional area of the spinal canal. CONCLUSIONS Treatment of patients with symptomatic LSS with a PLO procedure provided substantial enlargement of the area of the spinal canal and favorable clinical results for both disease-specific and non-disease-specific outcome measures at all follow-up time points out to 5 years. Future research is needed to compare this technique to alternative therapies for LSS.
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Affiliation(s)
- Sergey Mlyavykh
- 1Privolzhski Federal Medical Research Center, Nizhniy Novgorod, Russia
| | - Steven C Ludwig
- 2Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland; and
| | - Christopher K Kepler
- 3Department of Orthopaedics, Thomas Jefferson University/Rothman Institute, Philadelphia, Pennsylvania
| | - D Greg Anderson
- 3Department of Orthopaedics, Thomas Jefferson University/Rothman Institute, Philadelphia, Pennsylvania
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Hatta Y, Tonomura H, Nagae M, Takatori R, Mikami Y, Kubo T. Clinical Outcome of Muscle-Preserving Interlaminar Decompression (MILD) for Lumbar Spinal Canal Stenosis: Minimum 5-Year Follow-Up Study. Spine Surg Relat Res 2018; 3:54-60. [PMID: 31435552 PMCID: PMC6690127 DOI: 10.22603/ssrr.2017-0097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/08/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Favorable short-term outcomes have been reported following muscle-preserving interlaminar decompression (MILD), a less invasive decompression surgery for lumbar spinal canal stenosis (LSCS). However, there are no reports of mid- to long-term outcomes. The purpose of this study was to evaluate the clinical outcomes five or more years after treatment of LSCS with MILD. Methods Subjects were 84 cases with LSCS (44 males; mean age, 68.7 years) examined five or more years after MILD. All patients had leg pain symptoms, with claudication and/or radicular pain. The patients were divided into three groups depending on the spinal deformity: 44 cases were without deformity (N group); 20 had degenerative spondylolisthesis (DS group); and 20 had degenerative scoliosis (DLS group). The clinical evaluation was performed using Japanese Orthopedic Association (JOA) scores, and revision surgeries were examined. Changes in lumbar alignment and stability were evaluated using plain radiographs. Results The overall JOA score recovery rate was 65.5% at final follow-up. The recovery rate was 69.5% in the N group, 65.2% in the DS group, and 54.0% in the DLS group, with the rate of the DLS group being significantly lower. There were 16 revision surgery cases (19.0%): seven in the N group (15.9%), three in the DS group (15.0%) and six in the DLS group (30.0%). There were no significant differences between pre- and postoperative total lumbar alignment or dynamic intervertebral angle in any of the groups, slip percentage in the DS group, or Cobb angle in the DLS group. Conclusions The mid-term clinical results of MILD were satisfactory, including in cases with deformity, and there was no major impact on radiologic lumbar alignment or stability. The clinical outcomes of cases with degenerative scoliosis were significantly less favorable and the revision rate was high. This should be taken into consideration when deciding on the surgical procedure.
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Affiliation(s)
- Yoichiro Hatta
- Department of Orthopaedics, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masateru Nagae
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryota Takatori
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Tapp SJ, Martin BI, Tosteson TD, Lurie JD, Weinstein MC, Deyo RA, Mirza SK, Tosteson ANA. Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices. Spine J 2018; 18:584-592. [PMID: 28847740 DOI: 10.1016/j.spinee.2017.08.246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive lumbar spinal stenosis procedures have uncertain long-term value. PURPOSE This study sought to characterize factors affecting the long-term cost-effectiveness of such procedures using interspinous spacer devices ("spacers") relative to decompression surgery as a case study. STUDY DESIGN Model-based cost-effectiveness analysis. PATIENT SAMPLE The Medicare Provider Analysis and Review database for the years 2005-2009 was used to model a group of 65-year-old patients with spinal stenosis who had no previous spine surgery and no contraindications to decompression surgery. OUTCOME MEASURES Costs, quality-adjusted life years (QALYs), and cost per QALY gained were the outcome measures. METHODS A Markov model tracked health utility and costs over 10 years for a 65-year-old cohort under three care strategies: conservative care, spacer surgery, and decompression surgery. Incremental cost-effectiveness ratios (ICER) reported as cost per QALY gained included direct medical costsfor surgery. Medicare claims data were used to estimate complication rates, reoperation, and related costs within 3 years. Utilities and long-term reoperation rates for decompression were derived frompublished studies. Spacer failure requiring reoperation beyond 3 years and post-spacer health utilities are uncertain and were evaluated through sensitivity analyses. In the base-case, the spacer failure rate was held constant for years 4-10 (cumulative failure: 47%). In a "worst-case" analysis, the 10-year cumulative reoperation rate was increased steeply (to 90%). Threshold analyses were performed to determine the impact of failure and post-spacer health utility on the cost-effectiveness of spacer surgery. RESULTS The spacer strategy had an ICER of $89,500/QALY gained under base-case assumptions, and remained under $100,000 as long as the 10-year cumulative probability of reoperation did not exceed 54%. Under worst-case assumptions, the spacer ICER was $482,000/QALY and fell below $100,000 only if post-spacer utility was 0.01 greater than post-decompression utility or the cost of spacer surgery was $1,600 less than the cost of decompression surgery. CONCLUSIONS Spacers may provide a reasonably cost-effective initial treatment option for patients with lumbar spinal stenosis. Their value is expected to improve if procedure costs are lower in outpatient settings where these procedures are increasingly being performed. Decision analysis is useful for characterizing the long-term cost-effectiveness potential for minimally invasive spinal stenosis treatments and highlights the importance of complication rates and prospective health utility assessment.
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Affiliation(s)
- Stephanie J Tapp
- Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Brook I Martin
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84158, USA
| | - Tor D Tosteson
- Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jon D Lurie
- Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Milton C Weinstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard Medical School, 718 Huntington Ave, Boston, MA 02115, USA
| | - Richard A Deyo
- Departments of Family Medicine and Internal Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Sohail K Mirza
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Anna N A Tosteson
- Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
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Rocha RD, Pratali RDR, Motta RDL, Barsotti CEG, Santos FPED, Oliveira CEASD. FUNCTIONAL RESULTS IN PATIENTS SUBMITTED TO SURGERY FOR DEGENERATIVE LUMBAR DISEASE. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604179116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate functional results in patients submitted to lumbar arthrodesis for the treatment of degenerative disc disease. Methods: This is a retrospective study that considered patients submitted to surgery due to degenerative disc disease, with a minimum of 12 months of postoperative follow-up. The Oswestry Disability Index (ODI) and Scoliosis Research Society-22 (SRS-22) questionnaires, including total value and domains, were considered indicators of functional outcome and quality of life. Results: Sixty-one patients (mean age 60.4 years) met the inclusion criteria and had ODI and SRS-22 data recorded. Nineteen were male and 42 female. The mean of postoperative follow-up was 29 months (12-67 months). There was no statistically significant difference in any score between sexes. The mean values obtained by the questionnaires were ODI 43.4%; SRS-22 Total 2.7; Function/Activity 2.6; Pain 2.8; Appearance 2.6; Mental Health 3.0; Satisfaction 3.4. Conclusion: The values of the surgical outcome indicators were consistent with important functional disability, although the satisfaction indicator with the treatment showed satisfied patients.
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Doualla-Bija M, Takang MA, Mankaa E, Moutchia J, Ongolo-Zogo P, Luma-Namme H. Characteristics and determinants of clinical symptoms in radiographic lumbar spinal stenosis in a tertiary health care centre in sub-Saharan Africa. BMC Musculoskelet Disord 2017; 18:494. [PMID: 29179752 PMCID: PMC5704579 DOI: 10.1186/s12891-017-1844-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/14/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) refers to narrowing of the lumbar central spinal canal, lateral recess, and/or neuro-foramina. Radiographic LSS plays an important role in clinical LSS but is not solely accountable for the presence of symptoms. We sought to characterise clinical LSS and to determine factors associated with presence of symptoms of LSS in patients with radiographic LSS in a sub Saharan Africa setting. METHODS After prior ethical clearance, a case control study was done in a tertiary hospital in Douala-Cameroon, including 105 patients with radiographic LSS: 57 with symptoms of LSS (cases) and 58 with no symptoms (controls). Spinal stenosis was assessed using computed tomography (CT) scans. Data were analysed using SPSS version 23. RESULTS The mean age of our study participants was 53.4 ± 13.1 years. The mean age of onset of symptoms of LSS was 50.3 ± 11.6 years and the most common symptoms were Low back pain (100.0%), radicular symptoms (98.2%) and neurogenic claudication (98.2%). Obesity (p < 0.001) and a high waist circumference (p = 0.002) were significantly associated with presence of LSS symptoms in persons with radiographic LSS. After adjusting for body mass index, a positive family history of low back pain (p = 0.004), vertebra lesion at L2 (p = 0.034), L3 (p = 0.002), L4 (p = 0.025) and multiple (p = 0.008) levels, degenerative disc protrusion (p = 0.044), disc lesion at L3-L4 (p = 0.001), L4-L5 (p = 0.011) and multiple (p = 0.046) levels were significantly associated with presence of symptoms of LSS in persons with radiographic LSS. CONCLUSION Characteristics of clinical LSS have been described in this sub-Saharan Africa population. Obesity, a high waist circumference and a positive family history of low back pain are significantly associated with presence of symptoms of LSS in persons with radiographic LSS.
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Affiliation(s)
- Marie Doualla-Bija
- Faculty of medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon. .,General Hospital Douala-Cameroon, P.O. Box 4856, Douala, Africa, Cameroon.
| | - Mbeng Ashu Takang
- General Hospital Douala-Cameroon, P.O. Box 4856, Douala, Africa, Cameroon
| | - Emmanuella Mankaa
- General Hospital Douala-Cameroon, P.O. Box 4856, Douala, Africa, Cameroon
| | - Jude Moutchia
- General Hospital Douala-Cameroon, P.O. Box 4856, Douala, Africa, Cameroon
| | - Pierre Ongolo-Zogo
- Faculty of medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Henry Luma-Namme
- Faculty of medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,General Hospital Douala-Cameroon, P.O. Box 4856, Douala, Africa, Cameroon
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Kim HS, Patel R, Paudel B, Jang JS, Jang IT, Oh SH, Park JE, Lee S. Early Outcomes of Endoscopic Contralateral Foraminal and Lateral Recess Decompression via an Interlaminar Approach in Patients with Unilateral Radiculopathy from Unilateral Foraminal Stenosis. World Neurosurg 2017; 108:763-773. [PMID: 28919229 DOI: 10.1016/j.wneu.2017.09.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Percutaneous endoscopic contralateral interlaminar lumbar foraminotomy (PECILF) for lumbar degenerative spinal stenosis is an established procedure. Better preservation of contralateral facet joint compared with that of the approach side has been shown with uniportal bilateral decompression. The aim of this retrospective case series was to analyze the early clinical and radiologic outcomes of stand-alone contralateral foraminotomy and lateral recess decompression using PECILF. METHODS Twenty-six consecutive patients with unilateral lower limb radiculopathy underwent contralateral foraminotomy and lateral recess decompression using PECILF. Their clinical outcomes were evaluated with visual analog scale leg pain score, Oswestry Disability Index, and the MacNab criteria. Completeness of decompression was documented with a postoperative magnetic resonance imaging. RESULTS Mean age for the study group was 62.9 ± 9.2 years and the male/female ratio was 4:9. A total of 30 levels were decompressed, with 18 patients (60%) undergoing decompression at L4-L5, 9 at L5-S1 (30%), 2 at L3-L4 (6.7%), and 1 at L2-L3 (3.3%). Mean estimated blood loss was 27 ± 15 mL per level. Mean operative duration was 48 ± 12 minutes/level. Visual analog scale leg score improved from 7.7 ± 1 to 1.8 ± 0.8 (P < 0.0001). Oswestry Disability Index improved from 64.4 ± 5.8 to 21 ± 4.5 (P < 0.0001). Mean follow-up of the study was 13.7 ± 2.7 months. According to the MacNab criteria, 10 patients (38.5%) had good results, 14 patients (53.8%) had excellent results, and 2 patients (7.7%) had fair results. One patient required revision surgery. CONCLUSIONS Facet-preserving contralateral foraminotomy and lateral recess decompression with PECILF is effective for treatment of lateral recess and foraminal stenosis. Thorough decompression with acceptable early clinical outcomes and minimal perioperative morbidity can be obtained with the contralateral endoscopic approach.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, South Korea
| | - Ravish Patel
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, South Korea.
| | - Byapak Paudel
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, South Korea
| | - Jee-Soo Jang
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, South Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
| | - Seong-Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, South Korea
| | - Jae Eun Park
- Nanoori Medical Research Institute, Nanoori Hospital, Seoul, South Korea
| | - Sol Lee
- Nanoori Medical Research Institute, Nanoori Hospital, Seoul, South Korea
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Bouras T, Zairi F, Loufardaki M, Triffaux M, Stranjalis G. Which functional outcome parameters correlate better with elderly patients' satisfaction after non-fusion lumbar spine surgery? J Neurosurg Sci 2017; 63:365-371. [PMID: 28699719 DOI: 10.23736/s0390-5616.17.03977-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Elderly patients are increasingly operated for spinal degenerative diseases. The treatment objective is quality of life, which, in this population, is difficult to assess. Hence, patient satisfaction, although less objective, is of high importance. In this study, we have examined the relation of various functional parameters after non-fusion spinal surgery, with patient satisfaction. METHODS A 5-year follow-up after non-fusion lumbar spine surgery on 185 elderly patients was performed. Demographics, co-morbidity factors, type of lesion and operation performed were recorded. The Oswestry Disability Index (ODI) was calculated. Also, walking distance, use of analgesics, daily activities, social life and patient mobility were assessed by means of study-specific stratified pain-independent questionnaires. Finally, patient satisfaction was assessed by the single-item satisfaction question. RESULTS Postoperative ODI, and the improvement regarding ODI, analgesic use and walking distance indices were independent factors influencing patient satisfaction. The insertion of pain analog scale score into this model altered the results, and along with this score, only the walking distance improvement remained an independent statistically significant factor. When the independent from pain scales were used, the improvement of the walking distance score were independently related to the satisfaction of the elderly. CONCLUSIONS ODI is applicable in elderly patients, even with the exception of some of the categories assessed. Walking capacity should be assessed separately from other pain-dependent activities; its improvement should be an independent goal of lumbar spine surgery in the elderly. The level of the elderly patient subjectivity in auto-assessing the outcome of lumbar spine surgery is high, and objective outcome measurements remain important.
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Affiliation(s)
- Triantafyllos Bouras
- Department of Neurosurgery, Hospital of Wallonia and Picardy (CHWAPI), Tournai, Belgium -
| | - Fahed Zairi
- Department of Neurosurgery, Roger Salengro Hospital, Lille University Hospital, Lille, France
| | - Maria Loufardaki
- Prof. Petros Kokkalis Hellenic Center of Neurosurgical Research, Athens, Greece
| | - Michel Triffaux
- Department of Neurosurgery, Hospital of Wallonia and Picardy (CHWAPI), Tournai, Belgium
| | - George Stranjalis
- Prof. Petros Kokkalis Hellenic Center of Neurosurgical Research, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece
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Stand-alone Lateral Recess Decompression Without Discectomy in Patients Presenting With Claudicant Radicular Pain and MRI Evidence of Lumbar Disc Herniation: A Prospective Study. Spine (Phila Pa 1976) 2017; 42:984-991. [PMID: 27792115 DOI: 10.1097/brs.0000000000001944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE The aim of this study was to analyze the outcomes of stand-alone lateral recess decompression without discectomy in patients with claudicant radicular pain and magnetic resonance imaging (MRI) showing LRS (lateral recess stenosis) with lumbar disc herniation. SUMMARY OF BACKGROUND DATA Discectomy is the gold standard treatment for symptomatic lumbar disc herniations refractory to conservative care. Typically, patients with positive SLR (Straight leg raising test) and flexion dominant leg pain are the ideal candidates who can be benefited from discectomy. There is a subset of patients with morphological features of lumbar disc herniation with LRS on MRI and presenting with diametrically opposite symptoms such as claudicant leg pain, extension dominant leg pain, relief on flexion, and a negative SLR. Until now, no focused prospective study in the literature highlights stand-alone lateral recess decompression in this group of patients. METHODS From January 2007 to June 2013, 55 patients having unilateral claudicant radicular pain were selected to undergo stand-alone lateral recess decompression with tubular retractors. Intraoperatively, disc consistency and presence of sequestrated fragments were analyzed. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) score, and Macnab criteria were used to measure outcomes. RESULTS Out of 55 patients, stand-alone lateral recess decompression was successfully executed in 51 patients and remaining four patients had sequestrated discs that required removal. Mean age at presentation was 54.5 years (41-67 years), male:female ratio was 1.12:1, and mean follow-up was 3.8 years (3-5.8 years). Significant improvement (P < 0.0001) was noticed between preoperative and postoperative VAS score (8.39 ± 0.84 vs. 2.5 ± 0.48) and ODI score (46.79 ± 1.85 vs. 18.71 ± 2.41). As per Macnab criteria, 94% patients were satisfied with surgery. CONCLUSION Stand-alone lateral recess decompression without discectomy is clinically effective for a large majority of patients with claudicant radicular pain and MRI evidence of LRS with associated lumbar disc herniation. The ability to perform it with minimal invasive techniques makes it focused and targeted with minimal morbidity. LEVEL OF EVIDENCE 4.
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Berven S, DiGiorgio A. The Case for Deformity Correction in the Management of Radiculopathy with Concurrent Spinal Deformity. Neurosurg Clin N Am 2017; 28:341-347. [PMID: 28600009 DOI: 10.1016/j.nec.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The management of adult deformity varies significantly. Options range from nonoperative care to limited decompression to decompression with limited or extensive fusion. The appropriate surgical management is the approach that optimizes the likelihood of improvement in health-related quality of life, while limiting risks of complications and costs. Decompression alone is unreliable in the setting of significant deformity contributing to radiculopathy. Decompression with limited fusion is most appropriate for patients with age-appropriate global alignment of the spine, and decompression with more extensive fusion is most appropriate for patients with progressive deformity or with global sagittal or coronal malalignment.
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Affiliation(s)
- Sigurd Berven
- Department of Orthopaedic Surgery, UC San Francisco, 500 Parnassus Avenue, MU320W, San Francisco, CA 94143-0728, USA.
| | - Anthony DiGiorgio
- Department of Orthopaedic Surgery, UC San Francisco, 500 Parnassus Avenue, MU320W, San Francisco, CA 94143-0728, USA
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Gaudin D, Krafcik BM, Mansour TR, Alnemari A. Considerations in Spinal Fusion Surgery for Chronic Lumbar Pain: Psychosocial Factors, Rating Scales, and Perioperative Patient Education—A Review of the Literature. World Neurosurg 2017; 98:21-27. [DOI: 10.1016/j.wneu.2016.10.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 01/22/2023]
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Evaluation of Coflex interspinous stabilization following decompression compared with decompression and posterior lumbar interbody fusion for the treatment of lumbar degenerative disease: A minimum 5-year follow-up study. J Clin Neurosci 2017; 35:24-29. [PMID: 27815024 DOI: 10.1016/j.jocn.2016.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/17/2016] [Accepted: 09/21/2016] [Indexed: 11/20/2022]
Abstract
Few studies have compared the clinical and radiological outcomes between Coflex interspinous stabilization and posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease. We compared the at least 5-year clinical and radiological outcomes of Coflex stabilization and PLIF for lumbar degenerative disease. Eighty-seven consecutive patients with lumbar degenerative disease were retrospectively reviewed. Forty-two patients underwent decompression and Coflex interspinous stabilization (Coflex group), 45 patients underwent decompression and PLIF (PLIF group). Clinical and radiological outcomes were evaluated. Coflex subjects experienced less blood loss, shorter hospital stays and shorter operative time than PLIF (all p<0.001). Both groups demonstrated significant improvement in Oswestry Disability Index and visual analogue scale back and leg pain at each follow-up time point. The Coflex group had significantly better clinical outcomes during early follow-up. At final follow-up, the superior and inferior adjacent segments motion had no significant change in the Coflex group, while the superior adjacent segment motion increased significantly in the PLIF group. At final follow-up, the operative level motion was significantly decreased in both groups, but was greater in the Coflex group. The reoperation rate for adjacent segment disease was higher in the PLIF group, but this did not achieve statistical significance (11.1% vs. 4.8%, p=0.277). Both groups provided sustainable improved clinical outcomes for lumbar degenerative disease through at least 5-year follow-up. The Coflex group had significantly better early efficacy than the PLIF group. Coflex interspinous implantation after decompression is safe and effective for lumbar degenerative disease.
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Wen B, Zhang X, Zhang L, Huang P, Zheng G. Percutaneous endoscopic transforaminal lumbar spinal canal decompression for lumbar spinal stenosis. Medicine (Baltimore) 2016; 95:e5186. [PMID: 27977571 PMCID: PMC5268017 DOI: 10.1097/md.0000000000005186] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study aimed to evaluate the safety and curative effect of percutaneous endoscopic transforaminal lumbar spinal canal decompression in the treatment of lumbar spinal stenosis.This retrospective study recruited 64 patients with lumbar spinal stenosis who underwent percutaneous endoscopic lumbar spinal canal decompression via surgical approach of posterolateral intervertebral foramen. The postoperation neurological function and pain status were evaluated by the visual analog scale (VAS) score of pain and the Oswestry disability index (ODI), and the patient satisfaction was evaluated according to the MacNab outcome criteria. The data, including preoperative comorbidities, operation time, the quantity of bleeding, bed rest time, and intraoperative and postoperative complications, were recorded.The mean operation time was 78 min, the mean quantity of bleeding was 20 mL and bed rest time was 6 h to 3 days. All patients were followed-up for 4 months to 5 years. The mean preoperative VAS score was 7.7 ± 1.2, while postoperative 3 months, 6 months, and final follow-up VAS scores were 2.8 ± 0.7, 2.1 ± 0.6, and 0.8 ± 0.6, respectively (P < 0.001). The mean preoperative ODI score was 72.4 ± 1.2, while postoperative 3 months, 6 months, and final follow-up ODI scores were 29.7 ± 4.9, 23.9 ± 4.0, and 12.5 ± 3.9, respectively (P < 0.001). The excellent and good rate reached 73.4% at the final follow-up.The percutaneous endoscopic transforaminal lumbar spinal canal decompression is an easy, safe, and effective minimally invasive surgery for patients with lumbar spinal stenosis.
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Affiliation(s)
- Bingtao Wen
- Department of Orthopedics, Peking University International Hospital
| | - Xifeng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Lin Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Peng Huang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Guoquan Zheng
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Abstract
STUDY DESIGN Prospective noninterventional observation. OBJECTIVE To examine factors that influence a patient's real decision to accept the offer of surgery for lumbar spinal stenosis in a relatively controlled situation. SUMMARY OF BACKGROUND DATA A patient's decision to undergo spine surgery might be influenced by factors other than pathology. However, there is limited research exploring the decision. METHODS A study performed for other purposes recruited persons aged 55-90 years with medical record evidence of an offer of surgery for spinal stenosis by a university faculty surgeon. Inclusion criteria included neurogenic claudication, subjectively positive imaging, and difficulty walking 200 yards. Potential subjects with additional disabling conditions (eg, lower limb amputation), conditions that might mimic stenosis (eg, polyneuropathy), or some contraindications to invasive treatment (eg, anticoagulation) were excluded. Subjects filled out questionnaires on function, quality of life, pain, and health, and were examined by a spine surgeon masked to diagnostic category (Other recruits had back pain or no symptoms). Telephone follow-up 6-12 months later determined whether surgery was done. RESULTS Of 39 qualifying subjects, 20 followed through with surgery. A binary logistic regression revealed that significant factors that influence patient decision making included SF-36 measures of "Comparative Health" and "Role Limit Emotional" as well as the subject's overall perception of their quality of life. The combination of all 3 factors yielded a predictive model (P=0.031). Individually, however, only "Comparative Health" was significant and able to predict a decision to proceed with surgery (P=0.036). CONCLUSIONS In this population with significant disability, uncomplicated medical history, and a relatively clear diagnosis, the decision to accept surgical intervention was influenced by issues of perceived overall health and quality of life. Interventions to change real or perceived overall health may impact patient acceptance of surgery.
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Davis N, Hourigan P, Clarke A. Transforaminal epidural steroid injection in lumbar spinal stenosis: an observational study with two-year follow-up. Br J Neurosurg 2016; 31:205-208. [PMID: 27548310 DOI: 10.1080/02688697.2016.1206188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND CONTEXT Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. PURPOSE To evaluate the use of TFESI as an alternative to surgery in patients with symptomatic stenosis. STUDY DESIGN/SETTING An observational study which took place between May 2010 and July 2013. All patients were seen by the Extended Scope Physiotherapist (ESP) injection service. PATIENT SAMPLE A total of 68 consecutive patients were included. Thirty-one were male and 37 were female. The average age was 75 years. OUTCOME MEASURES The primary outcome measure was the avoidance of decompressive surgery. METHODS Patients with radicular leg pain were seen by an ESP in an Outpatient setting. Concordant clinical examination and magnetic resonance imaging were required for diagnosis. Peri-radicular bupivacaine hydrochloride 0.25% (3 ml) and triamcinolone (40 mg) were then injected. Outcome measures were recorded at 6 weeks, 1 year and 2 years. RESULTS Of 68 patients with spinal stenosis, 22 (32%) had opted for surgery at two year follow-up. Thirty (44%) patients were satisfied with non-surgical management at 2 years, required no further treatment, and were discharged. Of the remaining 24%, nine patients were referred for further injection, four declined surgery but were referred to the Pain Relief Clinic, two still had a similar level of pain but declined surgery and one had died. CONCLUSIONS Our study reports a considerably lower percentage patients opting for surgery than previously demonstrated by the available literature. TFESI is a reasonable treatment for lumbar spinal stenosis and can result in long-term relief from symptoms in a high proportion of patients.
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Affiliation(s)
- Niel Davis
- a Specialist Registrar in Trauma and Orthopaedics , Royal Devon and Exeter Hospital , UK
| | - Patrick Hourigan
- b Extended Scope Physiotherapist , Royal Devon and Exeter Hospital , UK
| | - Andrew Clarke
- c Consultant Spinal Orthopaedic Surgeon , Royal Devon and Exeter Hospital , UK
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Two Portal Percutaneous Endoscopic Decompression for Lumbar Spinal Stenosis: Preliminary Study. Asian Spine J 2016; 10:335-42. [PMID: 27114776 PMCID: PMC4843072 DOI: 10.4184/asj.2016.10.2.335] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/29/2022] Open
Abstract
Study Design Retrospective. Purpose To report the outcomes of patients with lumbar spinal stenosis treated with percutaneous endoscopic decompression, focusing on the results of clinical evaluations. Overview of Literature There are no studies about two portal percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis. Methods Medical and surgical complications were examined and clinical results were analyzed for 30 patients who consecutively underwent two portal percutaneous endoscopic decompression for lumbar spinal stenosis were reviewed. The operations were performed by unilateral laminotomy for bilateral decompression. Results All patients displayed clinical improvement when were evaluated with visual analog scale (VAS) score of pain, Oswestry disability index (ODI) and Macnab criteria. The improvement of VAS and ODI was 8.3±0.7 to 2.3±2.6 and 65.2±13.7 to 24.0±15.5, respectively (both p<0.05). Complications were the same as for open decompression. The most common complication was transient nerve root paresthesia. Conclusions Surgical decompression with two portal percutaneous endoscopic decompression has initial benefits, but long-term studies should pay more attention to the risks of postoperative instability and restenosis as well as the need for re-operation. Further investigations with long-term results are thus required.
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Influence of previous surgery on patient-rated outcome after surgery for degenerative disorders of the lumbar spine. 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 2016; 25:2553-62. [DOI: 10.1007/s00586-016-4383-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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Pakarinen M, Sinikallio S, Koivumaa-Honkanen H, Aalto T, Airaksinen O, Lehto SM, Viinamäki H. Low sense of coherence during postoperative recovery is associated with a poorer lumbar spinal stenosis - surgical outcome: A 5-year follow-up study. J Health Psychol 2015; 22:347-355. [PMID: 26430067 DOI: 10.1177/1359105315603471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated the association between the 3-month postoperative sense of coherence and the 5-year postoperative outcome of decompressive surgery for lumbar spinal stenosis. The participants with a lower sense of coherence at the 3-month follow-up had a poorer functional ability and lower satisfaction with surgery, higher pain ratings, lower life satisfaction and more depressive symptoms 5 years postoperatively. A low 3-month sense of coherence associated with greater pain and a poorer functional ability 5 years postoperatively. Evaluating sense of coherence and depressive symptoms in patients who have had lumbar spinal stenosis surgery may help in identifying those in need of enhanced support for postoperative recovery.
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Affiliation(s)
- Maarit Pakarinen
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland
| | | | - Heli Koivumaa-Honkanen
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland.,3 South-Savonia Hospital District, Finland.,4 North Karelia Central Hospital, Finland.,5 SOSTERI, Finland.,6 SOTE, Finland
| | | | | | - Soili M Lehto
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland
| | - Heimo Viinamäki
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland
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Prognostic Factors of Surgical Outcome after Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis. Asian Spine J 2015; 9:705-12. [PMID: 26435788 PMCID: PMC4591441 DOI: 10.4184/asj.2015.9.5.705] [Citation(s) in RCA: 9] [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: 02/01/2015] [Revised: 02/16/2015] [Accepted: 02/20/2015] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN A retrospective case review. PURPOSE To assess the clinical and radiographic outcomes and identify the predictive factors associated with poor clinical outcomes after lumbar spinous process-splitting laminectomy (LSPSL) for lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE LSPSL is an effective surgical treatment for LSS. Special care should be taken in patients with degenerative lumbar scoliosis (DLS). METHODS A consecutive retrospective case review of patients undergoing LSPSL for LSS with a minimum 2-year follow-up was performed. Mild DLS and mild degenerative spondylolisthesis (DS) were included in the study. The Japanese Orthopedic Association (JOA) score and recovery rate were reviewed. Poor clinical outcome was defined as a recovery rate <50% using Hirabayashi's method. RESULTS A total of 52 patients (mean age, 72 years) met the inclusion criteria and had a mean follow-up of 2.6 years (range, 2-4.5 years). The preoperative diagnosis was LSS in 19, DS in 19, and DLS in 14 cases. The mean JOA score significantly increased from 14.6 to 23.2 at the final follow-up. The overall mean recovery rate was 60.1%. Thirteen patients (25%) were assigned to the poor outcome group. A higher rate of pre-existing DLS was observed in the poor outcome (poor) group (good, 15%; poor, 62%; p=0.003) than in the good outcome (good) group. None of the patient factors examined were associated with a poor outcome. A progression of slippage ≥5 mm was found in 8 of 24 patients (33%) in the DS group. A progression of curvature ≥5° was found in 5 of 14 patients (36%) in the DLS group. The progression of scoliosis and slippage did not influence the clinical outcome. CONCLUSIONS The clinical and radiographic outcomes of LSPSL for LSS were favorable. Pre-existing DLS was significantly associated with poor clinical outcome.
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den Boogert HF, Keers JC, Marinus Oterdoom DL, Kuijlen JMA. Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction. J Neurosurg Spine 2015; 23:326-35. [DOI: 10.3171/2014.12.spine13994] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two popular techniques are rare. To address this shortcoming, this study compares postoperative functional disability, pain, and patient satisfaction among patients with single-level DLSS who underwent bilateral decompression using either a bilateral or unilateral approach.
METHODS
This retrospective study included patients who underwent operations between November 1, 2009, and October 1, 2011. These patients underwent single-level bilateral decompressive surgery using either the bilateral or unilateral interlaminar approach at one of 5 participating hospitals. Exclusion criteria included previous lumbar surgery, additional disc surgery, and spondylolisthesis requiring fusion surgery. Primary outcome measures included bodily pain (as reported using the visual analog scale [VAS]), the Roland-Morris Disability Questionnaire (RMDQ), and the Oswestry Disability Index (ODI). In addition, reductions in leg and back symptoms and the patient’s general evaluation of the procedure were queried. Finally, patient satisfaction and surgical parameters were evaluated. Questionnaires were sent to each patient’s home, and electronic patient files were used to collect the data.
RESULTS
One hundred and seventy-five patients returned the questionnaire (74.4% response rate; 68 and 107 patients who underwent the bilateral or unilateral approach, respectively). Mean age at surgery was 68 years (range 34–89 years), and the mean follow-up period was 14.2 months (range 3.3–27.4 years). There were no significant differences in ODI (20.3 vs 22.6 for the bilateral and unilateral approaches, respectively), RMDQ (3.99 vs 4.8, respectively), or pain scores between treatment groups. Back symptoms were reduced in 74.8% (bilateral: 74.6% vs unilateral: 75%; not significant), and leg symptoms in 80.6% of the patients (bilateral: 73.1% vs unilateral: 85.4%; p = 0.048). In total, 72.1% (bilateral) and 80.0% (unilateral) of patients reported good overall treatment results (p = 0.226). Significantly more patients in the unilateral group reported a better overall satisfaction with the procedure (82.1% vs 69.1%; p = 0.047).
CONCLUSIONS
There were no differences in postoperative functional disability and pain between the surgical techniques. The significant differences in patient satisfaction and reduction in leg symptoms were unrelated to surgical technique. The overall treatment results were satisfactory. Both techniques are safe and effective options for treating patients with single-level DLSS.
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Affiliation(s)
| | | | - D. L. Marinus Oterdoom
- 1Department of Neurosurgery, University Medical Center Groningen; and
- 3Department of Neurosurgery, Martini Hospital Groningen, The Netherlands
| | - Jos M. A. Kuijlen
- 1Department of Neurosurgery, University Medical Center Groningen; and
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Abstract
STUDY DESIGN Bibliometric review of the literature. OBJECTIVE To analyze and quantify the most frequently cited papers in lumbar spine surgery and to measure their impact on the entire lumbar spine literature. SUMMARY OF BACKGROUND DATA Lumbar spine surgery is a dynamic and complex field. Basic science and clinical research remain paramount in understanding and advancing the field. While new literature is published at increasing rates, few studies make long-lasting impacts. METHODS The Thomson Reuters Web of Knowledge was searched for citations of all papers relevant to lumbar spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each paper. RESULTS The most cited paper was found to be the classic paper from 1990 by Boden et al that described magnetic resonance imaging findings in individuals without back pain, sciatica, and neurogenic claudication showing that spinal stenosis and herniated discs can be incidentally found when scanning patients. The second most cited study similarly showed that asymptomatic patients who underwent lumbar spine magnetic resonance imaging frequently had lumbar pathology. The third most cited paper was the 2000 publication of Fairbank and Pynsent reviewing the Oswestry Disability Index, the outcome-measure questionnaire most commonly used to evaluate low back pain. The majority of the papers originate in the United States (n=58), and most were published in Spine (n=63). Most papers were published in the 1990s (n=49), and the 3 most common topics were low back pain, biomechanics, and disc degeneration. CONCLUSION This report identifies the top 100 papers in lumbar spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the lumbar spine and the body of knowledge used to guide evidence-based clinical decision making in lumbar spine surgery today. LEVEL OF EVIDENCE 3.
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Assaker R, Zairi F. Failed back surgery syndrome: to re-operate or not to re-operate? A retrospective review of patient selection and failures. Neurochirurgie 2015; 61 Suppl 1:S77-82. [PMID: 25662850 DOI: 10.1016/j.neuchi.2014.10.108] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Persisting pain after spine surgery remains a challenge for the patient and the pain physician. The etiology depends on age, pathology and the interval between the first and the revision surgery. In young patients who underwent initially to discectomy, the etiology of failed back surgery syndrome (FBSS) is commonly a recurrence of herniation whereas in the elderly population, who has previously undergone a spinal fusion, persisting pain might be due to secondary sagittal unbalance associated, as a consequence, to adjacent disc disease or pseudarthrosis. OBJECTIVE To review the etiology of failed back surgery syndrome and to discuss the radiological work-up and the treatment strategies. METHODS Retrospective analysis of 39 consecutive patients diagnosed with FBSS. For all cases, the following parameters were reviewed: original diagnosis and initial surgery, interval between the last surgery and the revision procedure, final diagnosis after revision. Treatment options were discussed. RESULTS Twelve patients have undergone decompressive procedures and 27 had one or multilevel fusion for various back and/or leg pain. In group 1 (decompressive surgery), the mean age of patients who had a disc herniation was 42.2 years and 69 years for patients who had laminectomies for lumbar stenosis. In group 2 (fusion), the mean age was 63.3. Loss of lumbar lordosis in elderly after one or several laminectomy(ies) was found to be a cause of failure because of sagittal kyphosis and consecutive back pain. In the fused group, suboptimal correction of lumbar lordosis could generate a pseudarthrosis, proximal junctional kyphosis and persisting pain. CONCLUSION Dealing with FBSS patients is far from simple but it corresponds to daily practice for spine surgeons. Clinical and radiological assessments should include a full diagnostic work-up focusing on sagittal balance. Surgical treatment and re-operation might be an option if a consistent source of pain is detected.
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Affiliation(s)
- R Assaker
- Department of Neurosurgery, Roger Salengro Teaching Hospital, 59037 Lille, France.
| | - F Zairi
- Department of Neurosurgery, Roger Salengro Teaching Hospital, 59037 Lille, France
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Kanbara S, Yukawa Y, Ito K, Machino M, Kato F. Surgical outcomes of modified lumbar spinous process-splitting laminectomy for lumbar spinal stenosis. J Neurosurg Spine 2015; 22:353-7. [PMID: 25594729 DOI: 10.3171/2014.9.spine1457] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The lumbar spinous process-splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined. The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p < 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively. The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy.
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Affiliation(s)
- Shunsuke Kanbara
- Department of Orthopedic Surgery, Chutoen General Medical Center, Shizuoka; and
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Nikitin AS, Asratyan SA, Kamchatnov PR. Stenosis of the vertebral canal in the lower spine. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:130-140. [DOI: 10.17116/jnevro201511571130-140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Knight MTN, Jago I, Norris C, Midwinter L, Boynes C. Transforaminal endoscopic lumbar decompression & foraminoplasty: a 10 year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery. Int J Spine Surg 2014; 8:14444-1021. [PMID: 25694924 PMCID: PMC4325492 DOI: 10.14444/1021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Conventional diagnosis between axial and foraminal stenosis is suboptimal and long-term outcomes limited to posterior decompression. Aware state Transforaminal Endoscopic Lumbar Decompression and Foraminoplasty (TELDF) offers a direct aware state means of localizing and treating neuro-claudicant back pain, referred pain and weakness associated with stenosis failing to respond to conventional rehabilitation, pain management or surgery. This prospective survivability study examines the outcomes 10 years after TELDF in patients with foraminal stenosis arising from degeneration or failed back surgery. Methods For 10 years prospective data were collected on 114 consecutive patients with multilevel spondylosis and neuro-claudicant back pain, referred pain and weakness with or without failed back surgery whose symptoms had failed to respond to conventional rehabilitation and pain management and who underwent TELDF. The level responsible for the predominant presenting symptoms of foraminal stenosis, determined on clinical grounds, MRI and or CT scans, was confirmed by transforaminal probing and discography. Patients underwent TELDF at the spinal segment at which the predominant presenting symptoms were reproduced. Those that required treatment at an additional segment were excluded. Outcomes were assessed by postal questionnaire with failures being examined by the independent authors using the Visual Analogue Pain Scale (VAPS), the Oswestry Disability Index (ODI) and the Prolo Activity Score. Results Cohort integrity was 69%. 79 patients were available for evaluation after removal of the deceased (12), untraceable (17) and decliners (6) from the cohort. VAP scores improved from a pre-operative mean of 7.3 to 2.4 at year 10. The ODI improved from a mean of 58.5 at baseline to 17.5 at year 10. 72% of reviewed patients fulfilled the definition of an “Excellent” or “Good Clinical Impact” at review using the Spinal Foundation Outcome Score. Based on the Prolo scale, 61 patients (77%) were able to return and continue in full or part-time work or retirement activity post-TELDF. Complications of TELDF were limited to transient nerve irritation, which affected 19% of the cohort for 2 – 4 weeks. TELDF was equally beneficial in those with failed back surgery. Conclusions TELDF is a beneficial intervention for the long-term treatment of severely disabled patients with neuro-claudicant symptoms arising from spinal or foraminal stenosis with a dural diameter of more than 3mm, who have failed to respond to conventional rehabilitation or chronic pain management. It results in considerable improvements in symptoms and function sustained 10 years later despite co-morbidity, ageing or the presence of failed back surgery. Clinical Relevance The long term outcome of TELDF in severely disabled patients with neuro-claudicant symptoms arising from foraminal stenosis which had failed to respond to conventional rehabilitation, surgery or chronic pain management suggests that foraminal pathology is a major cause of lumbar axial and referred pain and that TELDF should be offered as primary treatment for these conditions even in the elderly and infirm. The application of TELDF at multiple levels may further widen the benefits of this technique.
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Pakarinen M, Vanhanen S, Sinikallio S, Aalto T, Lehto SM, Airaksinen O, Viinamäki H. Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study. Spine J 2014; 14:2392-6. [PMID: 24486473 DOI: 10.1016/j.spinee.2014.01.047] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/29/2013] [Accepted: 01/17/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In lumbar spinal stenosis (LSS), conservative treatment is usually the first choice of treatment. If conservative treatment fails, surgery is indicated. Psychological factors such as depression and anxiety are known to affect the outcome of surgery. Previous studies on depression and surgery outcome using long follow-up times are scarce. PURPOSE The purpose of this study was to investigate the effect of depressive symptoms on the surgical outcome during a 5-year follow-up among patients with LSS. STUDY DESIGN A prospective observational study. PATIENT SAMPLE Patient sample included 102 LSS patients who needed surgical treatment. OUTCOME MEASURES The outcome of surgery was evaluated with the Oswestry Disability Index (ODI), visual analog scale pain assessment, and self-reported walking capacity. METHODS The patients completed a set of questionnaires preoperatively and 3 and 6 months, as well as 1, 2, and 5 years after the surgery. Depressive symptoms were assessed with the Beck Depression Inventory. The depressive burden was estimated by summing all individual Beck Depression Inventory scores. Statistical analyses included cross-sectional group comparisons and linear regression analyses. No conflicts of interest. RESULTS On 5-year follow-up, a high depressive burden associated with a poorer outcome of surgery when assessed with the ODI. In linear regression analysis, a high depressive burden associated with higher ODI score. CONCLUSIONS Even slightly elevated long-term depressive symptoms in LSS patients are associated with an increased risk of a poorer functional ability after decompressive surgery.
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Affiliation(s)
- Maarit Pakarinen
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
| | - Susanna Vanhanen
- Department of Physical and Rehabilitation Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Sanna Sinikallio
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Timo Aalto
- Kyyhkylä Rehabilitation Center, Mikkeli, Finland
| | - Soili M Lehto
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Olavi Airaksinen
- Department of Physical Medicine and Rehabilitation, Kuopio University Hospital, Kuopio, Finland
| | - Heimo Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Patil CG, Sarmiento JM, Ugiliweneza B, Mukherjee D, Nuño M, Liu JC, Walia S, Lad SP, Boakye M. Interspinous device versus laminectomy for lumbar spinal stenosis: a comparative effectiveness study. Spine J 2014; 14:1484-92. [PMID: 24291409 DOI: 10.1016/j.spinee.2013.08.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 07/16/2013] [Accepted: 08/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Currently no studies directly compare effectiveness between interspinous devices (IDs) and laminectomy in lumbar spinal stenosis (LSS) patients. PURPOSE To compare reoperations, complications, and costs between LSS patients undergoing ID placement versus laminectomy. STUDY DESIGN Retrospective comparative study. PATIENT SAMPLE The MarketScan database (2007-2009) was queried for adults with LSS undergoing ID placement as a primary inpatient procedure. OUTCOME MEASURES Reoperation rates, complication rates, and costs. METHODS Each ID patient was matched with a laminectomy patient using propensity score matching. Reoperations, complications, and costs were analyzed in patients with at least 18 months postoperative follow-up. The authors did not receive funding from any external sources for this study. RESULTS Among 498 inpatients that underwent ID placement between 2007 and 2009; the average age was 73 years. The cumulative reoperation rates after ID at 12 and 18 months were 21% and 23%, respectively. The average inpatient hospitalization lasted 1.6 days with an associated cost of $17,432. Two propensity-matched cohorts of 174 patients that had undergone ID versus laminectomy were analyzed. Longer length of stay was observed in the laminectomy cohort (2.5 days vs. 1.6 days, p<.0001), whereas ID patients accrued higher costs at index hospitalization ($17,674 vs. $12,670, p=.0001). Index hospitalization (7.5% vs. 3.5%, p=.099) and 90-day (9.2% vs. 3.5%, p=.028) complications were higher in the laminectomy cohort compared with the ID cohort. The ID patients had significantly higher reoperation rates than laminectomy patients at 12 months follow-up (12.6% vs. 5.8%, p=.026) and incurred higher cumulative costs than laminectomy patients at 12 months follow-up ($39,173 vs. $34,324, p=.289). CONCLUSIONS Twelve-month reoperation rates and index hospitalization costs were significantly higher among patients who underwent ID compared with laminectomy for LSS.
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Affiliation(s)
- Chirag G Patil
- Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA.
| | - J Manuel Sarmiento
- Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Suite 1103, Louisville, KY 40202, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA
| | - Miriam Nuño
- Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA
| | - John C Liu
- Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA
| | - Sartaaj Walia
- Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA
| | - Shivanand P Lad
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, 200 Trent Drive, Blue Zone- Room 4529, Durham, NC 27710, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Suite 1103, Louisville, KY 40202, USA; Roblex Rex VA Medical Center, 800 Zorn Ave., Louisville, KY 40206, USA
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Kang MH, Kim ER, Kim YG, Kim TH, Oh JS. The effects of lumbo-pelvic postural taping on gait parameters in patients with lumbar spinal stenosis. Clin Biomech (Bristol, Avon) 2014; 28:956-60. [PMID: 24168812 DOI: 10.1016/j.clinbiomech.2013.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered gait patterns with lumbar-flexed posture threaten the quality of life in patients with lumbar spinal stenosis; however, few studies have developed management strategies to improve gait patterns and lumbo-pelvic posture. The present study investigated the effects of lumbo-pelvic postural taping on pelvic tilt, spatiotemporal gait parameters, and pain during walking in patients with lumbar spinal stenosis. METHODS The pelvic tilt and gait parameters were assessed in 20 patients with lumbar spinal stenosis before sustained walking using a palpation meter and GAITRite system, respectively. Next, the participants were asked to walk on the ground for 20 min or until they complained of symptoms of neurogenic claudication. Pelvic tilt and gait parameters were measured immediately after the manifestation of neurogenic claudication followed by the application of lumbo-pelvic postural taping. The participants rated the pain intensity using a visual analog scale. Changes in dependent variables among the conditions were analyzed using a one-way repeated-measures analysis of variance. FINDINGS The results show a decreased pelvic anterior tilt, walking velocity, and step and stride lengths, as well as an increased base of support and pain after severe symptoms of neurogenic claudication (P<0.05). However, a greater pelvic anterior tilt, faster walking velocity with a longer step and stride length, and decreased base of support and pain were found after the application of postural taping (P≤0.001). INTERPRETATION These findings suggest that lumbo-pelvic postural taping can provide beneficial management for improving gait patterns and lumbo-pelvic posture in patients with lumbar spinal stenosis.
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Affiliation(s)
- Min-Hyeok Kang
- Department of Rehabilitation Science, Graduate School, INJE University, Gimhae, South Korea.
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Surgery for spinal stenosis: long-term reoperation rates, health care cost, and impact of instrumentation. Spine (Phila Pa 1976) 2014; 39:978-87. [PMID: 24718058 DOI: 10.1097/brs.0000000000000314] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To examine the complications, reoperation rates, and resource use after each of the surgical approaches for the treatment of spinal stenosis. SUMMARY OF BACKGROUND DATA There are no uniform guidelines for which procedure (decompression, decompression with instrumentation, or decompression with noninstrumented fusion) to perform for the treatment of spinal stenosis. With no clear evidence for increased efficacy, the rate of instrumented fusions is rising. METHODS We performed a retrospective cohort analysis of patients who underwent spinal stenosis surgery between 2002 and 2009 in the United States. Patients included (n = 12,657) were diagnosed with spinal stenosis without concurrent spondylolisthesis and had at least 2 years of preoperative enrollment. A total of 2385 patients with decompression only and 620 patients with fusion had follow-up data for 5 years or more. RESULTS Complication rates during the initial procedure hospitalization and at 90 days were significantly higher for those who underwent laminectomy with fusion than for those who underwent laminectomy alone, with reoperation rates not differing significantly between these groups. Long-term (≥5 yr) reoperation rates were similar for those undergoing decompression alone versus decompression with fusion (17.3% vs. 16.0%, P = 0.44). Those with instrumented fusions had a slightly higher rate of reoperation than patients with noninstrumented fusions (17.4% vs. 12.2%, P = 0.11) at more than 5 years. The total cost including initial procedure and hospital, outpatient, emergency department, and medication charges at 5 years was similar for those who received decompression alone and fusion. The long-term costs for instrumented and noninstrumented fusions were also similar, totaling $107,056 and $100,471, respectively. CONCLUSION For patients with spinal stenosis, if fusion is warranted, use of arthrodesis without instrumentation is associated with decreased costs with similar long-term complication and reoperation rates.
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