Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: a systematic review and meta-analysis

Chang, Wenli; Yuwen, Peizhi; Zhu, Yanbing; Wei, Ning; Chen, Feng; Zhang, Yingze; Chen, Wei

doi:10.1007/s00402-017-2685-z

Cited by 59 publications

(45 citation statements)

References 47 publications

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“…Outcomes and healing are known to differ based on type of surgery and indication for treatment. 10,19 We recommend confining analysis to cohorts with a single surgical indication or including patients undergoing only one type of spine procedure to optimize specificity of models to predict PRO most relevant to patient condition. Future studies may investigate the benefit of cohort selectivity in external validation methods.…”

Section: Synthesis and Suggested Guidelinesmentioning

confidence: 99%

Variability in the utility of predictive models in predicting patient-reported outcomes following spine surgery for degenerative conditions: a systematic review

Dietz

Sharma

Alhourani

et al. 2018

Neurosurgical Focus

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OBJECTIVEThere is increasing emphasis on patient-reported outcomes (PROs) to quantitatively evaluate quality outcomes from degenerative spine surgery. However, accurate prediction of PROs is challenging due to heterogeneity in outcome measures, patient characteristics, treatment characteristics, and methodological characteristics. The purpose of this study was to evaluate the current landscape of independently validated predictive models for PROs in elective degenerative spinal surgery with respect to study design and model generation, training, accuracy, reliability, variance, and utility.METHODSThe authors analyzed the current predictive models in PROs by performing a search of the PubMed and Ovid databases using PRISMA guidelines and a PICOS (participants, intervention, comparison, outcomes, study design) model. They assessed the common outcomes and variables used across models as well as the study design and internal validation methods.RESULTSA total of 7 articles met the inclusion criteria, including a total of 17 validated predictive models of PROs after adult degenerative spine surgery. National registry databases were used in 4 of the studies. Validation cohorts were used in 2 studies for model verification and 5 studies used other methods, including random sample bootstrapping techniques. Reported c-index values ranged from 0.47 to 0.79. Two studies report the area under the curve (0.71–0.83) and one reports a misclassification rate (9.9%). Several positive predictors, including high baseline pain intensity and disability, demonstrated high likelihood of favorable PROs.CONCLUSIONSA limited but effective cohort of validated predictive models of spine surgical outcomes had proven good predictability for PROs. Instruments with predictive accuracy can enhance shared decision-making, improve rehabilitation, and inform best practices in the setting of heterogeneous patient characteristics and surgical factors.

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Section: Synthesis and Suggested Guidelinesmentioning

confidence: 99%

Variability in the utility of predictive models in predicting patient-reported outcomes following spine surgery for degenerative conditions: a systematic review

Dietz

Sharma

Alhourani

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…[3,4] Various studies have evaluated the e cacy of decompression along versus decompression with fusion for this condition, but the results are still con icting. [5][6][7][8][9] Decompression alone have shown similar results in clinical outcomes compared to decompression with fusion in certain groups of patients. [5,7,9] Open discectomy with laminotomy or laminectomy alone has been considered as standard treatment for lumbar spinal stenosis without instability during the last decades.…”

Section: Introductionmentioning

confidence: 98%

“…[5][6][7][8][9] Decompression alone have shown similar results in clinical outcomes compared to decompression with fusion in certain groups of patients. [5,7,9] Open discectomy with laminotomy or laminectomy alone has been considered as standard treatment for lumbar spinal stenosis without instability during the last decades. [10] Percutaneous endoscopic decompression which features less tissue disruption and small incisions serves as a solution to these patients.…”

Section: Introductionmentioning

confidence: 98%

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

Lin

Chang

et al. 2020

Preprint

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Background The aim of this study is to report a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who could not endure major surgery due to multiple comorbidities. Decompression along using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. With 3D real-time image-guided navigation, we could improve the accuracy of surgery and maintain the spinal stability as preoperative condition. This is the first study which reports on treating spinal stenosis in patients with degenerative kyphoscoliosis using percutaneous endoscope under 3D real-time image-guided navigation. MethodsIn this study, we presented four cases. All patients were over 70 years old with variable degrees of kyphoscoliosis and multiple comorbidity who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed. Intraoperative photos demonstrating this technique are also provided Results All patients were successfully treated with percutaneous endoscopic laminotomy with under 3D real-time image-guided navigation. Post-operative X ray and MRI were arranged and revealed sufficient decompression without any unnecessary bone destruction. All preoperative neurological symptoms improved postoperatively. There is no surgery-related complication such as inadequate decompression, dural tear, iatrogenic neurological injury, uncontrolled epidural hemorrhage, unnecessary bone destruction with further instability. Conclusions To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique serves as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.

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“…[6][7][8] Various studies have evaluated the e cacy of decompression along versus decompression with fusion for this condition, but the results are still controversial. [9][10][11][12][13] Decompression alone have shown similar results in clinical outcomes compared to decompression with fusion. [9,11,13] Open discectomy with laminotomy or laminectomy alone has been considered as standard treatment for lumbar spinal stenosis without instability during the last decades.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13] Decompression alone have shown similar results in clinical outcomes compared to decompression with fusion. [9,11,13] Open discectomy with laminotomy or laminectomy alone has been considered as standard treatment for lumbar spinal stenosis without instability during the last decades. [14] Percutaneous endoscopic decompression which features less tissue disruption and small incisions serves as a solution to patients with multiple comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patients: An Innovative Preliminary Study

Lin

Chang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The aim of this study is to introduce a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who could not endure major surgery due to multiple comorbidities. Decompression along using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. The O-arm/StealthStation system, a 3D real-time image-guided navigation system, is popular for its ability to provide automated registration with intraoperative, postpositioning computed tomography (CT) with no radiation exposure to operative staffs. With 3D real-time image-guided navigation, we could improve the accuracy of surgery and maintain the spinal stability as preoperative condition. Methods In this study, we presented four cases. All patients were over seventy years old female with variable degrees of kyphoscoliosis and multiple comorbidity who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed with following steps. First, the reference pin was introduced over iliac crest. Second, all navigational instruments were registered to the O-arm Stealth Station. Third. With the interlaminar approach, a 8.0 mm dilator followed by operative sleeve was introduced toward the ligamentum flavum. Then the endoscope attached with universal tracker was inserted, and the boundaries of lamina and facet joint were well-identified through the monitor. Finally, unitaleral laminotomy and resection of ligamentum flavum with joy-stick technique for bilateral decompression were performed under the navigation system. Patients’ demographics, image study parameters, and outcome measurements including pre- and post-operative serial visual analog scale (VAS), and Oswestry Disability Index (ODI) were well documented. The follow-up time was one year. Results All patients were successfully treated with this technique. Pre- and post-operative MRI showed average dural sac cross sectional area (DSCSA) improved from 81.62 (range 67.34–89.07) to 153.27 (range 127.96-189.73). All preoperative neurological symptoms including radicular leg pain and sciatica improved postoperatively. The mean ODI (%) were 85 (range 82.5–90) at initial visit, 35.875 (range 25–51) at 1 month post-operatively, 26.875 (range 22.5–35) at 6 months post-operatively and 22.5 (range 17.5–30) at 12 months post-operatively (p < 0.05). The mean VAS score were 9 (range 8–10) at initial visit, 2.25 (range 2–3) at 1 month post-operatively, 1.75 (range 1–2) at 6 months post-operatively and 0.25 (range 0–1) at 12 months post-operatively (p < 0.05). There was no surgery-related complication such as inadequate decompression, dural tear, iatrogenic neurological injury, uncontrolled epidural hemorrhage, unnecessary bone destruction with further instability. Conclusions To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique may serve as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.

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Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: a systematic review and meta-analysis

Cited by 59 publications

References 47 publications

Variability in the utility of predictive models in predicting patient-reported outcomes following spine surgery for degenerative conditions: a systematic review

Variability in the utility of predictive models in predicting patient-reported outcomes following spine surgery for degenerative conditions: a systematic review

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patients: An Innovative Preliminary Study

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