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Ahn Y, Song SK. Transforaminal endoscopic lumbar foraminotomy for octogenarian patients. Front Surg 2024; 11:1324843. [PMID: 38362456 PMCID: PMC10867165 DOI: 10.3389/fsurg.2024.1324843] [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: 10/20/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Background Radiculopathy caused by lumbar foraminal stenosis in older people has become more common in the aging general population. However, patients aged ≥80 years rarely undergo conventional open surgery under general anesthesia because of the high risk of peri-operative morbidity and adverse events. Therefore, less invasive surgical alternatives are needed for older or medically handicapped patients. Transforaminal endoscopic lumbar foraminotomy (TELF) under local anesthesia may be helpful in at-risk patients, although only limited information is available regarding the clinical outcomes of this procedure in octogenarians. Therefore, this study aimed to investigate the safety and efficacy of TELF for treating radiculopathy induced by foraminal stenosis in octogenarian patients. Methods Overall, 32 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELF between January 2019 and January 2021. The inclusion criterion was unilateral radiculopathy secondary to lumbar foraminal stenosis. The pain focus was confirmed using imaging studies and selective nerve blocks. Full-scale foraminal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. Surgical outcomes were assessed using the visual analog pain score, Oswestry Disability Index, and modified MacNab criteria. Results The pain scores and functional outcomes improved significantly during the 24-month follow-up period, and the rate of clinical improvement was 93.75% in 30 of the 32 patients. None of the patients experienced systemic complications. Conclusion TELF under local anesthesia is an effective and safe treatment for foraminal stenosis in octogenarian or medically compromised patients. The mid-term follow-up did not reveal any significant progression in spinal stability. Therefore, this endoscopic procedure can be an effective alternative to aggressive surgery for managing lumbar foraminal stenosis in octogenarian patients with intractable radiculopathy.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Ahn Y, Jung JH. Transforaminal Endoscopic Lumbar Lateral Recess Decompression for Octogenarian Patients. J Clin Med 2024; 13:515. [PMID: 38256649 PMCID: PMC10816502 DOI: 10.3390/jcm13020515] [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: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
The incidence of radiculopathy due to lumbar spinal stenosis has been on the increase in the aging population. However, patients aged ≥ 80 years hesitate to undergo conventional open surgery under general anesthesia because of the risk of postoperative morbidity and adverse events. Therefore, less invasive surgical alternatives are required for the elderly or medically handicapped patients. Transforaminal endoscopic lumbar lateral recess decompression (TELLRD) may be helpful for those patients. This study aimed to demonstrate the efficacy of TELLRD for treating radiculopathy in octogenarian patients. A total of 21 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELLRD between January 2017 and January 2021. The inclusion criterion was unilateral radiculopathy, which stemmed from lumbar lateral recess stenosis. The pain source was verified using imaging studies and selective nerve blocks. Full-scale lateral canal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. We found the pain scores and functional status improved significantly during the 24-month follow-up period. The clinical improvement rate was 95.24% (20 of 21 patients) with no systemic complication. In conclusion, endoscopic lateral recess decompression via the transforaminal approach is practical for octogenarian patients.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea;
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Ono K, Fukuhara D, Nagahama K, Abe Y, Takahashi K, Majima T. Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion (PETLIF): Current Techniques, Clinical Outcomes, and Narrative Review. J Clin Med 2023; 12:5391. [PMID: 37629437 PMCID: PMC10455973 DOI: 10.3390/jcm12165391] [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: 06/26/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Full endoscopic techniques are becoming more popular for degenerative lumbar pathologies. Percutaneous endoscopic lumbar interbody fusion (PETLIF) is a minimally invasive surgical technique for spondylolisthesis and lumbar spinal canal stenosis with instability. Nagahama first introduced PETLIF in 2019. This study investigated the clinical outcomes and complications of 24 patients who underwent PETLIF in our facility and compared them with previous studies. Literature searches were conducted on PubMed and Web of Science. The PETLIF surgical technique involves three steps to acquire disc height under general anesthesia. The procedure includes bone harvesting, spondylolisthesis reduction, endoscopic foraminoplasty, disc height expansion using an oval dilator, and intervertebral disc curettage. A cage filled with autologous bone is inserted into the disc space and secured with posterior fixation. Patients underwent PETLIF with an average operation time of 130.8 min and a blood loss of 24.0 mL. Postoperative hospital stays were 9.5 days. Improvement in VAS, disc height, spinal canal area, and % slip was observed, while lumbar lordosis remained unchanged. Complications included end plate injury, subsidence, and exiting nerve root injury. The differences between PETLIF and the extracted literature were found in patients' age, direct decompression, epidural or local anesthesia, approach, order of PPS, and cage insertion. In conclusion, PETLIF surgery is a practical, minimally invasive surgical technique for patients with lumbar degenerative diseases suffering from back and leg pain, demonstrating significant improvements in pain scores. However, it is essential to carefully consider the potential complications and continue to refine the surgical technique further to enhance the safety and efficacy of this procedure.
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Affiliation(s)
- Koichiro Ono
- Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (D.F.); (T.M.)
| | - Daisuke Fukuhara
- Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (D.F.); (T.M.)
- Department of Orthopedic Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan;
| | - Ken Nagahama
- Sapporo Endoscopic Spine Surgery Clinic, 1-13, North-16, East-16, Higashi-ku, Sapporo 065-0016, Japan;
| | - Yuichiro Abe
- Sapporo Medical Research, 1-20-1501, Kita13 Higashi2, Hidashi-ku, Sapporo 065-0013, Japan;
| | - Kenji Takahashi
- Department of Orthopedic Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan;
| | - Tokifumi Majima
- Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (D.F.); (T.M.)
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Li K, Han X, Zhang H, Chen X, Xu D, Li Z. Comparison of Lumbar Fusion Surgical Outcomes Between Patients with Lumbar Spinal Stenosis ≥80 Versus 65-79 Years Old. Med Sci Monit 2023; 29:e938837. [PMID: 36843310 PMCID: PMC9983286 DOI: 10.12659/msm.938837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The efficacy of lumbar fusion surgery in patients age 80 years and older with lumbar spinal stenosis (LSS) is still controversial. This retrospective study aimed to evaluate the surgical outcomes of LSS patients ³80 vs 65-79 years. MATERIAL AND METHODS The study included 66 patients diagnosed with LSS from 2014 to 2020; 33 patients were ³80 years and 33 patients were 65-79 years. The 2 groups were matched for sex and surgical segment. All patients underwent posterior lumbar decompression, fixation, and fusion surgery. The Numerical Rating Scale (NRS) of leg and back pain, Oswestry Disability Index (ODI), Short-Form Health Survey (SF-36), and radiographic data were collected before surgery and at 3, 6, and 12 months postoperatively. RESULTS NRS (back) in the ≥80 years group was significantly higher than in the 65-79 years group at 3 months [2 (0-3) vs 1 (0-3), P=0.001]. Improvement of SF-36 (3 months: 15.7±4.9 vs 27.6±5.4, P<0.001; 6 months: 27.3±6.8 vs 31.5±5.6, P=0.011) and Physical Component Score (PCS) (3 months: 6.5±2.5 vs 17.0±3.6, P<0.001; 6 months: 15.9±3.4 vs 20.1±3.1, P<0.001) at 3 and 6 months in the ≥80 years group were significantly smaller than in 65-79 years group. There was a difference of Pfirrmann index of adjacent segment disc between the 2 groups at 12 months [≥80 vs 65-79 years group: 5.5 (4-8) vs 5 (3-8), P=0.003]. CONCLUSIONS Lumbar fusion surgery in patients ≥80 years with LSS can provide comparable improvements in clinical and radiographic outcomes compared with younger patients. Postoperative physiological function recovery was slower in patients ≥80 years.
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Affiliation(s)
- Kuan Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Xiao Han
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China,Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua University, Beijing, PR China
| | - Haozhi Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Xin Chen
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Derong Xu
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, PR China
| | - Zheng Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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Wang X, Tian Z, Mansuerjiang M, Younusi A, Xu L, Xiang H, Cao L, Wang C. A single-arm retrospective study of the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis. Front Surg 2023; 9:1062451. [PMID: 36756660 PMCID: PMC9901529 DOI: 10.3389/fsurg.2022.1062451] [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: 10/05/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023] Open
Abstract
Objective The purpose of this study was to investigate the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) for lumbar spinal stenosis (LSS). Methods Patients who underwent UBE-TLIF due to single-segment LSS between August 2019 and July 2021 were retrospectively included in the study. Clinical outcomes evaluated include operative time, estimated blood loss (including postoperative drainage), time to ambulation, postoperative hospital stay, complications, visual analog scale (VAS) scores of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and modified Macnab criteria. Interbody bony fusion at the index level was assessed using Bridwell grading criteria. Results A total of 73 patients (29 males and 44 females) were enrolled in this study. All surgeries were successfully performed without intraoperative conversion to open surgery. Magnetic resonance imaging (MRI) revealed optimal direct neural decompression after UBE-TLIF. The mean operative time was 150.89 ± 15.58 min. The mean estimated blood loss was 126.03 ± 17.85 ml (postoperative drainage was 34.84 ± 8.31 ml). Time to ambulation was 2.0 ± 0.75 days after the procedure. Postoperatively, the mean hospital stay was 5.96 ± 1.38 days. VAS scores of low back pain and leg pain, JOA, and ODI were significantly improved postoperatively compared with those before the operation, and differences were statistically significant (P < 0.05). Excellent and good outcomes were reported by 87.67% of patients according to the modified Macnab criteria at the final follow-up. A total of nine perioperative complications occurred, with an incidence of 12.33%. X-ray or computerized tomography (CT) 6 months after the procedure showed that 37 cases (50.68%) presented with segmental fusion, 30 cases (41.10%) showed incomplete fusion, and 6 cases (8.22%) showed no signs of fusion. However, bony fusion was achieved in all cases at the final follow-up. Conclusions UBE-TLIF for LSS has the advantages of less surgical invasiveness and fast postoperative recovery.
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Affiliation(s)
| | | | | | | | | | | | - Li Cao
- Correspondence: Chong Wang Li Cao
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Liu L, Dong J, Wang D, Zhang C, Zhou Y. Clinical Outcomes and Quality of Life in Elderly Patients Treated with a Newly Designed Double Tube Endoscopy for Degenerative Lumbar Spinal Stenosis. Orthop Surg 2022; 14:1359-1368. [PMID: 35633039 PMCID: PMC9251268 DOI: 10.1111/os.13304] [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: 12/20/2020] [Revised: 04/03/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the clinical outcome and quality of life in elderly patients in poor conditions with unilateral symptomatic degenerative lumbar spinal stenosis (DLSS) who were treated with percutaneous endoscopic lumbar discectomy (PELD) assisted by double tubes. Methods This study was designed retrospectively. From June 2017 to June 2018, 31 consecutive elderly patients who were presented with unilateral symptomatic DLSS, underwent PELD assisted by double tubes under local anesthesia. American Society of Anesthesiology score (ASA) was used to evaluate the patients' conditions. The operative time, intraoperative blood loss, hospital stay, and complications were evaluated. Clinical outcomes were assessed by the visual analog scale (VAS), Oswestry disability index (ODI), and modified Macnab criteria. Short Form 36 (SF‐36) was used to evaluate the life quality. The CT or MRI was used to evaluate the spinal area. Results Thirty‐one patients were enrolled and 25 cases achieved at least a 24‐month follow‐up. Three patients were lost to follow‐up and three patients died from other diseases. A total of 76% (19/25) of the patients presented an ASA score of more than 3. The mean operative time was 67.80 min, the mean blood loss was 18.2 ml, and the hospital stay was 6.92 days. The postoperative 12‐month follow‐up VAS score significantly decreased compared with that before the operation (1.12 ± 0.73 vs. 5.12 ± 1.81, p < 0.01). Although the VAS score decreased at the final follow‐up, there was no significant difference compared with that at the 12‐month follow‐up (0.92 ± 0.64 vs. 1.12 ± 0.73, p = 0.549). So did the ODI. Also, there was no difference in the ODI scores between the 12‐month follow‐up and the final follow‐up (12.52 ± 5.58 vs. 9.44 ± 6.32, p = 0.172). The overall excellent rate was 92% (23/25) at the final follow‐up. The scores of the physical function, mental function, and social function of SF‐36 after the operation improved significantly compared with those before operation (p < 0.05). But there was no difference in the physical function score (84.00 ± 6.29 vs 84.40 ± 6.18, p = 0.871), mental function score (81.76 ± 8.01 vs 81.68 ± 6.67, p = 0.974), or social function score (115.50 ± 13.64 vs 118.50 ± 12.03, p = 0.437) between the 12‐month follow‐up and the final follow‐up. There were no differences in the VAS, ODI, and SF‐36 between the L4/5 and L5S1 groups before operation or at the final follow‐up (p > 0.05). The postoperative radiology indicated the lateral recess is opened and the area of the dural sac is expanded. Two cases (8.0%, 2/25) experienced recurrence and a secondary PELD was performed. Conclusions PELD assisted by double tubes is effective for unilateral symptomatic DLSS in elderly patients with comorbidities and could improve life quality.
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Affiliation(s)
- Lantao Liu
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Jian Dong
- Department of Spinal Surgery, The People's Hospital of Dianjiang Country, Chongqing, China
| | - Dechun Wang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Chao Zhang
- Department of Orthopedics, Xinqiao Hospital, The Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, The Army Medical University, Chongqing, China
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Rault F, Briant AR, Kamga H, Gaberel T, Emery E. Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk? Neurosurg Rev 2022; 45:2385-2399. [PMID: 35243565 DOI: 10.1007/s10143-022-01756-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 01/10/2023]
Abstract
Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complication rate was higher for elderly patients and to find confounding factors. We conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded. Nine hundred ninety-six patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. Of the patients, 5.2% presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI and accidental durotomies were independent risk factors for SC. Surgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complication risk is increased although an optimal preparation is the way to avoid them.
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Affiliation(s)
- Frédérick Rault
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France.
| | - Anaïs R Briant
- Unité de Biostatistique Et Recherche Clinique (UBRC), Avenue de la Côte de Nacre, 14000, Caen, France
| | - Hervé Kamga
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
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Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis. Sci Rep 2022; 12:2821. [PMID: 35181747 PMCID: PMC8857319 DOI: 10.1038/s41598-022-06797-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022] Open
Abstract
Evidence on the role of depression and anxiety in patients undergoing surgical treatment for symptomatic degenerative lumbar spinal stenosis (DLSS) is conflicting. We aimed to assess the association between depression and anxiety with symptoms and function in patients undergoing surgery for DLSS. Included were patients with symptomatic DLSS participating in a prospective multicentre cohort study who underwent surgery and completed the 24-month follow-up. We used the hospital anxiety and depression scale (HADS) to assess depression/anxiety. We used mixed-effects models to quantify the impact on the primary outcome change in the spinal stenosis measure (SSM) symptoms/function subscale from baseline to 12- and 24-months. Logistic regression analysis was used to quantify the odds of the SSM to reach a minimal clinically important difference (MCID) at 24 months follow-up. The robustness of the results in the presence of unmeasured confounding was quantified using a benchmarking method based on a multiple linear model. Out of 401 patients 72 (17.95%) were depressed and 80 anxious (19.05%). Depression was associated with more symptoms (β = 0.36, 95% confidence interval (CI) 0.20 to 0.51, p < 0.001) and worse function (β = 0.37, 95% CI 0.24 to 0.50, p < 0.001) at 12- and 24-months. Only the association between baseline depression and SSM symptoms/function was robust at 12 and 24 months. There was no evidence for baseline depression/anxiety decreasing odds for a MCID in SSM symptoms and function over time. In patients undergoing surgery for symptomatic DLSS, preoperative depression but not anxiety was associated with more severe symptoms and disability at 12 and 24 months.
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Bays A, Stieger A, Held U, Hofer LJ, Rasmussen-Barr E, Brunner F, Steurer J, Wertli MM. 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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Affiliation(s)
- Amandine Bays
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Andrea Stieger
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Lisa J Hofer
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Eva Rasmussen-Barr
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Johann Steurer
- Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
- Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
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Silaban MR, Kadar PD. Posterior Lumbar Interbody Fusion with Spinal Decompression using Minimally Invasive Spine Surgery in the Treatment of Symptomatic Degenerative Spinal Stenosis. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction
Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. The incidence of this case is 3.57% (3570 per 100,000) population in Southeast Asia. The main symptoms are low back pain, numbness, and weakness in the lower extremity that occur and intensify on walking caused by the load of the body weight on the spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis , all contribute to impact the spinal canal and intervertebral foramen in lumbar stenosis . There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or become destabilized following decompression who would benefit from fusion procedure.
Objective
Surgical treatment of lumbar spinal stenosis by posterior lumbar interbody fusion is indicated for patients with symptoms of low back pain and lower limb radicular pain, that are unsuccessful treated with medicines and /or patients with persisting or worsening neurological deficit.However, this procedure may lead to possible complications. This case report study was conducted to show how our hospital handling spinal stenosis case.
Case
A 67-year-old woman presented with low back pain that has occured for two years, and had been worsening for the past 3 months. She described the pain as an intermitten ache down on her leg, the pain was severe and worsened when the patient is standing, sitting, or walking for a long time , The pain severity was measured by visual analog score (vas), graded between 7/10 to 9/10. She also complained numbness from the bilateral gluteal region to the lateral side of lower extremities, when she feel too tired. On the physical examination, She was found to have limited range of motion for flexion and extension, on the lumbar spine, due to pain. The motoric strength of both lower limbs were decreased, so did the sensory function. The Radiological examination showed a severe stenosis at lumbar spinal bone region on L4-L5 area. After the examination, the patient agreed to undergo the suggested operative procedure and gare the consent at the hospital.
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Yin G, Huang B, Wang C, Liu SQ. Therapeutic effects of full endoscopic spine surgery via transforaminal approach in elderly patients with lumbar spinal stenosis: A retrospective clinical study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:166-170. [PMID: 33847580 PMCID: PMC11229625 DOI: 10.5152/j.aott.2021.20076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/23/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the therapeutic effects of full endoscopic spine surgery on clinical and radiological outcomes in elderly patients over 70 years with lumbar spinal stenosis, without any obvious segmental instability. METHODS A total of 47 patients (27 males, 20 females; the mean age=74.23±5.16) above 70 years who underwent a transforaminal percutaneous endoscopic decompression with the diagnosis of lumbar spinal stenosis, were included in this retrospective study. The mean follow-up was 26±2.97 months. The clinical efficacy of the surgical procedure was assessed by the Oswestry disability index (ODI) and the visual analog scale (VAS) of the leg and lower back at 1 week, 3 months, and 1 year postoperatively, and at the final follow-up examination. Modified MacNab criteria was also performed to assess the clinical efficiency of surgery at the final follow-up. RESULTS An excellent outcome as per modified MacNab criteria was obtained in 9 patients (19.1%), a good outcome in 33 patients (70.2%), a fair outcome in 3 patients (6.4%), and poor results in 2 patients (4.3%). The mean ODI score significantly improved from 71.29±5.69 preoperatively to 32.05±10.71 at postoperative 1 week, 30.27±9.89 at 3 months, 27.23±8.47 at 1 year, and 23.11±9.97 at the final follow-up (p<0.05 for each evaluation point). The mean VAS score of the leg and lower back significantly decreased from 6.10±0.96 and 5.71±1.13 preoperatively to 1.69±0.96, 2.24±1.01 at postoperative 1 week, 1.69±0.84, 2.45±0.87 at 3 months, 1.71±0.81, 2.38±0.79 at 1 year, and 1.71±0.92, 2.48±0.67 at the final follow-up, respectively (p<0.05 for each evaluation term). Postoperative computed tomography or magnetic resonance imaging showed adequate decompression of the central or lateral recess and removal of combined herniated discs. CONCLUSION The results of our preliminary study have demonstrated that full endoscopic spine surgery is a safe and efficient technique for the therapy of neurogenic claudication and radiculopathy in elderly patients with lumbar spinal stenosis. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- Guodong Yin
- Department of orthopedic Surgery, 923nd Hospital of People's Liberation Army, Guangxi Province, China
| | - Baohua Huang
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi Province, China
| | - Chong Wang
- Department of orthopedic Surgery, 923nd Hospital of People's Liberation Army, Guangxi Province, China
| | - Shi-Qin Liu
- Department of orthopedic Surgery, 923nd Hospital of People's Liberation Army, Guangxi Province, China
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Amitkumar M, Singh PK, Singh KJ, Khumukcham T, Sawarkar DP, Chandra SP, Kale SS. Surgical Outcome in Spinal Operation in Patients Aged 70 Years and Above. Neurol India 2020; 68:45-51. [PMID: 32129242 DOI: 10.4103/0028-3886.279672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction The world is seeing a growth of the aging population and the number of surgical treatments in this age group which is also true for spinal conditions. The greatest increase in spinal fusion surgery has been observed in patients aged 65 years and above. Only a few works of literature were available on the issue, especially in India. Materials and Methods An observational study in which 70 patients aged 70 years and above who underwent spinal surgery for degenerative and traumatic spinal injury, from January 2013 to July 2017 in the neurosurgery department of a single institute, were reviewed. Around 53 patients were assessed for disability/functional outcome and their health-related quality of life (HRQOL) using the Oswestry disability index (ODI) and RAND 36-item health survey 1.0 scoring method (SF-36) comparing the preoperative and postoperative status. Result The mean age was 74.19 years (range 70-91 years). Laminectomy-19 (27.14%) was the most common surgical procedure performed. Overall there were nine (12.85%) major complications with mortality of five (7.14%) patients. There was a significant reduction of crippled patients (14-9, P = 0.009) in the ODI score. SF-36: There was significant improvement in degenerative patient (P = 0.000 to P = 0.012). In traumatic patient, only pain had significant improvement (P = 0.045). Conclusion This study showed that the age of the patient should not be the limiting factor for the surgical management of a patient with a degenerative or a traumatic spinal condition.
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Affiliation(s)
- Mayanglambam Amitkumar
- Department of Neurosurgery and Gamma Knife, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Pankaj K Singh
- Department of Neurosurgery and Gamma Knife, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | | | - Dattaraj P Sawarkar
- Department of Neurosurgery and Gamma Knife, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery and Gamma Knife, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery and Gamma Knife, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Jain S, Deer T, Sayed D, Chopra P, Wahezi S, Jassal N, Weisbein J, Jameson J, Malinowski M, Golovac S. Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety. Pain Manag 2020; 10:331-348. [DOI: 10.2217/pmt-2020-0037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Lumbar spinal stenosis is a common degenerative spine condition. In properly selected patients, minimally invasive lumbar decompression ( mild®) may be an option to improve outcomes. This review provides an in-depth description of the mild procedure and a comprehensive examination of safety and efficacy. Two randomized controlled trials, together with 11 other controlled clinical studies, have established the efficacy of mild, which is a minimally invasive procedure that does not involve implants and has demonstrated excellent efficacy and safety. With an established safety profile equivalent to epidural steroid injections, and efficacy that has been shown to be superior to such injections, mild can reasonably be positioned early in the treatment algorithm for these patients. Based on extensive review of the literature, robust safety and efficacy through 2 years, and in accordance with minimally invasive spine treatment guidelines, mild is recommended as the first intervention after failure of conservative measures for lumbar spinal stenosis patients with neurogenic claudication and ligamentum flavum hypertrophy.
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Affiliation(s)
- Sameer Jain
- Pain Treatment Centers of America, Little Rock, AR 72211, USA
| | - Timothy Deer
- The Spine & Nerve Center of The Virginias, Charleston, WV 25301, USA
| | - Dawood Sayed
- University of Kansas Hospital, Kansas City, KS 66160, USA
| | - Pooja Chopra
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sayed Wahezi
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Navdeep Jassal
- Spine & Pain Institute of Florida, Lakeland, FL 33805, USA
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Du C, Wu T, Mao T, Jia F, Hai B, Zhu B, Liu X. From clinic to hypothesis, an innovative operation for the treatment of lumbar spinal stenosis in a minimal invasive way. Med Hypotheses 2020; 144:110007. [PMID: 32592920 DOI: 10.1016/j.mehy.2020.110007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
Concerning the damage to back muscles and posterior ligament complex (PLC) by posterior open approach for lumbar spinal stenosis (LSS), the oblique lateral intervertebral fusion (OLIF) is pretty popular nowadays. However, oblique lateral approach has obvious drawbacks, which are limited vision and operative scope for achieving spinal canal decompression. Herein, we present a hypothesis that lumbar canal decompression can be well achieved by OLIF combined with spinal endoscope operative system. Nerval decompression and spinal reconstruction are achieved in a minimal invasive way, which may play an instructive role for the treatment of serious LSS.
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Affiliation(s)
- Chuanchao Du
- Department of Orthopaedic, Peking University Third Hospital, Beijing, PR China
| | - Tao Wu
- Orthopaedic Department, Heze Municipal Hospital, Heze, Shandong, PR China
| | - Tianli Mao
- Department of Orthopaedic, Peking University Third Hospital, Beijing, PR China
| | - Fei Jia
- Department of Orthopaedic, Peking University Third Hospital, Beijing, PR China
| | - Bao Hai
- Department of Orthopaedic, Peking University Third Hospital, Beijing, PR China
| | - Bin Zhu
- Pain Medicine Center, Peking University Third Hospital, Beijing, PR China
| | - Xiaoguang Liu
- Department of Orthopaedic, Peking University Third Hospital, Beijing, PR China; Pain Medicine Center, Peking University Third Hospital, Beijing, PR China.
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Yang F, Chen R, Gu D, Ye Q, Liu W, Qi J, Xu K, Fan X. Clinical Comparison of Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in the Treatment of Elderly Lumbar Spinal stenosis: A Retrospective Study with 12-Month Follow-Up. J Pain Res 2020; 13:1377-1384. [PMID: 32606904 PMCID: PMC7295456 DOI: 10.2147/jpr.s254275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Although lumbar spinal stenosis (LSS) is the most common spinal disease in the elderly, there is still a confusion about the appropriate surgical treatment strategy. The aim of this study was to compare the safety and efficacy of full-endoscopic and microscopic unilateral laminotomy for bilateral decompression (ULBD) for LSS in elderly patients. Patients and Methods A retrospective analysis of 61 consecutive elderly patients with LSS who underwent either full-endoscopic (FE group) or microscopic (Micro group) unilateral laminotomy for bilateral decompression was performed. Clinical data were assessed before 2 weeks, 3 months, 6 months and 12 months after surgery using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the modified MacNab criteria. Results There are no significant differences in VAS (back and leg) and ODI between the two groups. However, the VAS back pain in the FE group was significantly improved compared to the Micro group at 2 weeks. The rate of excellent or good outcomes was 87.88% and 85.71% in the FE and Micro group, respectively (P>0.05). The hospital stay and early ambulation in FE group were shorter than those in Micro group, but the operation time was longer (P<0.05). The complications between the FE group (18.18%) and the Micro group (17.86%) were minor (P>0.05). Conclusion Both full-endoscopic and microscopic decompression have achieved favorable clinical results in treating elderly lumbar spinal stenosis, and the complications are minor. Full-endoscopic decompression has the advantages of small incision and rapid recovery, which can be used as an alternative for the treatment of lumbar spinal stenosis, especially the elderly with comorbidities.
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Affiliation(s)
- Fei Yang
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Rigao Chen
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Dangwei Gu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Qingqing Ye
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Wei Liu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Jianhua Qi
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Kai Xu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Xiaohong Fan
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
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Ahn Y, Keum HJ, Son S. Percutaneous Endoscopic Lumbar Foraminotomy for Foraminal Stenosis with Postlaminectomy Syndrome in Geriatric Patients. World Neurosurg 2019; 130:e1070-e1076. [PMID: 31323406 DOI: 10.1016/j.wneu.2019.07.087] [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: 03/01/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Postlaminectomy syndrome (PLS) or failed back surgery syndrome is a condition characterized by persistent pain following a back surgery. Degenerative processes may result in foraminal stenosis development over time, even after a successful surgery. Percutaneous endoscopic lumbar foraminotomy (PELF) offers a minimally invasive means of treating foraminal stenosis after a back surgery. The objective of this study was to evaluate the outcomes of PELF for foraminal stenosis with PLS in geriatric patients. METHODS Two-year follow-up data were collected from 21 consecutive patients aged 65 years or older (mean age, 72.4 years) who underwent PELF for foraminal stenosis with PLS. Transforaminal endoscopic foraminal decompression was performed under local anesthesia. Outcomes were assessed using visual analog scale pain score, Oswestry Disability Index, and modified Macnab criteria. RESULTS Mean visual analog scale for leg pain improved from 8.48 at baseline to 3.33 at 6 weeks, 2.10 at 1 year, and 2.19 at 2 years after PELF (P < 0.01). Mean Oswestry Disability Index improved from 67.29 at baseline to 30.69 at 6 weeks, 22.50 at 1 year, and 20.81 at 2 years after PELF (P < 0.01). Based on the modified Macnab criteria, excellent or good results were obtained in 81.0% of patients and symptomatic improvements were obtained in 95.2% of patients. CONCLUSIONS The transforaminal endoscopic approach can provide a better access angle to achieve a sophisticated foraminal decompression with less facet and dural injury. Therefore, PELF under local anesthesia can be useful for PLS or postoperative foraminal stenosis in elderly patients.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.
| | - Han Joong Keum
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | - Seong Son
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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Ahn Y, Keum HJ, Shin SH, Choi JJ. Laser-assisted endoscopic lumbar foraminotomy for failed back surgery syndrome in elderly patients. Lasers Med Sci 2019; 35:121-129. [PMID: 31102002 DOI: 10.1007/s10103-019-02803-7] [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: 01/21/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
Elderly patients with failed back surgery syndrome (FBSS) or post-laminectomy foraminal stenosis have a higher risk of perioperative morbidity with extensive revision surgery. Thus, there is a need for safer and less invasive surgical options, such as laser-assisted endoscopic lumbar foraminotomy (ELF). A pin-point laser beam can allow precise tissue ablation and dissection in fibrotic adhesion tissues while preventing normal tissue injury. The present study aimed to describe the surgical technique of laser-assisted ELF and to evaluate the clinical outcomes of elderly patients with FBSS. Two-year follow-up data were collected from 26 consecutive patients aged 65 years or older who were treated with laser-assisted ELF for FBSS. Full-endoscopic foraminal decompression was performed using a side-firing laser and mechanical instruments. The average age of the patients was 70.2 years (range, 65-83 years). The mean visual analog pain score for leg pain improved from 8.58 at baseline to 3.35 at 6 weeks, 2.19 at 1 year, and 2.35 at 2 years after ELF (P < 0.001). The mean Oswestry disability index improved from 65.93 at baseline to 31.41 at 6 weeks, 21.77 at 1 year, and 20.64 at 2 years after ELF (P < 0.001). Based on the modified Macnab criteria, excellent or good results were obtained in 84.6% patients and symptomatic improvements were obtained in 92.3%. Extensive revision surgery in elderly patients might cause significant surgical morbidities. Laser-assisted ELF under local anesthesia could be a safe and effective surgical alternative for such patients at risk.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea.
| | - Han Joong Keum
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | - Sang Ha Shin
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | - Jung Ju Choi
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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Lee JJ, An SB, Kim TW, Shin DA, Yi S, Kim KN, Yoon DH, Shin HC, Ha Y. Analysis of Risk Factors Associated with Hospital Readmission Within 360 Days After Degenerative Lumbar Spine Surgery in Elderly Patients. World Neurosurg 2019; 126:e196-e207. [PMID: 30797909 DOI: 10.1016/j.wneu.2019.01.293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a paucity of studies on readmission rates in elderly patients over a period of 360 days after spinal surgery. METHODS We identified 1248 patients older than 70 years who underwent degenerative lumbar spinal surgery from November 2005 to April 2015. We reviewed the patients who were readmitted within 360 days and compared them by univariate and multivariate analysis with the nonreadmitted patients for each period of 0-30, 30-90, 90-180, and 180-360 days postoperatively to determine risk factors for hospital readmission. RESULTS A total of 1248 patients (733 female, 58.7%) were enrolled in the study. The number of readmitted patients was 37 (2.96%), 94 (7.53%), 145 (11.62%), 182 (14.58%), and 213 (17.07%) at 30, 90, 180, 270, and 360 days, respectively. Surgical site-related problems decreased gradually in the first 0-90 days and slightly increased after then. Non-surgical site-related problems gradually increased with time. Logistic multiple regression analysis showed that electrocardiographic abnormalities, male sex, low hemoglobin levels, asthma, heart disease, intensive care unit admission, low alanine aminotransferase level, high body mass index, and high platelet level were risk factors for readmission. CONCLUSIONS We found that electrocardiographic abnormalities, male sex, low hemoglobin levels, asthma, heart disease, intensive care unit admission, low aspartate aminotransferase level, high body mass index, and high platelet level were risk factors for readmission. As the postoperative observational period became longer, the reasons for readmission tended to be more related to non-surgical site-related problems than to surgical-related problems.
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Affiliation(s)
- Jong Joo Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Bae An
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Woo Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Chul Shin
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Is There a “Sex Effect” in 30-Day Outcomes After Elective Posterior Lumbar Fusions? World Neurosurg 2018; 120:e428-e433. [DOI: 10.1016/j.wneu.2018.08.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
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Staats PS, Chafin TB, Golovac S, Kim CK, Li S, Richardson WB, Vallejo R, Wahezi SE, Washabaugh EP, Benyamin RM. Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: 2-Year Results of MiDAS ENCORE. Reg Anesth Pain Med 2018; 43:789-794. [PMID: 30199512 PMCID: PMC6319572 DOI: 10.1097/aap.0000000000000868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients. METHODS This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections. Follow-up occurred at 6 months and at 1 year for the randomized phase and at 2 years for MILD subjects only. Oswestry Disability Index, Numeric Pain Rating Scale, and Zurich Claudication Questionnaire were used to evaluate function and pain. Safety was evaluated by assessing incidence of device-/procedure-related adverse events. RESULTS All outcome measures demonstrated clinically meaningful and statistically significant improvement from baseline through 6-month, 1-year, and 2-year follow-ups. At 2 years, Oswestry Disability Index improved by 22.7 points, Numeric Pain Rating Scale improved by 3.6 points, and Zurich Claudication Questionnaire symptom severity and physical function domains improved by 1.0 and 0.8 points, respectively. There were no serious device-/procedure-related adverse events, and 1.3% experienced a device-/procedure-related adverse event. CONCLUSIONS MILD showed excellent long-term durability, and there was no evidence of spinal instability through 2-year follow-up. Reoperation and spinal fracture rates are lower, and safety is higher for MILD versus other lumbar spine interventions, including interspinous spacers, surgical decompression, and spinal fusion. Given the minimally invasive nature of this procedure, its robust success rate, and durability of outcomes, MILD is an excellent choice for first-line therapy for select patients with central spinal stenosis suffering from neurogenic claudication symptoms with hypertrophic ligamentum flavum. CLINICAL TRIAL REGISTRATION This study was registered at ClinicalTrials.gov, identifier NCT02093520.
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Affiliation(s)
| | - Timothy B. Chafin
- Department of Pain Management and Rehabilitation Medicine, Vidant Roanoke-Chowan Hospital, Ahoskie, NC
| | | | | | - Sean Li
- Premier Pain Centers, Shrewsbury, NJ
| | | | | | - Sayed E. Wahezi
- Departments of Physical Medicine and Rehabilitation and Anesthesiology, Albert Einstein College of Medicine at Montefiore, Montefiore Medical Center, Bronx, NY; and
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Kim JH, Kim HS, Kapoor A, Adsul N, Kim KJ, Choi SH, Jang JS, Jang IT, Oh SH. Feasibility of Full Endoscopic Spine Surgery in Patients Over the Age of 70 Years With Degenerative Lumbar Spine Disease. Neurospine 2018; 15:131-137. [PMID: 29991242 PMCID: PMC6104732 DOI: 10.14245/ns.1836046.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/17/2018] [Indexed: 12/28/2022] Open
Abstract
Background/Aims Degenerative spine disease, encompassing disc prolapse and stenosis, is a common ailment in old age. This prospective study was undertaken to evaluate the role of endoscopic spine surgery in elderly patients (above 70 years of age) with clinical and radiological follow-up.
Methods In this study, a retrospective analysis was conducted of 53 patients with lumbar disc prolapse or spinal stenosis who were treated with percutaneous endoscopic discectomy or decompression from November 2015 to June 2017. Clinical follow-up was done at 1 week, 3 months, and 1 year, and at yearly intervals thereafter. The outcomes were assessed using the modified Macnab criteria, a visual analogue scale, and the Oswestry Disability Index.
Results Of the 53 patients, 21 were men and 32 were women. Their mean age was 76±4 years. The mean follow-up period was 17 months. Percutaneous endoscopic discectomy was performed in 24 patients and endoscopic decompression in 24 patients, while 5 patients underwent combined surgery. An excellent outcome in terms of the MacNab criteria was observed in 9 patients (16.98%), a good outcome in 38 patients (71.7%), and a poor outcome in 6 patients (11.3%). Of the 6 patients with a poor outcome, 5 (9.4%, 5 of 53) developed recurrent disc prolapse, and 1 developed hematoma with motor weakness. All 6 of these cases required revision surgery.
Conclusion Managing degenerative spine disease in elderly patients with multiple comorbidities is a challenging task. Percutaneous endoscopic spine surgery is pivotal for addressing this concern. The authors have shown that optimal results can be achieved with various types of disc prolapse and stenosis with favorable long-term outcomes.
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Affiliation(s)
- Jeong Hoon Kim
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea
| | - Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Seoul, Korea
| | - Ankur Kapoor
- Department of Neurosurgery, Nanoori Hospital, Seoul, Korea
| | - Nitin Adsul
- Department of Neurosurgery, Nanoori Hospital, Seoul, Korea
| | - Ki Joon Kim
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea
| | - Sung Ho Choi
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea
| | - Jee-Soo Jang
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Seoul, Korea
| | - Seong-Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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