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Zhong N, Wang HY, Wei Q, Li H, Zhang N, Hao JX. Effects of minimally invasive surgery combined with specialized pain management nursing care on postoperativepain improvement and life quality after spinal injury. Pak J Med Sci 2024; 40:1158-1162. [PMID: 38952517 PMCID: PMC11190397 DOI: 10.12669/pjms.40.6.8652] [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: 08/25/2023] [Revised: 01/22/2024] [Accepted: 02/16/2024] [Indexed: 07/03/2024] Open
Abstract
Objective To determine the impacts to research the impacts of pain's Specialized Pain Management Nursing Care in the perioperative period on pain symptoms and life quality of patients experiencing minimally invasive surgery for spinal injury. Method Eighty patients with a spinal injury who underwent minimally invasive surgery in the Department of Orthopedics of Baoding No.1 Hospital from January 2018 to December 2021 were retrospectively analyzed. They were split into two groups following different nursing methods (n=40 each group). Specialized Pain Management Nursing Care were given to patients in the observation group. Those in the control group were given treated with routine care. Their pain score and nursing effect were compared, after which their quality of life, daily living ability and complication rate compared and analyzed. Results The pain degree in the control group was considerably more than that in the observation group in the 1st postoperative period. The pain degree, which decreased in both groups, slumped more significantly in the observation group on the 2nd and 3rd postoperative days. The postoperative hospital stays and pain duration in the observation group were shorter than those in the control group (P<0.05), and the nursing effect was significantly better than that in the control group (P<0.05). After postoperative nursing intervention. Conclusion Minimally invasive surgery integrated with the Specialized Pain Management Nursing Care can remarkably ameliorate pain after spinal injury surgery, reducing complications' incidence, and improving the life quality for patients.
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Affiliation(s)
- Na Zhong
- Na Zhong Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Hai-yun Wang
- Hai-yun Wang Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Qiong Wei
- Qiong Wei Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Hui Li
- Hui Li Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Na Zhang
- Na Zhang Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Jian-xue Hao
- Jian-xue Hao Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
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Süner HI, Castaño JP, Vargas-Jimenez A, Wagner R, Mazzei AS, Velazquez W, Jorquera M, Sallabanda K, Barcia Albacar JA, Carrascosa-Granada A. Comparison of the Tubular Approach and Uniportal Interlaminar Full-Endoscopic Approach in the Treatment of Lumbar Spinal Stenosis: Our 3-Year Results. World Neurosurg 2023; 173:e148-e155. [PMID: 36775236 DOI: 10.1016/j.wneu.2023.02.022] [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: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND To report the long-term results of patients with lumbar spinal stenosis (LSS), for whom we applied the tubular and endoscopic approaches and previously published the short-term results. METHODS A multicenter, prospective, randomized, double-blind study was carried out to evaluate 2 groups of patients with LSS who underwent microsurgery via a tubular retractor with a unilateral approach (T group) and bilateral spinal decompression using uniportal interlaminar endoscopic approaches (E group). Dural sac cross-sectional and spinal canal cross-sectional areas were measured with the patients' preoperative and postoperative magnetic resonance images. The visual analog scale, Oswestry Disability Index, and Japanese Orthopedic Association scores in the preoperative period and the first, second, and third years after surgery were evaluated. RESULTS Twenty patients met the inclusion criteria for the research (T group; n = 10, E group; n = 10). The groups' visual analog scale (respectively; P = 0.315, P = 0.529, and P = 0.853), Oswestry Disability Index (respectively; P = 0.529, P = 0.739, and P = 0.912), and Japanese Orthopedic Association (respectively; P = 0.436, P =0.853, and P = 0.684) scores from the first, second, and third postoperative years were quite good compared with the preoperative period, but there was no statistically significant difference. A significant difference was found in the E group, with less blood loss (P < 0.001). CONCLUSIONS The long-term results of the patients with LSS treated with tubular and endoscopic approaches were similar and very good. Bilateral decompression with minimally invasive spinal surgery methods can be completed with less tissue damage, complications, and blood loss with the unilateral approach.
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Affiliation(s)
- Halil Ibrahim Süner
- Department of Neurosurgery, Baskent University School of Medicine, Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey.
| | | | | | | | | | | | - Manuela Jorquera
- Department of Imaging Diagnostics, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Juan Antonio Barcia Albacar
- Department of Neurosurgery, Hospital Clinico San Carlos, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
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Shahi P, Song J, Dalal S, Melissaridou D, Shinn DJ, Araghi K, Mai E, Sheha E, Dowdell J, Qureshi SA, Iyer S. Improvement following minimally invasive lumbar decompression in patients 80 years or older compared with younger age groups. J Neurosurg Spine 2022; 37:828-835. [PMID: 35901712 DOI: 10.3171/2022.5.spine22361] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the outcomes of minimally invasive lumbar decompression in patients ≥ 80 years of age and compare them with those of younger age groups. METHODS This was a retrospective cohort study. Patients who underwent primary unilateral laminotomy for bilateral decompression (ULBD) (any number of levels) and had a minimum of 1 year of follow-up were included and divided into three groups by age: < 60 years, 60-79 years, and ≥ 80 years. The outcome measures were 1) patient-reported outcome measures (PROMs) (visual analog scale [VAS] back and leg, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey [SF-12] Physical Component Summary [PCS] and Mental Component Summary [MCS] scores, and Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF]); 2) percentage of patients achieving the minimal clinically important difference (MCID) and the time taken to do so; and 3) complications and reoperations. Two postoperative time points were defined: early (< 6 months) and late (≥ 6 months). RESULTS A total of 345 patients (< 60 years: n = 94; 60-79 years: n = 208; ≥ 80 years: n = 43) were included in this study. The groups had significantly different average BMIs (least in patients aged ≥ 80 years), age-adjusted Charlson Comorbidity Indices (greatest in the ≥ 80-year age group), and operative times (greatest in 60- to 79-year age group). There was no difference in sex, number of operated levels, and estimated blood loss between groups. Compared with the preoperative values, the < 60-year and 60- to 79-year age groups showed a significant improvement in most PROMs at both the early and late time points. In contrast, the ≥ 80-year age group only showed significant improvement in PROMs at the late time point. Although there were significant differences between the groups in the magnitude of improvement (least improvement in ≥ 80-year age group) at the early time point in VAS back and leg, ODI, and SF-12 MCS, no significant difference was seen at the late time point except in ODI (least improvement in ≥ 80-year group). The overall MCID achievement rate decreased, moving from the < 60-year age group toward the ≥ 80-year age group at both the early (64% vs 51% vs 41% ) and late (72% vs 58% vs 52%) time points. The average time needed to achieve the MCID in pain and disability increased, moving from the < 60-year age group toward the ≥ 80-year age group (2 vs 3 vs 4 months). There was no significant difference seen between the groups in terms of complications and reoperations except in immediate postoperative complications (5.3% vs 4.8% vs 14%). CONCLUSIONS Although in this study minimally invasive decompression led to less and slower improvement in patients ≥ 80 years of age compared with their younger counterparts, there was significant improvement compared with the preoperative baseline.
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Affiliation(s)
- Pratyush Shahi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Junho Song
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Sidhant Dalal
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | | | - Daniel J Shinn
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Kasra Araghi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Eric Mai
- 2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
| | - Evan Sheha
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - James Dowdell
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Sheeraz A Qureshi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
| | - Sravisht Iyer
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
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Chiang PL, Chen YY, Chen KT, Hsu JC, Wu C, Lee CY, Huang TJ, Huang YH, Chen CM, Wu MH. Comparison Between Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression and Other Decompression Approaches for Lumbar Spinal Stenosis: A Systematic Review. World Neurosurg 2022; 168:369-380. [DOI: 10.1016/j.wneu.2022.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
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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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Li Y, Yu Y, Hou TY, Zhang ZH, Xing JC, Lu HW, Zhou R, Cheng P, Xu JZ, Wu WJ, Luo F. Efficacy of Biocage in treating single-segment lumbar degenerative disease in patients with high risk of non-fusion: a prospective controlled study with at least 2 years' follow-up. J Int Med Res 2020; 48:300060520945500. [PMID: 32962480 PMCID: PMC7518008 DOI: 10.1177/0300060520945500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/06/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy of an allogeneic bone cage (Biocage; Beijing Datsing Bio-Tech Co., Ltd., Beijing, China) for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion. METHODS From January 2013 to December 2016, 67 patients who underwent lumbar fusion were divided into the Biocage group (n = 33) and polyether ether ketone (PEEK) group (n = 34). The patients were followed up for 24 to 48 months. The mean intervertebral height of the fusion level, fusion rate, height of the intervertebral foramen, visual analog scale score, and Oswestry disability index were compared. RESULTS The PEEK group had a lower fusion rate than the Biocage group (88.24% vs. 90.91%), although the difference was not statistically significant. During follow-up, the height of the intervertebral space was similar between the Biocage and PEEK groups (12.88 ± 0.45 and 12.84 ± 1.01 mm, respectively). The height of the intervertebral foramen was larger in the Biocage than PEEK group (20.67 ± 1.34 vs. 20.00 ± 2.05 mm). Good clinical efficacy was achieved in both groups. CONCLUSION The Biocage is efficient and safe for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.
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Affiliation(s)
- Yang Li
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Yang Yu
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tian-yong Hou
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Ze-hua Zhang
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Jun-chao Xing
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Hong-wei Lu
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Rui Zhou
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Peng Cheng
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Jian-Zhong Xu
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Wen-jie Wu
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
| | - Fei Luo
- National & Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, The First Affiliated Hospital to Army Medical University (Southwest Hospital), Chongqing, China
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Bisson EF, Mummaneni PV, Virk MS, Knightly J, Alvi MA, Goyal A, Chan AK, Guan J, Glassman S, Foley K, Slotkin JR, Potts EA, Shaffrey ME, Shaffrey CI, Haid RW, Fu KM, Wang MY, Park P, Asher AL, Bydon M. Open versus minimally invasive decompression for low-grade spondylolisthesis: analysis from the Quality Outcomes Database. J Neurosurg Spine 2020; 33:349-359. [PMID: 32384269 DOI: 10.3171/2020.3.spine191239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbar decompression without arthrodesis remains a potential treatment option for cases of low-grade spondylolisthesis (i.e., Meyerding grade I). Minimally invasive surgery (MIS) techniques have recently been increasingly used because of their touted benefits including lower operating time, blood loss, and length of stay. Herein, the authors analyzed patients enrolled in a national surgical registry and compared the baseline characteristics and postoperative clinical and patient-reported outcomes (PROs) between patients undergoing open versus MIS lumbar decompression. METHODS The authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Among more than 200 participating sites, the 12 with the highest enrollment of patients into the lumbar spine module came together to initiate a focused project to assess the impact of fusion on PROs in patients undergoing surgery for grade I lumbar spondylolisthesis. For the current study, only patients in this cohort from the 12 highest-enrolling sites who underwent a decompression alone were evaluated and classified as open or MIS (tubular decompression). Outcomes of interest included PROs at 2 years; perioperative outcomes such as blood loss and complications; and postoperative outcomes such as length of stay, discharge disposition, and reoperations. RESULTS A total of 140 patients undergoing decompression were selected, of whom 71 (50.7%) underwent MIS and 69 (49.3%) underwent an open decompression. On univariate analysis, the authors observed no significant differences between the 2 groups in terms of PROs at 2-year follow-up, including back pain, leg pain, Oswestry Disability Index score, EQ-5D score, and patient satisfaction. On multivariable analysis, compared to MIS, open decompression was associated with higher satisfaction (OR 7.5, 95% CI 2.41-23.2, p = 0.0005). Patients undergoing MIS decompression had a significantly shorter length of stay compared to the open group (0.68 days [SD 1.18] vs 1.83 days [SD 1.618], p < 0.001). CONCLUSIONS In this multiinstitutional prospective study, the authors found comparable PROs as well as clinical outcomes at 2 years between groups of patients undergoing open or MIS decompression for low-grade spondylolisthesis.
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Affiliation(s)
- Erica F Bisson
- 1Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Praveen V Mummaneni
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael S Virk
- 3Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - John Knightly
- 4Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Mohammed Ali Alvi
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anshit Goyal
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Jian Guan
- 1Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | | | - Kevin Foley
- 7Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Eric A Potts
- 9Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 10Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher I Shaffrey
- 11Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | | | - Kai-Ming Fu
- 3Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Michael Y Wang
- 13Department of Neurologic Surgery, University of Miami, Florida
| | - Paul Park
- 14Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan; and
| | - Anthony L Asher
- 15Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Mohamad Bydon
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To report the feasibility, nuances, technical tips as well as outcomes of managing single-level grade D (extreme stenosis) and to compare the outcomes with nonextreme stenosis using the tubular retractor system. SUMMARY OF BACKGROUND DATA Minimally invasive decompression in extreme stenosis is a challenge due to technical difficulty, feasibility of adequate decompression, and a steep learning curve. METHODS Consecutive patients from January 2007 to January 2017 presenting with neurogenic claudication secondary to single-level spinal stenosis operated using tubular retractors were included in the study. The patients were divided into two groups; extreme-stenosis and nonextreme stenosis. The outcomes of surgery were evaluated and compared using visual analogue score (VAS) for leg and back pain, Oswestry disability index (ODI), and MacNab's criteria. RESULTS A total of 325 patients (out of 446 patients after excluding the multilevel cases) fulfilled the inclusion criteria. One hundred forty patients were cases of extreme stenosis and 185 were nonextreme stenosis. The mean VAS for back and leg pain for extreme stenosis improved from 3.23 ± 1.30 to 2.15 ± 0.91 and 7.33 ± 0.78 to 1.66 ± 1.03 respectively as compared with nonextreme stenosis where the mean VAS for back and leg pain improved from 3.01 ± 1.15 to 1.86 ± 1.10 and 6.57 ± 1.00 to 1.54 ± 1.12 respectively. The mean ODI changed from 66.47 ± 7.53 to 19.95 ± 2.90 in extreme stenosis as compared with nonextreme stenosis where mean ODI changed from 59.05 ± 5.08 to 19.88 ± 2.67. As per MacNab's criteria 102 (of 120 patients) and 139 (of 157 patients) reported excellent and good outcomes in extreme and nonextreme stenosis respectively. CONCLUSION Tubular decompression is feasible in patients with extreme-stenosis with no difference in the outcomes as well as complication rates when compared with a cohort of nonextreme stenosis. LEVEL OF EVIDENCE 3.
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Carrascosa-Granada A, Velazquez W, Wagner R, Saab Mazzei A, Vargas-Jimenez A, Jorquera M, Albacar JAB, Sallabanda K. Comparative Study Between Uniportal Full-Endoscopic Interlaminar and Tubular Approach in the Treatment of Lumbar Spinal Stenosis: A Pilot Study. Global Spine J 2020; 10:70S-78S. [PMID: 32528810 PMCID: PMC7263328 DOI: 10.1177/2192568219878419] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Multicenter, prospective, randomized, and double-blinded study. OBJECTIVES To compare tubular and endoscopic interlaminar approach. METHODS Patients with lumbar spinal stenosis and neurogenic claudication of were randomized to tubular or endoscopic technique. Enrollment period was 12 months. Clinical follow up at 1, 3, 6 months after surgery with visual analogue scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiologic evaluation with magnetic resonance pre- and postsurgery. RESULTS Twenty patients were enrolled: 10 in tubular approach (12 levels) and 10 in endoscopic approach (11 levels). The percentage of enlargement of the spinal canal was higher in endoscopic approach (202%) compared with tubular approach (189%) but was not statistically significant (P = .777). The enlargement of the dural sac was higher in endoscopic group (209%) compared with tubular group (203%) but no difference was found between the 2 groups (P = .628). A modest significant correlation was found between the percentage of spinal canal decompression and enlargement of the dural sac (r = 0.5, P = .023). Both groups reported a significant clinical improvement postsurgery. However, no significant association was found between the percentage of enlargement of the spinal canal or the dural sac and clinical improvement as determined by scales scores. Endoscopic group had lower intrasurgical bleeding (P < .001) and lower disability at 6 months of follow-up than tubular group (p=0.037). CONCLUSIONS In the treatment of lumbar spinal stenosis, endoscopic technique allows similar decompression of the spinal canal and the dural sac, lower intrasurgical bleeding, similar symptoms improvement, and lower disability at 6 months of follow-up, as compared with the tubular technique.
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Affiliation(s)
| | | | | | | | | | | | | | - Kita Sallabanda
- Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
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10
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Kulkarni AG, Das S, Kunder TS. Are There Differences Between Patients with Extreme Stenosis and Non-extreme Stenosis in Terms of Pain, Function or Complications After Spinal Decompression Using a Tubular Retractor System? Clin Orthop Relat Res 2020; 478:348-356. [PMID: 31633587 PMCID: PMC7438131 DOI: 10.1097/corr.0000000000001004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/03/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Micro-tubular decompression in extreme lumbar spinal stenosis is challenging because it is technically difficult to achieve adequate decompression. Whether the results of micro-tubular decompression related to pain, function, and complications in lumbar spinal stenosis of the extreme and non-extreme varieties are different has not yet been conclusively established. QUESTIONS/PURPOSES Are there differences between patients with extreme stenosis and non-extreme stenosis in terms of (1) VAS back or leg pain, (2) Oswestry Disability Index (ODI), or (3) complications when they were treated with spinal decompression using a tubular retractor system? METHODS Between January 2007 and January 2017, one surgeon performed 325 single-level lumbar micro-tubular decompressions without fusion. Of those, 43% (140 of 325) had extreme stenosis (defined as the absence of cerebrospinal fluid signal and a grey homogeneous dural sac with unrecognizable rootlets and posterior epidural fat in T2 weighted axial MRI image) and the rest had non-extreme stenosis. During this time, we used tubular retractors for these procedures in patients with simple lumbar spinal stenosis who had persistent symptoms despite conservative treatment for neurogenic claudication. No alternate form of decompression was performed in the study period. Patients with complex lumbar spinal stenosis associated with a deformity or instability who were treated with instrumented fusion were excluded. A total of 14% (20 of 140) patients in the extreme stenosis group and 15% (28 of 185) patients in the non-extreme stenosis group were lost to follow-up before 2 years; the remaining 120 patients with extreme stenosis and 157 patients with non-extreme stenosis were analyzed at a mean follow-up of 33 ± 5 months in this retrospective, comparative study. The groups were not different at baseline in terms of preoperative VAS score for back pain, age, gender, BMI or the percentage who had diabetes or who smoked. However, patients with extreme stenosis had higher preoperative ODI scores and higher preoperative VAS score for leg pain compared with the non-extreme group. There was a higher proportion of men in the non-extreme stenosis group (56% [104 of 185] versus 50% [71 of 140]; p = 0.324). Study endpoints were VAS score for leg and back pain, ODI, and complications, all of which were ascertained by chart review. With the numbers available, we could detect with 80% power at p < 0.05 a difference of 0.93 cm of 10 cm on a 10-cm VAS scale for VAS leg pain; a difference of 1.00 cm of 10 cm on a 10-cm VAS scale for VAS back pain and a difference of 2.12 cm of 100 cm on a 100-cm ODI scale. RESULTS In terms of pain, both groups improved after surgery, but there was no between-group difference in terms of the VAS scores at the most recent follow-up. VAS back pain improved from a mean of 3 ± 1 to 2 ± 1 in the extreme stenosis group and from 3 ± 1 to 1 ± 1 in the non-extreme stenosis group (p = 0.904); VAS leg pain improved from 7 ± 1 to 1 ± 1 versus 6 ± 1 to 1 ± 1, respectively (p = 0.537). ODI scores likewise improved in both groups, with no between-group difference in the ODI scores at latest follow-up (66 ± 7 to 19 ± 2 in the extreme stenosis group versus 59 ± 5 to 19 ± 2 in the non-extreme stenosis group (p = 0.237). Complications in the group with extreme stenosis occurred in six patients (incidental dural tears in two patients, urinary retention in three patients, and Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH) in one patient); complications in the non-extreme stenosis occurred in two patients (incidental dural tears in two patients). CONCLUSIONS The results in terms of improvement in VAS for leg and back pain and ODI scores were not different between patients with extreme and non-extreme stenosis. Micro-tubular decompression can be thus considered an alternative for patients with extreme stenosis. Future studies, ideally multicentre, comparative trials, are needed to confirm our preliminary results. LEVEL OF EVIDENCE LEVEL III, therapeutic study.
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Affiliation(s)
- Arvind G Kulkarni
- A. G. Kulkarni, S. Das, T. S. Kunder, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Swaroop Das
- A. G. Kulkarni, S. Das, T. S. Kunder, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Tushar S Kunder
- A. G. Kulkarni, S. Das, T. S. Kunder, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
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