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Shafiekhani P, Hajimohammadebrahim-Ketabforoush M, Jajin EA, Zandpazandi S, Shahmohammadi M. Clinical Outcomes Following Decompression of Central Canal and Lateral Recess Simultaneous Stenosis, with a Focus on Multilevel Stenosis: A Randomized Comparison of Microscopic Bilateral Laminotomy versus Total Laminectomy with Posterior Spinal Fusion. World Neurosurg 2024; 187:e257-e263. [PMID: 38685350 DOI: 10.1016/j.wneu.2024.04.072] [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: 11/27/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND In patients with simultaneous lumbar central spinal stenosis (LCSS) and lateral recess stenosis (LRS) at multiple levels, spinal decompression using microscopic bilateral laminotomy was compared to total laminectomy plus medial facetectomy and fusion (LF). METHODS From 2017 to 2022, this trial was performed to examine 96 patients with concomitant LCS and LRS at multilevel. Of the 96 patients, 48 were allocated to the following groups: LF (group I) or microscopic bilateral laminotomy (group II). However, 76 patients completed the study. We compared the outcomes in these 2 groups. RESULTS Microscopic bilateral laminotomy was superior in most outcome measures. Delta-visual analog scale leg pain in group II was significantly greater than in group I (mean-group I: 4.368 vs. group II: 5.368, P value = 0.001). Complication and revision rates were lower in the microscopic bilateral laminotomy than in group I, except for incidental durotomy occurrence (group II: 31.58% -group I: 7.89%, P value = 0.0190). The rate of revision surgery for group I compared with group II was 44.74% versus 13.16% (P value = 0.0047), indicating the superiority of laminotomy over LF. The mean length of hospital stay was 3.551 ± 0.6349 in group II versus 6.774 ± 1.197 in group I (P value <0.0001). Also, blood loss during surgery was significantly lower in group II (P value <0.0001). CONCLUSIONS The findings indicate that microscopic bilateral laminotomy provides favorable clinical and radiological outcomes for individuals experiencing multilevel lumbar central canal and LRS. However, a higher frequency of durotomy may occur during microsurgical procedures.
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Affiliation(s)
- Paria Shafiekhani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Melika Hajimohammadebrahim-Ketabforoush
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Amanzadeh Jajin
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Zandpazandi
- STAR program Post-Doctoral Research Scholar, Department of Neurological Surgery, Medical University of South Carolina, Columbia, South Carolina, USA
| | - Mohammadreza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Fan G, Wang D, Li Y, Xu Z, Wang H, Liu H, Liao X. Machine Learning Predicts Decompression Levels for Lumbar Spinal Stenosis Using Canal Radiomic Features from Computed Tomography Myelography. Diagnostics (Basel) 2023; 14:53. [PMID: 38201362 PMCID: PMC10795799 DOI: 10.3390/diagnostics14010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The accurate preoperative identification of decompression levels is crucial for the success of surgery in patients with multi-level lumbar spinal stenosis (LSS). The objective of this study was to develop machine learning (ML) classifiers that can predict decompression levels using computed tomography myelography (CTM) data from LSS patients. METHODS A total of 1095 lumbar levels from 219 patients were included in this study. The bony spinal canal in CTM images was manually delineated, and radiomic features were extracted. The extracted data were randomly divided into training and testing datasets (8:2). Six feature selection methods combined with 12 ML algorithms were employed, resulting in a total of 72 ML classifiers. The main evaluation indicator for all classifiers was the area under the curve of the receiver operating characteristic (ROC-AUC), with the precision-recall AUC (PR-AUC) serving as the secondary indicator. The prediction outcome of ML classifiers was decompression level or not. RESULTS The embedding linear support vector (embeddingLSVC) was the optimal feature selection method. The feature importance analysis revealed the top 5 important features of the 15 radiomic predictors, which included 2 texture features, 2 first-order intensity features, and 1 shape feature. Except for shape features, these features might be eye-discernible but hardly quantified. The top two ML classifiers were embeddingLSVC combined with support vector machine (EmbeddingLSVC_SVM) and embeddingLSVC combined with gradient boosting (EmbeddingLSVC_GradientBoost). These classifiers achieved ROC-AUCs over 0.90 and PR-AUCs over 0.80 in independent testing among the 72 classifiers. Further comparisons indicated that EmbeddingLSVC_SVM appeared to be the optimal classifier, demonstrating superior discrimination ability, slight advantages in the Brier scores on the calibration curve, and Net benefits on the Decision Curve Analysis. CONCLUSIONS ML successfully extracted valuable and interpretable radiomic features from the spinal canal using CTM images, and accurately predicted decompression levels for LSS patients. The EmbeddingLSVC_SVM classifier has the potential to assist surgical decision making in clinical practice, as it showed high discrimination, advantageous calibration, and competitive utility in selecting decompression levels in LSS patients using canal radiomic features from CTM.
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Affiliation(s)
- Guoxin Fan
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518056, China; (G.F.); (Z.X.); (H.W.)
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Dongdong Wang
- Department of Orthopaedics, Putuo People’s Hospital, Tongji University, Shanghai 200060, China;
| | - Yufeng Li
- Department of Sports Medicine, Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China;
| | - Zhipeng Xu
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518056, China; (G.F.); (Z.X.); (H.W.)
| | - Hong Wang
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518056, China; (G.F.); (Z.X.); (H.W.)
| | - Huaqing Liu
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Guangzhou 510700, China
| | - Xiang Liao
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518056, China; (G.F.); (Z.X.); (H.W.)
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Kirker K, Masaracchio MF, Loghmani P, Torres-Panchame RE, Mattia M, States R. Management of lumbar spinal stenosis: a systematic review and meta-analysis of rehabilitation, surgical, injection, and medication interventions. Physiother Theory Pract 2023; 39:241-286. [PMID: 34978252 DOI: 10.1080/09593985.2021.2012860] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) has a substantial impact on mobility, autonomy, and quality of life. Previous reviews have demonstrated inconsistent results and/or have not delineated between specific nonsurgical interventions. OBJECTIVE The purpose of this systematic review is to assess the effectiveness of interventions in the management of LSS. METHODS Eligible studies were randomized controlled trials (RCTs) or prospective studies, included patients with LSS, assessed the effectiveness of any interventions (rehabilitation, surgical, injection, medication), included at least two intervention groups, and included at least one measure of pain, disability, ambulation assessment, or LSS-specific symptoms. Eighty-five articles met inclusion criteria. Meta-analyses were conducted across outcomes. Effect sizes were calculated using Hedge's g and reported descriptively. Formal grading of evidence was conducted. RESULTS Meta-analysis comparing rehabilitation to no treatment/placebo demonstrated significant effects on pain favoring rehabilitation (mean difference, MD -1.63; 95% CI: -2.68, -0.57; I2 = 71%; p = .002). All other comparisons to no treatment/placebo revealed nonsignificant findings. The level of evidence ranged from very low to high for rehabilitation and medication versus no treatment/placebo for pain, disability, ambulation ability, and LSS symptoms. CONCLUSIONS Although the findings of this review are inconclusive regarding superiority of interventions, this accentuates the value of multimodal patient-centered care in the management of patients with LSS.
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Affiliation(s)
- Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | - Parisa Loghmani
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | - Michael Mattia
- Department of Allied Health, Kingsborough Community College, Brooklyn, NY, USA
| | - Rebecca States
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
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Zhang Y, Wei FL, Liu ZX, Zhou CP, Du MR, Quan J, Wang YP. Comparison of posterior decompression techniques and conventional laminectomy for lumbar spinal stenosis. Front Surg 2022; 9:997973. [PMID: 36268217 PMCID: PMC9577104 DOI: 10.3389/fsurg.2022.997973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare the efficacy of posterior decompression techniques with conventional laminectomy for lumbar spinal stenosis. Methods The Embase, PubMed, and Cochrane Library databases were searched with no language limitations from inception to January 13, 2022. The main outcomes were functional disability, perceived recovery, leg and back pain, complications. A random effects model was used to pooled data. Risk ratio (RR), mean difference (MD) and 95% confidence interval (CI) were used to report results. The study protocol was published in PROSPERO (CRD42022302218). Results 14 trials including 1,106 participants were included in the final analysis. Bilateral laminotomy was significantly more efficacious in improve functionality than laminectomy [MD: -2.94; (95% CI, -4.12 to -1.76)]. Low incidence of iatrogenic instability due to bilateral laminectomy compared with laminectomy [RR: 0.11; (95% CI, 0.02 to 0.59)]. In addition, between those who received bilateral laminotomy and those undergoing laminectomy, the result showed significant difference regarding recovery [RR: 1.31; (95% CI, 1.03 to 1.67)]. Conclusions This study provides evidence that bilateral laminotomy has advantages in functional recovery, postoperative stability, and postoperative rehabilitation outcomes. Further research is needed to determine whether posterior techniques provide a safe and effective option for conventional laminectomy.
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Affiliation(s)
- Yong Zhang
- Department of Orthopedics, An Kang Central Hospital, AnKang, China
| | - Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Zhi-Xin Liu
- Department of Orthopedics, An Kang Central Hospital, AnKang, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Ming-Rui Du
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Jian Quan
- Second Department of Orthopedics, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China,Correspondence: Yan-Peng Wang Jian Quan
| | - Yan-Peng Wang
- Second Department of Orthopedics, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China,Correspondence: Yan-Peng Wang Jian Quan
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Zhang C, Chen L, Li J, Huang D, Zhang W, Lin J. Should Posterior Midline Structures Be Preserved in Decompression Surgery for Lumbar Spinal Stenosis?: A Systematic Review and Meta-analysis. Clin Spine Surg 2022; 35:341-349. [PMID: 34711752 DOI: 10.1097/bsd.0000000000001268] [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] [Received: 04/23/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a systematic review and meta-analysis study. OBJECTIVE The purpose of this study is to evaluate the available evidence on the preservation of posterior midline structures in decompression surgery for lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA The gold-standard treatment for LSS refractory to conservative management is facet-preserving laminectomy. The question remains whether the midline structures should be preserved in decompression surgery for LSS. MATERIALS AND METHODS We performed a systematic review of the Medline, PubMed, Embase, and Cochrane databases in search of published reports comparing midline structure preservation (MSP) and conventional laminectomy (CL) for LSS. The population was divided into 2 groups: (1) MSP group (intervention) and (2) CL group (control). The various outcome parameters including blood loss, operation time, hospital stay, back and leg pain, functional scores including Oswestry Disability Index (ODI) score, Japanese Orthopedic Association score, and 36-Item Short Form Survey (SF-36) scores, satisfaction, and instability rates were analyzed. Data were extracted and aggregated for meta-analysis. RESULTS Of the published reports, 16 met our inclusion criteria with an aggregated 540 in the intervention and 538 in the control groups, respectively. The aggregated data demonstrated patients undergoing MSP had significantly decreased back pain Visual Analog Scale compared with CL, regardless of time after surgery ( P =0.007). The MSP group also showed a significantly lower Oswestry Disability Index score and SF-36 Mental Component Summary score ( P =0.005 and 0.03, respectively) and longer 6-month walking distance ( P <0.00001). The patient satisfaction rate was significantly higher in the MSP group ( P =0.02), and the instability rate was significantly lower in the MSP group compared with the CL group ( P <0.0001). At 3 days after surgery, MSP significantly decreased the level of creatinine phosphokinase ( P <0.00001). Regarding intraoperative blood loss, hospital stay, leg pain Visual Analog Scale score, Japanese Orthopedic Association score, and SF-36 Physical Component Summary score, there were no significant differences between the 2 groups. However, MSP showed significantly higher operation time ( P =0.04). CONCLUSIONS We concluded despite heterogenous and limited data, this study suggests that preservation of midline structure leads to less severe back pain, better functional recovery, and satisfaction rate. Meanwhile, it decreases creatinine phosphokinase level and instability rate. LEVEL OF EVIDENCE Level III-therapeutic.
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Affiliation(s)
- Chaofan Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
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Jin K, Zhu Y, Li N, Li Y, Yao Y, Mo Z, Fan Y. Biomechanical effect of posterior ligament repair in lamina repair surgery. Comput Methods Biomech Biomed Engin 2022; 26:799-806. [PMID: 35762201 DOI: 10.1080/10255842.2022.2089024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cervical laminectomy has usually been applied in treating cervical spinal cord tumour. However, spinal instability after laminectomy was observed with high occurrence rate, due to excising of posterior structures. This study was to investigate the biomechanical performances of ligament repair on the cervical stability in lamina repair surgery. A finite element of cervical spine model (C2-C7) was developed, and lamina repair surgery with and without ligament repair was simulated at C3-C6 segments. All models were loaded with pure moment of 1.5 Nm to produce flexion, extension, lateral blending and axial torsion. Compared to intact model, the range of motion (ROM) at C2-C3, C6-C7 increased by 12.8%-113.6% in lamina repair model (LRM), while the change of ROM in other segments was less than 9.2%. The change of ROM in all segments in the lamina and ligament repair model (LLRM) was less than 7.2%. The maximal intradiscal pressure (IDP) in adjacent segment (C2-C3 and C6-C7) increased by 73.7%, and the maximal stresses in capsular ligament increased by 168.6% in LRM model. By the other hand, the change of facet joint contact stress, IDP and stresses in capsular ligament in LLRM model were less than 11.5%. The differences of stresses on bone-screw interface and screw-plate system in C4,C5 between LRM and LLRM were less than 5.9 MPa (2.7%), but this value in C3 and C6 were up to 105.7 MPa (41.8%). Laminectomy without reconstruction of posterior ligament resulted larger mobility in the adjacent segments, which might induce spinal instability as postoperative complications. Repairing or preserving the posterior ligament in the lamina repair is benefit to spinal integrity and stability.
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Affiliation(s)
- Kaixiang Jin
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, P. R. China.,School of Engineering Medicine, Beihang University, Beijing, P. R. China
| | - Yuanjun Zhu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, P. R. China
| | - Nan Li
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, P. R. China
| | - Yinghui Li
- Beijing No.2 Middle School, Beijing, P. R. China
| | - Yan Yao
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, P. R. China.,School of Engineering Medicine, Beihang University, Beijing, P. R. China
| | - Zhongjun Mo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Technical Aids Analysis and Identification Key Laboratory of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, Beijing, P. R. China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, P. R. China.,School of Engineering Medicine, Beihang University, Beijing, P. R. China
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Nolte MT, Louie PK, Basques BA, Varthi AG, Paul JC, Khanna K, Khurana T, Chaudhri A, Samartzis D, Goldberg EJ, An HS. Patients Undergoing 3-Level-or-Greater Decompression-Only Surgery for Lumbar Spinal Stenosis Have Similar Outcomes to Those Undergoing Single-Level Surgery at 2 Years. Int J Spine Surg 2021; 15:945-952. [PMID: 34551931 PMCID: PMC8651207 DOI: 10.14444/8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stability following multilevel decompressive laminectomy without fusion has been debated using in vitro biomechanical and radiographic models. However, there is a lack of information regarding clinical outcomes for these patients. The aim of the present study was to determine the association between clinical outcomes and number of levels decompressed via laminectomy for treatment of lumbar spinal stenosis. METHODS We performed a retrospective cohort analysis of patients who underwent a primary lumbar laminectomy between 2009 and 2015 by senior orthopedic spine surgeons for lumbar spinal stenosis. Patients were divided into 2 groups based on the number of decompression levels: single level or 3 or more levels. Patient-reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey scores, and Veterans Rand 12-Item Health Mental and Physical Survey scores. RESULTS Overall, 138 consecutive patients were assessed, of which 106 underwent a single-level and 32 underwent a 3-or-more-level laminectomy. Average follow-up was 24.2 months. There were no significant differences in the preoperative VAS back, VAS leg, or ODI scores between the single-level laminectomy and 3-or-more-level laminectomy groups. Both groups of patients experienced significant improvements in these clinical outcomes postoperatively with no clinically significant difference in the degree of improvement. Reoperation rates were low and similar between the 2 groups. CONCLUSIONS Patients undergoing decompression of 3 or more levels present with similar postoperative outcomes to those who undergo a single-level decompression for lumbar spinal stenosis. Under specific clinical and radiographic criteria, a multilevel decompression of 3 or more levels may be a safe and effective procedure with acceptable outcomes at 2 years after surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Michael T. Nolte
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Philip K. Louie
- Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York
| | - Bryce A. Basques
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Arya G. Varthi
- Yale School of Medicine, Orthopaedics, and Rehabilitation, New Haven, Connecticut
| | | | - Krishn Khanna
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Tarush Khurana
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Arshan Chaudhri
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Dino Samartzis
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Edward J. Goldberg
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Howard S. An
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
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Wei FL, Du MR, Li T, Zhu KL, Zhu YL, Yan XD, Yuan YF, Wu SD, An B, Gao HR, Qian JX, Zhou CP. Therapeutic Effect of Large Channel Endoscopic Decompression in Lumbar Spinal Stenosis. Front Surg 2021; 8:603589. [PMID: 34222312 PMCID: PMC8249583 DOI: 10.3389/fsurg.2021.603589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Percutaneous endoscopic decompression (PED) is a minimally invasive surgical technique that is now used for not only disc herniation but also lumbar spinal stenosis (LSS). However, few studies have reported endoscopic surgery for LSS. Therefore, we conducted this study to evaluate the outcomes and safety of large channel endoscopic decompression. Methods: Forty-one patients diagnosed with LSS who underwent PED surgery were included in the study. The estimated blood loss, operative time, length of hospital stay, hospital costs, reoperations, complications, visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, Japanese Orthopaedic Association (JOA) score and SF-36 physical-component summary scores were assessed. Preoperative and postoperative continuous data were compared through paired-samples t-tests. The significance level for all analyses was defined as p < 0.05. Results: A total of 41 consecutive patients underwent PED, including 21 (51.2%) males and 20 (48.8%) females. The VAS and ODI scores decreased from preoperatively to postoperatively, but the JOA and SF-36 physical component summary scores significantly increased. The VAS (lumbar) score decreased from 5.05 ± 2.33 to 0.45 ± 0.71 (P = 0.000); the VAS (leg) score decreased from 5.51 ± 2.82 to 0.53 ± 0.72 (P = 0.000); the ODI score decreased from 52.80 ± 20.41 to 4.84 ± 3.98 (P = 0.000), and the JOA score increased from 11.73 ± 4.99 to 25.32 ± 2.12 (P = 0.000). Only 1 patient experienced an intraoperative complication (2.4%; dural tear), and 1 patient required reoperation (2.4%). Conclusions: Surgical treatment for LSS is to sufficiently decompress and minimize the trauma and complications caused by surgery. This study did not reveal any obvious shortcomings of PED and suggested PED is a safe and effective treatment for LSS.
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi-Li Zhu
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Xiao-Dong Yan
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi-Fang Yuan
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Sheng-Da Wu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Bo An
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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Wu MH, Wu PC, Lee CY, Lin YK, Huang TJ, Lin CL, Lin CH, Huang YH. Outcome analysis of lumbar endoscopic unilateral laminotomy for bilateral decompression in patients with degenerative lumbar central canal stenosis. Spine J 2021; 21:122-133. [PMID: 32871276 DOI: 10.1016/j.spinee.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has been reported as an alternative treatment for degenerative lumbar central canal stenosis (DLCS). PURPOSE To investigate the outcomes of LE-ULBD for different types of DLCS, including simple DLCS, DLCS with degenerative spondylolisthesis (DSL), and DLCS with degenerative scoliosis (DSC). STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE One-hundred sixteen patients with DLCS who underwent LE-ULBD at a spine center from April 2015 to June 2017 were enrolled in this study. OUTCOME MEASURES Operative time, postoperative duration of hospitalization, and clinical outcomes (Oswestry disability index [ODI], visual analog scale [VAS], and modified Macnab outcome scale), and adverse events. METHODS A comparative analysis was performed evaluating medical records, radiological studies, and patient reported outcomes including ODI score, VAS scores and modified Macnab outcome scales in patients who underwent LE-ULBD. Data were prospectively collected at preoperative, postoperative 3-, 6-, 12-, 24-month to assess clinical and radiological outcomes and complications. RESULTS The study analyzed 106 patients (45 men and 61 women, with a mean age of 69.5 years); 40 (37.8%) had simple DLCS, 41 (38.7%) had DLCS with DSL, and 25 (23.5%) had DLCS with DSC. The mean follow-up period was 33.3 months. The mean preoperative and postoperative follow-up ODI score and VAS scores for leg and back pain showed significant improvement in all time points. No significant difference was found among different pathologies in terms of VAS scores for back and leg pain, ODI scores and modified Macnab outcome scales at all follow-up periods. CONCLUSIONS LE-ULBD is a feasible treatment method for DLCS. It did not result in worse outcomes in cases with DLCS with DSL or DLCS with DSC as compared with cases with simple DLCS.
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Affiliation(s)
- Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Po-Chien Wu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yen-Kuang Lin
- Research Center of Biostatistics, Taipei Medical University, Taipei 11031, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan 70101, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
| | - Yi-Hung Huang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan.
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Azad TD, Varshneya K, Herrick DB, Pendharkar AV, Ho AL, Stienen M, Zygourakis C, Bagshaw HP, Veeravagu A, Ratliff JK, Desai A. Timing of Adjuvant Radiation Therapy and Risk of Wound-Related Complications Among Patients With Spinal Metastatic Disease. Global Spine J 2021; 11:44-49. [PMID: 32875859 PMCID: PMC7734271 DOI: 10.1177/2192568219889363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN This was an epidemiological study using national administrative data from the MarketScan database. OBJECTIVE To investigate the impact of early versus delayed adjuvant radiotherapy (RT) on wound healing following surgical resection for spinal metastatic disease. METHODS We queried the MarketScan database (2007-2016), identifying patients with a diagnosis of spinal metastasis who also underwent RT within 8 weeks of surgery. Patients were categorized into "Early RT" if they received RT within 4 weeks of surgery and as "Late RT" if they received RT between 4 and 8 weeks after surgery. Descriptive statistics and hypothesis testing were used to compare baseline characteristics and wound complication outcomes. RESULTS A total of 540 patients met the inclusion criteria: 307 (56.9%) received RT within 4 weeks (Early RT) and 233 (43.1%) received RT within 4 to 8 weeks (Late RT) of surgery. Mean days to RT for the Early RT cohort was 18.5 (SD, 6.9) and 39.7 (SD, 7.6) for the Late RT cohort. In a 90-day surveillance period, n = 9 (2.9%) of Early RT and n = 8 (3.4%) of Late RT patients developed wound complications (P = .574). CONCLUSIONS When comparing patients who received RT early versus delayed following surgery, there were no significant differences in the rates of wound complications. Further prospective studies should aim to identify optimal patient criteria for early postoperative RT for spinal metastases.
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Affiliation(s)
- Tej D. Azad
- Stanford University School of Medicine, Stanford, CA, USA
- Tej D. Azad and Kunal Varshneya contributed equally toward this study
| | - Kunal Varshneya
- Stanford University School of Medicine, Stanford, CA, USA
- Tej D. Azad and Kunal Varshneya contributed equally toward this study
| | | | | | - Allen L. Ho
- Stanford University School of Medicine, Stanford, CA, USA
| | - Martin Stienen
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Atman Desai
- Stanford University School of Medicine, Stanford, CA, USA
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11
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Roller BL, Boutin RD, O'Gara TJ, Knio ZO, Jamaludin A, Tan J, Lenchik L. Accurate prediction of lumbar microdecompression level with an automated MRI grading system. Skeletal Radiol 2021; 50:69-78. [PMID: 32607805 DOI: 10.1007/s00256-020-03505-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lumbar spine MRI interpretations have high variability reducing utility for surgical planning. This study evaluated a convolutional neural network (CNN) framework that generates automated MRI grading for its ability to predict the level that was surgically decompressed. MATERIALS AND METHODS Patients who had single-level decompression were retrospectively evaluated. Sagittal T2 images were processed by a CNN (SpineNet), which provided grading for the following: central canal stenosis, disc narrowing, disc degeneration, spondylolisthesis, upper/lower endplate morphologic changes, and upper/lower marrow changes. The grades were used to calculate an aggregate score. The variables and the aggregate score were analyzed for their ability to predict the surgical level. For each surgical level subgroup, the surgical level aggregate scores were compared with the non-surgical levels. RESULTS A total of 141 patients met the inclusion criteria (82 women, 59 men; mean age 64 years; age range 28-89 years). SpineNet did not identify central canal stenosis in 32 patients. Of the remaining 109, 96 (88%) patients had a decompression at the level of greatest stenosis. The higher stenotic grade was present only at the surgical level in 82/96 (85%) patients. The level with the highest aggregate score matched the surgical level in 103/141 (73%) patients and was unique to the surgical level in 91/103 (88%) patients. Overall, the highest aggregate score identified the surgical level in 91/141 (65%) patients. The aggregate MRI score mean was significantly higher for the L3-S1 surgical levels. CONCLUSION A previously developed CNN framework accurately predicts the level of microdecompression for degenerative spinal stenosis in most patients.
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Affiliation(s)
- Brandon L Roller
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd., Winston Salem, NC, 27157, USA.
| | - Robert D Boutin
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Tadhg J O'Gara
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ziyad O Knio
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amir Jamaludin
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Josh Tan
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd., Winston Salem, NC, 27157, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd., Winston Salem, NC, 27157, USA
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12
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Wu H, Gao ZW, Zhao DX, Li LY. Clinical study on minimally invasive transforaminal lumbar interbody fusion surgery for lumbar spondylolisthesis combined with severe narrowing of the intervertebral space. J Int Med Res 2020; 48:300060519889458. [PMID: 32216522 PMCID: PMC7133414 DOI: 10.1177/0300060519889458] [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: 11/17/2022] Open
Abstract
Objective To investigate the different clinical characteristics of minimally invasive transforaminal lumbar interbody fusion on treatment of lumbar spondylolisthesis combined with severe narrowing of the intervertebral space or simple grade II lumbar spondylolisthesis. Methods Thirty-eight patients were divided into groups A (16 cases combined with severe intervertebral space narrowing) or B (22 cases of simple grade II lumbar spondylolisthesis without intervertebral space narrowing). Differences in preoperative preparation, operation time, blood loss, tool selection, decompression, reduction, pedicle screw, cage size selection, and other aspects were compared. The Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) scores were used to assess the effect of treatment. Results The operation time was significantly longer, blood loss was greater, the anatomical reduction rate was lower, and cage size was smaller in group A than in group B. Furthermore, special tools were required for treating the lumbar intervertebral space and the pedicle screws were different between the groups. JOA and VAS scores were similar between the groups Conclusions Cases of severe intervertebral space narrowing need to be fully released, with bilateral decompression, and special intervertebral processing tools need to be prepared. Long pedicle screws are conducive to connecting the rod and reducing slippage.
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Affiliation(s)
- Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhong-Wen Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dong-Xu Zhao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Long-Yun Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
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13
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Yang F, Ren E, Yang L, Wang Y, Hu X, Yang Y, Kang X. The limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis with instability: Follow-up at least 12 months an observational study. Medicine (Baltimore) 2019; 98:e18277. [PMID: 31852100 PMCID: PMC6922491 DOI: 10.1097/md.0000000000018277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ± 10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients' functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients' functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.
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Affiliation(s)
- Fengguang Yang
- Lanzhou University Second Hospital
- Orthopedics Key laboratory of Gansu Province, Lanzhou
- The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Gansu, PR China
| | - Enhui Ren
- Lanzhou University Second Hospital
- Orthopedics Key laboratory of Gansu Province, Lanzhou
- The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Gansu, PR China
| | - Liang Yang
- Lanzhou University Second Hospital
- Orthopedics Key laboratory of Gansu Province, Lanzhou
- The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Gansu, PR China
| | - Yonggang Wang
- Lanzhou University Second Hospital
- Orthopedics Key laboratory of Gansu Province, Lanzhou
| | - Xuchang Hu
- Lanzhou University Second Hospital
- Orthopedics Key laboratory of Gansu Province, Lanzhou
| | - Yong Yang
- Lanzhou University Second Hospital
- Orthopedics Key laboratory of Gansu Province, Lanzhou
| | - Xuewen Kang
- Lanzhou University Second Hospital
- Orthopedics Key laboratory of Gansu Province, Lanzhou
- The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Gansu, PR China
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14
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Bello F, Njami VA, Bogne SL, Lekane NA, Mbele GI, Nchufor R, Ndome OL, Haman ON, Djientcheu VDP. Quality of life of patients operated for lumbar stenosis at the Yaoundé Central Hospital. Br J Neurosurg 2019; 34:62-65. [PMID: 31747796 DOI: 10.1080/02688697.2019.1692784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Several studies have been conducted in many African countries on lumbar stenosis but none on the quality of life of patients after surgery. We conducted this study to evaluate the quality of life of patients following surgery indicated for lumbar stenosis.Methods: A cross-sectional study from January 2010 to December 2015 in the neurosurgery department of the Yaoundé Central Hospital. We included all patients operated for lumbar stenosis, whose post-operative follow-up was at least of one year. Sampling was consecutive using operating room registries and archives of the neurosurgery department. We used the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) to evaluate patient's quality of life.Results: We recruited 52 patients. The mean age was 58.13 years. Pre-operatively, 67.3% of patients presented with severe pain (mean VAS of 8.9). At 3 months, 59.6% presented with moderate pain (mean VAS = 4.75). At six months following surgery, 92.3% of patients had mild pain (mean VAS = 2.92). At one year, all patients had only mild pain (mean VAS = 1.05). Pre-operatively, 67.30% of patients presented with severe walking disability; the mean ODI was 77.88% and a third were bedridden. Three months after surgery 61.50% presented with moderate disability and the mean ODI was 38.17%. Six months following surgery, 48.10% of patients presented with moderate disability and 42.30% presented with a mild disability (the mean ODI was 24.80%). At one year, 82% of patients presented with mild disability and the mean ODI was 12.67%.Conclusion: Surgery improved the physical condition of patients.
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Affiliation(s)
- F Bello
- Neurosurgery department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - V A Njami
- Neurosurgery department, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - S L Bogne
- Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
| | - N A Lekane
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G I Mbele
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - R Nchufor
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - O L Ndome
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - O N Haman
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - V de P Djientcheu
- Neurosurgery department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
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15
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Peng H, Tang G, Zhuang X, Lu S, Bai Y, Xu L. Minimally invasive spine surgery decreases postoperative pain and inflammation for patients with lumbar spinal stenosis. Exp Ther Med 2019; 18:3032-3036. [PMID: 31555386 PMCID: PMC6755410 DOI: 10.3892/etm.2019.7917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/06/2018] [Indexed: 12/14/2022] Open
Abstract
In certain cases, lumbar spinal stenosis may lead to lumbar nervous disorder. A previous study indicated that minimally invasive spine surgery (MISS) presents benefits compared with conventional open surgery (COS). In the current study, the efficacy of MISS and COS for lumbar spinal stenosis patients was investigated. A total of 82 patients with lumbar spinal stenosis were enrolled and divided into two age-matched groups that received MISS (n=41) or COS (n=41). Patient parameters, including symptoms, inflammatory score, visual analog score (VAS), wound length, Oswestry Disability Index (ODI), hospital stay and postoperative outcomes were analyzed in the current study. Outcomes indicated that both MISS and COS significantly improved symptoms of lumbar spinal stenosis compared with the baseline. It was observed that MISS resulted in decreased wound length and hospital stay compared with COS for patients with lumbar spinal stenosis. The results revealed that MISS had better outcomes compared with COS in improving ODI and inflammatory score for patients with lumbar spinal stenosis. Notably, it was identified that MISS exhibited improved VAS for back and leg pain compared with the COS group for patients with lumbar spinal stenosis. In conclusion, these outcomes indicate that MISS was more effective compared with COS for improving symptoms in patients with lumbar stenosis.
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Affiliation(s)
- Hui Peng
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Guangping Tang
- Department of Orthopedics, Wuhan Hanyang Hospital, Wuhan, Hubei 430050, P.R. China
| | - Xiaoqiang Zhuang
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Shenglin Lu
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yu Bai
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Li Xu
- Department of Traumatology, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
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16
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Zini C, Bellini M, Masala S, Marcia S. Percutaneous Interspinous Spacer in Spinal-Canal-Stenosis Treatment: Pros and Cons. MEDICINA-LITHUANIA 2019; 55:medicina55070381. [PMID: 31315310 PMCID: PMC6681403 DOI: 10.3390/medicina55070381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022]
Abstract
A comprehensive description of the literature regarding interspinous process devices (IPD) mainly focused on comparison with conservative treatment and surgical decompression for the treatment of degenerative lumbar spinal stenosis. Recent meta-analysis and articles are listed in the present article in order to establish IPD pros and cons.
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Affiliation(s)
- Chiara Zini
- Dipartimento di Radiologia, Azienda USL Toscana Centro, 50012 Firenze, Italy
| | - Matteo Bellini
- UOC NINT Neuroimmagini e Neurointerventistica, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Salvatore Masala
- Diagnostica per Immagini e Radiologia Interventistica Ospedale San Giovanni Battista, 00148 Roma, Italy
| | - Stefano Marcia
- Radiologia PO SS Trinità, ATS Sardegna ASSL Cagliari, 09121 Cagliari, Italy.
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17
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Strube P, Putzier M, Siewe J, Eicker SO, Dreimann M, Zippelius T. To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis. Arch Orthop Trauma Surg 2019; 139:613-621. [PMID: 30542763 DOI: 10.1007/s00402-018-3096-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Surgical treatment methods for degenerative spondylolisthesis (decompression versus decompression and fusion) have been critically debated. The medical care situation is almost unknown for either treatment. Therefore, the aim of the present study was to provide information regarding the use of parameters for decision-making and the employment of surgical techniques. MATERIALS AND METHODS A web-based survey was performed among members of the German-Spine-Society (DWG). Information regarding participant characteristics (specialty, age, DWG certification status, number of spine surgeries performed at the participant's institution each year, institutional status), estimates of the use of both treatment options, clinical and morphological decision-making criteria for additive fusion, and the surgical technique used was queried. RESULTS 305 members (45% neurosurgeons/ 55% orthopedic or trauma surgeons) participated in the present study. The participants estimated that in 41.7% of the cases, decompression only was required, while 55.6% would benefit from additional fusion. Among the participants, 74% reported that low back pain was an important indicator of the need for fusion if the numerical rating scale for back pain was at least 6/10. The most commonly used decompression technique was minimally invasive unilateral laminotomy, whereas open approach-based interbody fusion with transpedicular fixation and laminotomy was the most frequently used fusion technique. Specialty, age, certification status, and institutional status had a partial effect on the responses regarding indications, treatment and surgical technique. CONCLUSIONS The present survey depicts the diversity of approaches to surgery for degenerative spondylolistheses in Germany. Considerable differences in treatment selection were observed in relation to the participants' educational level and specialty.
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Affiliation(s)
- Patrick Strube
- Orthopedic Department, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Michael Putzier
- Department of Traumatology and Orthopedics, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jan Siewe
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln (AöR), Kerpener Straße 62, 50937, Cologne, Germany
| | - Sven Oliver Eicker
- Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marc Dreimann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Timo Zippelius
- Orthopedic Department, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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18
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Lee CW, Yoon KJ, Kim SW. Percutaneous Endoscopic Decompression in Lumbar Canal and Lateral Recess Stenosis - The Surgical Learning Curve. Neurospine 2019; 16:63-71. [PMID: 30943708 PMCID: PMC6449834 DOI: 10.14245/ns.1938048.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The purpose of this study is to characterize the learning curve of endoscopic lumbar decompression based on peri- and postoperative parameters and to suggest the potential of full endoscopic decompression as a primary treatment option for lumbar canal and lateral recess stenosis. METHODS The records of 223 consecutive patients who underwent percutaneous endoscopic decompression by a single surgeon for their lumbar canal and lateral recess stenosis were reviewed. Patients were stratified into group 1 (n=100) and group 2 (n=123), depending on their case number. After the 100th case, the procedural time reached a plateau and subsequent patients were assigned to the second group. Demographics and surgical outcomes, including operative times, change in dural sac dimensions, length of hospital stay, and intraoperative complication rates were compared between the 2 groups. Postoperative clinical outcomes, including the visual analogue scale (VAS), the Oswestry Disability Index (ODI) and reoperation rates were compared between the 2 groups (group 1, n=90; group 2, n=110) by follow-up evaluation. RESULTS Procedural times were greater in group 1 than group 2 (group 1, 105.26 minutes; group 2, 67.65 minutes; p<0.05) and they had higher complication rates (group 1, 16% [16 of 100]; group 2, 8.3% [8 of 123]; p<0.05). The length of hospitalization, postoperative improvement in VAS and ODI, and reoperation rates were not different between the groups. In both groups, stenotic spinal canals were effectively decompressed. CONCLUSION Continued surgical experience was associated with a reduction in operative times and less intraoperative complications. Although the learning curve was steep and additional surgical experience may be needed to overcome the learning curve, percutaneous full endoscopic lumbar decompression is a safe, clinically-feasible, and effective surgical technique and can be adopted as the primary treatment for lumbar canal and lateral recess stenosis.
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Affiliation(s)
- Chul-Woo Lee
- Department of Neurosurgery, St Peter's Hospital, Seoul, Korea
| | - Kang-Jun Yoon
- Department of Neurosurgery, St Peter's Hospital, Seoul, Korea
| | - Sung-Won Kim
- Department of Neurosurgery, St Peter's Hospital, Seoul, Korea
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19
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Rieger B, Sitoci-Ficici KH, Reinshagen C, Brautferger U, Schackert G, Hudak R, Zivcak J, Molcanyi M, Pinzer T. Endoscopic and Microscopic Segmental Decompression via Translaminar Crossover Spinal Approach in Elderly Patients. World Neurosurg 2019; 125:e361-e371. [PMID: 30703594 DOI: 10.1016/j.wneu.2019.01.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE For effective minimally invasive lumbar decompression, we changed the routine of segmental decompression. Using a high-speed drill or an ultrasound knife, we created a working channel, starting at the base of the spinous process of the upper vertebra slightly above the disc level, to target and decompress the contralateral recess, and termed it the translaminar crossover decompression (TCD). We evaluated the feasibility and compared the outcomes of a navigation-guided endoscopic translaminar crossover approach for segmental decompression (eTCD) in elderly patients with microscopic decompression using the same approach (mTCD). METHODS A total of 740 elderly patients were enrolled in a prospective cohort study. Of the 740 patients, 297, who had undergone mTCD, and 253, who had undergone eTCD, completed a 1-year follow-up visit. In addition to the surgical data, numerical rating scales (NRSs) for back and leg pain, the Core Outcome Measures Index and Oswestry Disability Index were recorded preoperatively and 3, 6, and 12 months after surgery. The MacNab criteria were supplemented by qualitative assessment of the patients' postoperative pain-free walking distance. RESULTS A comparison of the preoperative and postoperative clinical scores showed significant improvement after TCD in both cohorts (P < 0.01): Oswestry Disability Index, from 50.3% ± 12.6% to 15.5% ± 7.43%; NRS (back), from 6.9 ± 1.9 to 2.5 ± 1.3; NRS (leg), from 8.0 ± 0.85 to 1.6 ± 0.33; Core Outcome Measures Index (back), from 7.8 ± 2.0 to 2.7 ± 1.5. No statistically significant differences were found in the outcomes between the 2 cohorts. CONCLUSIONS TCD inherently eliminated central stenosis and facilitated decompression of both recesses via mutual undercutting, with preservation of facet joint integrity.
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Affiliation(s)
- Bernhard Rieger
- Short Care Clinic, Greifswald, Germany; Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany.
| | - Kerim Hakan Sitoci-Ficici
- Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany
| | - Clemens Reinshagen
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Gabriele Schackert
- Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany
| | - Radovan Hudak
- Department of Biomedical Engineering, Technical University of Košice, Košice, Slovakia
| | - Jozef Zivcak
- Department of Biomedical Engineering, Technical University of Košice, Košice, Slovakia
| | - Marek Molcanyi
- Department of Neurosurgery, Medical University Graz, Austria; Institute of Neurophysiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Thomas Pinzer
- Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany
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Lim KT, Nam HGW, Kim SB, Kim HS, Park JS, Park CK. Therapeutic Feasibility of Full Endoscopic Decompression in One- to Three-Level Lumbar Canal Stenosis via a Single Skin Port Using a New Endoscopic System, Percutaneous Stenoscopic Lumbar Decompression. Asian Spine J 2018; 13:272-282. [PMID: 30472819 PMCID: PMC6454282 DOI: 10.31616/asj.2018.0228] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/07/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This retrospective study involved 450 consecutive cases of degenerative lumbar stenosis treated with percutaneous stenoscopic lumbar decompression (PSLD). PURPOSE We determined the feasibility of PSLD for lumbar stenosis at single and multiple levels (minimum 1-year follow-up) by image analysis to observe postoperative widening of the vertebral canal in the area. OVERVIEW OF LITERATURE The decision not to perform an endoscopic decompression might be due to the surgeon being uncomfortable with conventional microscopic decompression or unfamiliar with endoscopic techniques or the unavailability of relevant surgical tools to completely decompress the spinal stenosis. METHODS The decompressed canal was compared between preoperative controls and postoperative treated cases. Data on operative results, including length of stay, operative time, and surgical complications, were analyzed. Patients were assessed clinically on the basis of the Visual Analog Scale (VAS) score for the back and legs and using the Oswestry Disability Index (ODI). RESULTS Postoperative magnetic resonance imaging revealed that PSLD increased the canal cross-sectional area by 52.0% compared with the preoperative area at the index segment (p<0.001) and demonstrated minimal damage to the normal soft tissues including muscles and the extent of removed normal bony tissues. Mean improvements in VAS score and ODI were 4.0 (p<0.001) and 40% (p<0.001), respectively. CONCLUSIONS PSLD could be an alternative to microscopic or microendoscopic decompression with various advantages in the surgical management of lumbar stenosis.
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Affiliation(s)
- Kang Taek Lim
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Han Ga Wi Nam
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Soo Beom Kim
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Hyung Suk Kim
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Jin Soo Park
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Chun-Kun Park
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
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Percutaneous Endoscopic Laminotomy with Flavectomy by Uniportal, Unilateral Approach for the Lumbar Canal or Lateral Recess Stenosis. World Neurosurg 2018; 113:e129-e137. [PMID: 29425979 DOI: 10.1016/j.wneu.2018.01.195] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate clinical feasibility and safety of percutaneous endoscopic decompression by a uniportal, unilateral approach for lumbar canal or lateral recess stenosis. METHODS In this retrospective study, the procedure was performed with endoscopic instruments in the same way as conventional microscopic laminotomy and flavectomy. Clinical outcomes (visual analog scale, Oswestry Disability Index, modified MacNab criteria) were evaluated. Surgical outcomes, including operative time, hospital stay, and complications, were recorded. RESULTS Decompression was performed in 213 patients (232 lumbar levels) for spinal canal or lateral recess stenosis (unilateral laminotomy, n = 80; bilateral laminotomy, n = 152). Mean follow-up period was 26.45 months. Mean visual analog scale for leg pain, and back pain and mean Oswestry Disability Index improved from 8.24%, 5.35%, and 67.8% at baseline to 1.93% (P < 0.001), 2.05% (P < 0.001), and 17.14% (P < 0.001) at final follow-up. Based on modified MacNab criteria, excellent or good results were obtained in 93.8% of patients. Average operative time was 105.3 ± 56 minutes. In the late period of the learning curve, mean operative time was shortened by two thirds, and mean hospital stay was 2.45 days. There were 12 cases of transient postoperative dysesthesia, 3 cases of motor weakness, and 6 cases of dural tear. No patient had postoperative infection, hematoma, or need for revision surgery for incomplete decompression. CONCLUSIONS Percutaneous endoscopic decompression by a uniportal, unilateral approach is a safe, clinically feasible, and effective surgical technique for treatment of lumbar stenosis.
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Lundberg J, Langevin JP. Lumbar Microlaminectomy vs Traditional Laminectomy. Fed Pract 2017; 34:32-35. [PMID: 30766247 PMCID: PMC6370467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lumbar microlaminectomy is associated with shorter hospitalization and lower cost within the VA system.
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Affiliation(s)
- Jaclyn Lundberg
- is a medical student at Creighton University School of Medicine in Omaha, Nebraska. is a physician at Greater Los Angeles VA Healthcare System in California
| | - Jean-Philippe Langevin
- is a medical student at Creighton University School of Medicine in Omaha, Nebraska. is a physician at Greater Los Angeles VA Healthcare System in California
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