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Muthu S, Ćorluka S, Buser Z, Malcolm JG, Luo Z, Gollahalli Shivashankar P, Ambrosio L, Griffoni C, Demetriades AK, Ivandić S, Wu Y, Wang J, Meisel HJ, Yoon TS. Rate of Reoperation Following Decompression-Only Procedure for Lumbar Degenerative Spondylolisthesis: A Systematic Review of Literature. JB JS Open Access 2024; 9:e23.00163. [PMID: 38974406 PMCID: PMC11221853 DOI: 10.2106/jbjs.oa.23.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Management of lumbar degenerative spondylolisthesis with decompression-only procedure has been performed for its added benefit of a shorter duration of surgery, lower blood loss, and shorter hospital stay. However, reported failure rates for decompression-only procedures vary depending on the methods utilized for decompression. Hence, we aim to identify the failure rates of individual methods of decompression-only procedures performed for degenerative lumbar spondylolisthesis. Methods An independent systematic review of 4 scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis guidelines. Studies reporting on failure rates defined by reoperation at the index level following decompression-only procedure for degenerative lumbar spondylolisthesis were included for analysis. Studies were appraised using ROBINS tool of Cochrane, and analysis was performed using the Open Meta[Analyst] software. Results The overall failure rate of decompression-only procedure was 9.1% (95% confidence interval [CI] [6.5-11.7]). Furthermore, open decompression had failure rate of 10.9% (95% CI [6.0-15.8]), while microendoscopic decompression had failure rate of 6.7% (95% CI [2.9-10.6]). The failure rate gradually increased from 6.9% (95% CI [2.0-11.7]) at 1 year to 7% (95% CI [3.6-10.3]), 11.7% (95% CI [4.5-18.9]), and 11.7% (95% CI [6.6-16.7]) at 2, 3, and 5 years, respectively. Single level decompression had a failure rate of 9.6% (95% CI [6.3-12.9]), while multilevel decompression recorded a failure rate of 8.7% (95% CI [5.6-11.7]). Conclusion High-quality evidence on the decompression-only procedure for degenerative spondylolisthesis is limited. The decompression-only procedure had an overall failure rate of 9.1% without significant differences between the decompression techniques. Level of Evidence Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sathish Muthu
- Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Faculty of Engineering, Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
| | - Stipe Ćorluka
- Spinal Surgery Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York
| | | | - Zhuojing Luo
- Department of Orthopeadic Surgery, Xijing Hospital, China
| | | | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andreas K. Demetriades
- Department of Neurosurgery, Edinburgh Spinal Surgery Outcome Studies Group, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Stjepan Ivandić
- Spinal Surgery Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hans-Jorg Meisel
- Department of Neurosurgery, Bergmannstrost Hospital, Halle, Germany
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Diebo BG, Balmaceno-Criss M, Lafage R, McDonald CL, Alsoof D, Halayqeh S, DiSilvestro KJ, Kuris EO, Lafage V, Daniels AH. Sagittal Alignment in the Degenerative Lumbar Spine: Surgical Planning. J Bone Joint Surg Am 2024; 106:445-457. [PMID: 38271548 PMCID: PMC10906213 DOI: 10.2106/jbjs.23.00672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.
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Affiliation(s)
- Bassel G. Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Christopher L. McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sereen Halayqeh
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kevin J. DiSilvestro
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eren O. Kuris
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Kanematsu R, Hanakita J, Takahashi T, Minami M, Miyasaka K, Shimauchi-Ohtaki H, Tomita Y. Severe low back pain with mild leg symptoms due to lumbar spine stenosis. Br J Neurosurg 2024; 38:35-38. [PMID: 33463390 DOI: 10.1080/02688697.2020.1868402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Some patients with lumbar spine stenosis (LSS) have severe low back pain (LBP) with only mild leg symptoms. The effects of decompression surgery for such patients remain unknown. METHODS Of 818 patients with LSS who underwent surgical treatment in our institution from 2011 to 2019, eight patients had a numeric rating scale (NRS) score of ≥7 for LBP and 3≤ for leg pain. The patients' age, sex, clinical characteristics, preoperative leg symptoms, and level of LSS were investigated. The detailed characteristics of LBP, such as the disease duration, location of LBP, and exacerbating factors, were obtained from each patient. The NRS and Japanese Orthopaedic Association (JOA) scores for LBP were evaluated on admission, at 1 and 3 months postoperatively, and at the final follow-up (>1 year postoperatively). RESULTS All patients were male with a mean age of 71.5 years (range, 57-82 years). LBP was exacerbated during walking in six patients and during an extension posture in three patients. The median duration of LBP was 2.9 years (range, 0.3-7 years). The stenosis was located at L2/3 in three patients, L3/4 in five patients, and L4/5 in seven patients. The stenosis involved one level in three patients and more than two levels in five patients. Other pathologies, such as sacroiliac joint lesions, facet pain, superior/middle cluneal nerve pain, and discogenic pain, were excluded by diagnostic anesthetic block and detailed physical examination. All patients underwent posterior decompression surgery without fusion. In all eight patients, the NRS score for LBP significantly improved from 7.6 (range, 7-10) to 1.7 (range, 0-3) and the JOA score improved from 13.1 (range, 4-19) to 21.8 (range, 18-27). CONCLUSION A low proportion of patients showed walking-evoked severe LBP with mild leg symptoms due to lumbar spine stenosis. The patients' pain was improved by decompression surgery with satisfactory results.
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Affiliation(s)
- Ryo Kanematsu
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Junya Hanakita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Toshiyuki Takahashi
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Manabu Minami
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Kazuhiro Miyasaka
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | | | - Yosuke Tomita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
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Mui T, Iwata E, Nakajima H, Sada T, Tanaka M, Okuda A, Kawasaki S, Shigematsu H, Tanaka Y. Central sensitization adversely affects quality of recovery following lumbar decompression surgery. J Orthop Sci 2024; 29:78-82. [PMID: 36526518 DOI: 10.1016/j.jos.2022.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/17/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central sensitization (CS) is defined as increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. The CS phenomenon is caused by continuous, intense nociceptor inputs triggering a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in the central nociceptive pathway. Most patients undergoing surgery for lumbar spinal stenosis (LSS) experience symptoms for more than three months; therefore, it is possible that CS is associated with postoperative symptoms of LSS. The aim of this study was to clarify the influence of CS in patients who underwent surgery for LSS. METHODS We used the Central Sensitization Inventory (CSI) to evaluate CS preoperatively. Clinical and neurological symptoms were assessed before surgery and three months after surgery using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI). To evaluate the correlation between the preoperative CSI score and each parameter of the JOA-BPEQ before and three months after surgery, a Pearson correlation coefficient was used. We also evaluated the correlation between preoperative CSI and improvement scores for each parameter of the JOA-BPEQ for surgery. Similarly, the ODI was assessed. RESULTS This study included 118 patients. After surgery, the parameters of lumbar function disorder, social life function disorder, and mental health disorder revealed a statistically significant relationship (r = -0.289, -0.0354, and -0.493, respectively). There was no significant correlation between CSI and improvement scores of the JOA-BPEQ. The ODI assessment after surgery revealed a statistically significant relationship (r = 0.344). There was no significant correlation between the CSI and ODI improvement scores. CONCLUSION This study showed that the severity of the CSI influenced the postoperative outcomes, and that surgical treatment improved the symptoms of LSS regardless of the occurrence of CS preoperatively.
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Affiliation(s)
- Takahiro Mui
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Eiichiro Iwata
- Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan.
| | - Hiroshi Nakajima
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Takuya Sada
- Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Sachiko Kawasaki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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Minetama M, Kawakami M, Teraguchi M, Matsuo S, Enyo Y, Nakagawa M, Yamamoto Y, Nakatani T, Sakon N, Nagata W, Nakagawa Y. MRI grading of spinal stenosis is not associated with the severity of low back pain in patients with lumbar spinal stenosis. BMC Musculoskelet Disord 2022; 23:857. [PMID: 36096768 PMCID: PMC9465904 DOI: 10.1186/s12891-022-05810-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although lumbar spinal stenosis (LSS) often coexists with other degenerative conditions, few studies have fully assessed possible contributing factors for low back pain (LBP) in patients with LSS. The purpose of this study was to identify factors associated with the severity of LBP in patients with LSS. Methods The patients with neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging (MRI) were included in this cross-sectional study. Data included ratings of LBP, buttock and leg pain, and numbness on a numerical rating scale (NRS), 36-item Short-Form Survey (SF-36) scores, muscle mass measured by bioelectrical impedance analysis, and radiographic measurements including lumbopelvic alignment and slippage. The severity of LSS, endplate defects, Modic endplate changes, intervertebral disc degeneration, and facet joint osteoarthritis were evaluated on MRI. Spearman correlation and multivariate linear regression analyses were used to examine the factors associated with the severity of LBP (NRS score). Results A total of 293 patients (135 male and 158 female, average age 72.6 years) were analyzed. LBP was moderately correlated with buttock and leg pain, and buttock and leg numbness. Significant but weak correlations were observed between LBP and body mass index, appendicular and trunk muscle mass, all domains of SF-36, pelvic tilt, total number of endplate defects and Modic endplate changes, and summary score of disc degeneration grading, but not severity or number of spinal stenoses. In the multivariate regression analysis, age, female sex, trunk muscle mass, diabetes, NRS buttock and leg pain, NRS buttock and leg numbness, SF-36 vitality, pelvic tilt, and total number of endplate defects were associated with the severity of LBP. Conclusions Trunk muscle mass, lumbopelvic alignment, and endplate defects, but not severity of stenosis are partly associated with severity of LBP, but buttock and leg pain and buttock and leg numbness have strongest relationships with LBP in patients with LSS.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan.
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan.,Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, 45 Jyunibancho, Wakayama, 640-8158, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yoshio Enyo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Wakana Nagata
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
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Endplate defects, not the severity of spinal stenosis, contribute to low back pain in patients with lumbar spinal stenosis. Spine J 2022; 22:370-378. [PMID: 34600109 DOI: 10.1016/j.spinee.2021.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT It is controversial whether lumbar spinal stenosis (LSS) itself contributes to low back pain (LBP). Lower truncal skeletal muscle mass, spinopelvic malalignment, intervertebral disc degeneration, and endplate abnormalities are thought to be related to LBP. However, whether these factors cause LBP in patients with LSS is unclear. PURPOSE To identify factors associated with LBP in patients with LSS. STUDY DESIGN/SETTING Cross-sectional design. PATIENT SAMPLE A total of 260 patients (119 men and 141 women, average age 72.8 years) with neurogenic claudication caused by LSS, as confirmed by magnetic resonance imaging (MRI). OUTCOME MEASURES Ratings of LBP, buttock and leg pain, and numbness on a numerical rating scale (NRS), 36-Item Short Form Survey (SF-36) scores, muscle mass measured by bioelectrical impedance analysis, and radiographic measurements including slippage and lumbopelvic alignment. The severity of LSS, endplate defects, Modic endplate changes, intervertebral disc degeneration, and facet joint osteoarthritis were assessed on MRI. METHODS The presence of LBP was defined as an NRS score ≥3. The demographic data, patient-reported outcomes, and radiological and MRI findings were compared between patients with and without LBP. Multivariate logistic regression analysis was used to identify the factors that were independently associated with the presence of LBP. RESULTS There were significant differences between patients with and without LBP for buttock and leg pain and numbness on the NRS, general health on the SF-36, presence of endplate defects, presence of Modic changes, disc degeneration grading, and disc height grading (all p < .05). Multivariate logistic regression analysis showed significant associations between LBP and diabetes (OR 2.43; 95% CI 1.07-5.53), buttock and leg numbness on the NRS (OR 1.34; 95% CI 1.17-1.52), general health on the SF-36 (OR 0.97; 95% CI 0.95-0.99), and the presence of erosive endplate defects (OR 3.04; 95% CI 1.51-6.11) (all p < .05). CONCLUSIONS These results suggest that LBP in patients with LSS should be carefully assessed not only for spinal stenosis but also clinical factors and endplate defects.
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Improving effect of microendoscopic decompression surgery on low back pain in patients with lumbar spinal stenosis and predictive factors of postoperative residual low back pain: a single-center retrospective study. BMC Musculoskelet Disord 2021; 22:954. [PMID: 34781941 PMCID: PMC8594242 DOI: 10.1186/s12891-021-04844-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are reports on the effectiveness of microendoscopic laminotomy using a spinal endoscope as decompression surgery for lumbar spinal stenosis, predicting the improvement of low back pain (LBP) still poses a challenge, and no clear index has been established. This study aimed to investigate whether microendoscopic laminotomy for lumbar spinal stenosis improves low back pain and determine the preoperative predictors of residual LBP. METHODS In this single-center retrospective study, we examined 202 consecutive patients who underwent microendoscopic laminotomy for lumbar spinal stenosis with a preoperative visual analog scale (VAS) score for LBP of ≥40 mm. The lumbar spine Japanese Orthopaedic Association (JOA), and VAS scores for LBP, leg pain (LP), and leg numbness (LN) were examined before and at 1 year after surgery. Patients with a 1-year postoperative LBP-VAS of ≥25 mm composed the residual LBP group. The preoperative predictive factors associated with postoperative residual LBP were analyzed. RESULTS JOA scores improved from 14.1 preoperatively to 20.2 postoperatively (p < 0.001), LBP-VAS improved from 66.7 to 29.7 mm (p < 0.001), LP-VAS improved from 63.8 to 31.2 mm (p < 0.001), and LN-VAS improved from 63.3 to 34.2 mm (p < 0.001). Ninety-eight patients (48.5%) had a postoperative LBP-VAS of ≥25 mm. Multiple logistic regression analysis revealed that Modic type 1 change (odds ratio [OR], 5.61; 95% confidence interval [CI], 1.68-18.68; p = 0.005), preoperative VAS for LBP ≥ 70 mm (OR, 2.19; 95% CI, 1.17-4.08; p = 0.014), and female sex (OR, 1.98; 95% CI, 1.09-3.89; p = 0.047) were preoperative predictors of residual LBP. CONCLUSION Microendoscopic decompression surgery had an ameliorating effect on LBP in lumbar spinal stenosis. Modic type 1 change, preoperative VAS for LBP, and female sex were predictors of postoperative residual LBP, which may be a useful index for surgical procedure selection.
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Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2413-2426. [PMID: 33844059 DOI: 10.1007/s00586-021-06827-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/05/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Positive spinal sagittal alignment is known to correlate with pain and disability. The association between lumbar spinal stenosis and spinal sagittal alignment is less known, as is the effect of lumbar decompressive surgery on the change in that alignment. The objective was to study the evidence on the effect of lumbar decompressive surgery on sagittal spinopelvic alignment. METHODS The Cochrane Controlled Trials Register (CENTRAL), Medline, Embase, Scopus and Web of Science databases were searched in October 2019, unrestricted by date of publication. The study selection was performed by two independent reviewers. The risk of systematic bias was assessed according to the NIH Quality Assessment Tool. The data were extracted using a pre-defined standardized form. RESULTS The search resulted in 807 records. Of these, 18 were considered relevant for the qualitative analysis and 15 for the meta-synthesis. The sample size varied from 21 to 89 and the average age was around 70 years. Decompression was mostly performed on one or two levels and the surgical techniques varied widely. The pooled effect sizes were most statistically significant but small. For lumbar lordosis, the effect size was 3.0 (95% CI 2.2 to 3.7) degrees. Respectively, for pelvic tilt and sagittal vertical axis, the effect sizes were - 1.6 (95% CI .2.6 to - 0.5) degrees and - 9.6 (95% CI - 16.0 to - 3.3) mm. CONCLUSIONS It appears that decompression may have a small, statistically significant but probably clinically insignificant effect on lumbar lordosis, sagittal vertical axis and pelvic tilt.
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Kitagawa T, Ogura Y, Kobayashi Y, Takahashi Y, Yonezawa Y, Yoshida K, Takahashi Y, Yasuda A, Shinozaki Y, Ogawa J. Improvement of Lower Back Pain in Lumbar Spinal Stenosis After Decompression Surgery and Factors That Predict Residual Lower Back Pain. Global Spine J 2021; 11:212-218. [PMID: 32875871 PMCID: PMC7882817 DOI: 10.1177/2192568220905617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP. METHODS We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R. RESULTS LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P < .001; JOABPEQ LBP score, 41.3 vs 79.6, P < .001; RMDQ, 10.3 vs 3.6, P < .001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R. CONCLUSIONS Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.
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Affiliation(s)
- Takahiro Kitagawa
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan,Takahiro Kitagawa, Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Ohtemachi, Aoi-ku, Shizuoka 420-0853, Japan.
| | - Yoji Ogura
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Yoshiomi Kobayashi
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | | | - Yoshiro Yonezawa
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Kodai Yoshida
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Yohei Takahashi
- Fujita Health University, Dengakugakubo, Kutsukakecho, Toyoake, Aichi, Japan
| | - Akimasa Yasuda
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Yoshio Shinozaki
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Jun Ogawa
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
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Bond M, Evaniew N, Bailey CS, Glennie RA, Paquet J, Dea N, Hall H, Manson N, Thomas K, McIntosh G, Soroceanu A, Abraham E, Johnson M, Kingwell S, Charest-Morin R, Christie S, Rampersaud YR, Fisher CG. Back pain in surgically treated degenerative lumbar spondylolisthesis: what can we tell our patients? Spine J 2020; 20:1940-1947. [PMID: 32827708 DOI: 10.1016/j.spinee.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 02/03/2023]
Abstract
OF BACKGROUND DATA Surgery for degenerative lumbar spondylolisthesis (DLS) has traditionally been indicated for patients with neurogenic claudication. Surgery improves patients' disability and lower extremity symptoms, but less is known about the impact on back pain. OBJECTIVE To evaluate changes in back pain after surgery and identify factors associated with these changes in surgically-treated DLS. STUDY DESIGN Retrospective review of prospectively collected data. METHODS There were 486 consecutive patients with surgically-treated DLS who were enrolled in the Canadian Spine Outcomes Research Network prospective registry and identified for this study. Patients had demographic data, clinical information, disability (Oswestry Disability Index), and back pain rating scores collected prospectively at baseline, and 12 months follow-up RESULTS: Of the 486 DLS patients, 376 (77.3%) were successfully followed at 12 months. Mean age at baseline was 66.7 (standard deviation [SD] 9.2) years old, and 63% were female. Back pain improved significantly at 12 months, compared with baseline (p<.001). Improvement in Numeric Rating Scale (NRS)-back pain ratings was on average 2.97 (SD 2.5) points at one year and clinically significant improvement in back pain was observed in 75% of patients (minimal clinically important difference (MCID) NRS-Pain 1.2 points). Multivariable logistic regression revealed five factors associated with meeting MCID NRS-back pain at 12 month follow up: higher baseline back pain, better baseline physical function (higher SF-12 Physical Component Score), symptoms duration less than 1 to 2 years, and having no intraoperative adverse events. CONCLUSIONS Back pain improved significantly for patients treated surgically for DLS at 1-year follow-up.
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Affiliation(s)
- Michael Bond
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Evaniew
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada; Departments of Surgery and Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Christopher S Bailey
- Division of Orthopaedics, Department of Surgery, Orthopaedic Spine Program, London Health Science Centre, University of Western Ontario, London, Ontario, Canada
| | | | - Jerome Paquet
- Hôpital de L'Enfant-Jésus, Laval University, Quebec City, Quebec, Canada
| | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hamilton Hall
- Departments of Surgery and Orthopedics, University of Toronto, Toronto, Ontario, Canada
| | - Neil Manson
- Canada East Spine Center and Dalhousie University, Saint John, New Brunswick, Canada; Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Ken Thomas
- Departments of Surgery and Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Greg McIntosh
- Research Operations, Canadian Spine Society, 10 Armstrong Crescent, Markdale, Ontario, Canada.
| | - Alex Soroceanu
- Departments of Surgery and Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Edward Abraham
- Canada East Spine Center and Dalhousie University, Saint John, New Brunswick, Canada; Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Michael Johnson
- Orthopedics and Neurosurgery, Winnipeg Spine Program, University of Manitoba, Winning, Manitoba, Canada
| | - Stephen Kingwell
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Raphaele Charest-Morin
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Y Raja Rampersaud
- Departments of Surgery and Orthopedics, University of Toronto, Toronto, Ontario, Canada
| | - Charles G Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
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Masuda S, Kanba Y, Kawai J, Ikeda N. Outcomes after decompression surgery without fusion for patients with lumbar spinal stenosis and substantial low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:147-152. [DOI: 10.1007/s00586-019-06130-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/24/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
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Wang H, Wu Z. Association Between Irregular Alteration of Facet Orientation and Degenerative Lumbar Spondylolisthesis. World Neurosurg 2019; 131:e298-e302. [PMID: 31356974 DOI: 10.1016/j.wneu.2019.07.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Numerous studies have reported that irregular alteration of facet orientation (IAFO) is associated with lumbar disc herniation (LDH) in adolescents. The present study investigated the association between IAFO and degenerative lumbar spondylolisthesis (DLS) at the L4-5 segment. METHODS Forty-two adults with DLS were enrolled in this study. Facet angles were measured in the bone window of the computed tomography scan. Large-small-large (LSL) was defined as a type of IAFO that includes the angle of facet joints at L4-5, which is smaller than that in L3-4 and L5-S1 segments. Fifty subjects with LDH at L4-5 served as controls. Data were analyzed using logistic regression analysis. RESULTS In the 42 patients and 50 controls, the facet angle was measured at 276 levers from L3-4 to L5-S1. The mean included angles of L3-4, L4-5, and L5-S1 were 71.5 ± 19.97°, 51.79 ± 21.43°, and 102.89 ± 20.37°, respectively, in the DLS group and 77.48 ± 17.24°, 91.00 ± 17.24, and 102.94 ± 19.75°, respectively, in the control group. LSL was detected in 38 of 42 subjects (90.5%) in the DLS group, compared with 9 of 50 (18.0%) in the controls. The sagittal orientation facet joint in L4-5 was associated with DLS (odds ratio [OR], 26.24; 95% confidence interval [CI], 13.30-155.35; P = 0.000). The facet in L3-4 with a more coronal orientation than that in L4-5 was also correlated with DLS (OR, 33.68; 95% CI, 9.86-115.06; P = 0.000). There was no correlation between the facet in L5-S1 and DLS in L4-5 (P = 0.999), but there was a strong relationship between LSL in L3-5 and DLS in L4-5 (OR, 43.278; 95% CI, 12.303-152.232; P = 0.000). CONCLUSIONS The data presented here demonstrate that LSL, which is an irregular alteration of facet joint orientation, is associated with the degenerative lumbar spondylolisthesis at L4-5.
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Affiliation(s)
- Honggang Wang
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Zenghui Wu
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.
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Koenig S, Jauregui JJ, Shasti M, Jazini E, Koh EY, Banagan KE, Gelb DE, Ludwig SC. Decompression Versus Fusion for Grade I Degenerative Spondylolisthesis: A Meta-Analysis. Global Spine J 2019; 9:155-161. [PMID: 30984494 PMCID: PMC6448200 DOI: 10.1177/2192568218777476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Meta-analysis of evidence level I to IV studies. OBJECTIVE To compare decompression alone versus decompression plus fusion in the treatment of grade I degenerative spondylolisthesis (DS). METHODS Following established guidelines, we systematically reviewed 3 electronic databases to assess studies evaluating patients with grade I DS. We stratified all patients into 2 cohorts; the first cohort underwent a decompression-type surgery, and the second cohort underwent decompression plus fusion. We noted clinical outcomes, complications, reoperations, and surgical details such as blood loss. Descriptive statistics and random-effects models were used to determine the specified outcome metrics with 95% confidence intervals (CIs). RESULTS In both cohorts, the pain (legs and lower back) significantly decreased and the physical component of the Short Form 36 showed better patient clinical outcomes. The decompression cohort had a 5.8% complication rate (95% CI = 1.7-2.1), and the decompression plus fusion cohort had an 8.3% complication rate (95% CI = 5.5-11.6). The reoperation rate was higher in the decompression-only cohort (8.5%; 95% CI = 2.9-17.0) compared with the decompression plus fusion cohort (4.9%; 95% CI = 2.5-7.9). CONCLUSIONS There does not appear to be any advantage of one procedure over the other. Patients undergoing decompression alone tended to be older with a higher percentage of leg pain, whereas patients additionally undergoing fusion tended to be younger with more lower back pain. The decompression-only cohort had fewer complications but a higher revision rate.
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Affiliation(s)
| | | | | | | | | | | | | | - Steven C. Ludwig
- University of Maryland, Baltimore, MD, USA,Steven C. Ludwig, Department of Orthopaedics,
University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 300,
Baltimore, MD 21201 USA.
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Hendrickson NR, Kelly MP, Ghogawala Z, Pugely AJ. Operative Management of Degenerative Spondylolisthesis. JBJS Rev 2018; 6:e4. [DOI: 10.2106/jbjs.rvw.17.00181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Minimally invasive decompression in patients with degenerative spondylolisthesis associated with lumbar spinal stenosis. Report of a surgical series and review of the literature. Neurol Neurochir Pol 2018; 52:448-458. [PMID: 30025719 DOI: 10.1016/j.pjnns.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/14/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022]
Abstract
We reported the results of minimally invasive spinal decompression (MISD) in patients with degenerative spondylolisthesis (DS) associated with lumbar spinal stenosis (LSS) and performed a literature review in order to evaluate the clinical and radiological outcomes, the complications and reoperation rate of MISD procedures in these patients. Data of 28 patients submitted to MISD for DS associated to LSS were reviewed. We evaluated the Visual Analogue Scale (VAS) both for low back pain (LBP) and legs pain, the Oswestry Disability Index (ODI) and the degree of the slippage. A PubMed search of the English literature was conducted. Only papers with more than 10 patients and reporting explicitly data of patients with DS were included in the analysis. We found a statistically significant improvement of LBP, legs pain and ODI in our series. The degree of slippage was stable at follow-up (FU) with no need of reoperation. No major complications occurred. In our literature review, we were able to analyze the differences in ODI in 156 patients and the differences in Japanese Orthopedic Association (JOA) score in 218 patients. We observed a statistically significant improvement of ODI and JOA score at FU compared to pre-operative. The percentage of slippage, evaluated in 283 patients, was unchanged at FU compared to pre-operative. The overall complication rate was 1.6%. The overall reoperation rate was 4.5%. MISD procedures are safe and effective in patients with DS associated to LSS and are associated to low morbidity and significant improvement of disability without progression of slippage.
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Risk Factors of Postoperative Low Back Pain for Low-Grade Degenerative Spondylolisthesis: An At Least 2-Year Follow-Up Retrospective Study. World Neurosurg 2017; 107:789-794. [DOI: 10.1016/j.wneu.2017.08.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/20/2022]
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Káplár Z, Wáng YXJ. South Korean degenerative spondylolisthesis patients had surgical treatment at earlier age than Japanese, American, and European patients: a published literature observation. Quant Imaging Med Surg 2016; 6:785-790. [PMID: 28090453 DOI: 10.21037/qims.2016.11.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Zoltán Káplár
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong, China
| | - Yì-Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong, China
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