Analysis of Factors Contributing to Postoperative Spinal Instability after Lumbar Decompression for Spinal Stenosis

Yang, Joo Chul; Kim, Sung Gon; Kim, Tae Wan; Park, Kwan Ho

doi:10.14245/kjs.2013.10.3.149

Cited by 21 publications

(13 citation statements)

References 19 publications

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“…Postoperative instability is a major concern in decompression surgery. In general, excessive removal of the facet joints has been associated with destabilization of the spine [ 28 , 29 ]; traditional open paraspinal decompression peels off the paraspinal muscles and removes the lamina and spinous process extensively, and it is thus easy to damage the structure of the posterior column complex, resulting in iatrogenic segmental instability and spondylolisthesis [ 30 , 31 ]. In our study, no postoperative lumbar instability occurred in the patients with stable lumbar spines after operation at the last follow-up, with no significantly increase in ROM and segmental angulation after the operation.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment

Xue

Chen

Zhu

et al. 2021

BMC Musculoskelet Disord

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Background Recently, a percutaneous spinal endoscopy unilateral posterior interlaminar approach to perform bilateral decompression has been proposed for use in treatment of lumbar spinal stenosis, As a development and supplement to traditional surgery, its advantages regarding therapeutic effects and prognosis, such as minor soft tissue damage, little intraoperative blood loss, and a quick return to daily life. However, there are few analyses of this surgery with a follow-up of more than 1 year,we conducted this study in order to quantitatively investigate radiographic and clinical efficacies of this surgery for central lumbar spinal stenosis. Materials and methods Forty-six patients with central lumbar spinal stenosis were enrolled from January 2017 to July 2018. The visual analog scale (VAS) for back pain and leg pain, Oswestry disability index (ODI), modified MacNab criteria were used to evaluate clinical efficiency at preoperative and postoperative time points. The intervertebral height index (IHI), cross-sectional area of the spinal canal (CSAC), calibrated disc signal (CDS) and spinal stability were examined to assess radiographic decompression efficiency via magnetic resonance imaging and X-ray at preoperative and postoperative time points. Results The VAS score for lower back pain and leg pain improved from 7.50 ± 0.78 to 1.70 ± 0.66 and from 7.30 ± 0.79 to 1.74 ± 0.68, respectively, and the ODI improved from 72.35 ± 8.15 to 16.15 ± 4.51. In terms of modified MacNab criteria, 91.3% of the patients achieved good or excellent outcomes. Furthermore, significant changes after surgery were observed for the percentage of CSAC, increasing from 125.3 ± 53.9 to 201.4 ± 78 mm2; however, no significant differences were observed for the remaining measurement indicators. Conclusions The clinical and radiographic efficacies of this surgery for central lumbar spinal stenosis were good in short-term follow-up, and this surgery did not cause meaningful changes in IHI, CDS, and spine stability in short-term follow-up. The effect of long-term follow-up needs further investigation.

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Section: Discussionmentioning

confidence: 99%

Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment

Xue

Chen

Zhu

et al. 2021

BMC Musculoskelet Disord

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“…According to Guha et al there was a higher incidence of reoperation among patients with preexisting spondylolisthesis (8.9%) versus stenosis alone (1.1%) and among patients in whom open decompression was performed (11%) in comparison to a minimally invasive decompression (0.7%) [9]. In a study of 105 patients who had laminectomies across 1-4 levels for degenerative lumbar disease, ten patients (9.5%) developed iatrogenic instability at the same operative levels, according to Ramhmdani et al [10], while 42 patients underwent single-level decompressive laminectomy without fusion and discectomy for the first time, according to Yang et al Spinal instability occurred in 15 patienSts (35.7 %) [11].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Iatrogenic Lumbar Spinal Instability after Laminectomy, Discectomy or Facetectomy

Hafez

Ashry

Elsayed

et al. 2021

Open Access Maced J Med Sci

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OBJECTIVE: This thesis aim to report the incidence of iatrogenic spinal instability that occurs after laminectomy, discectomy or facetectomy in Lumbar spine surgery. METHODS: This is a prospective study of 50 cases of degenerative lumbar spondylosis complaining of various symptoms of claudication, sciatica and back pain which were surgically managed by laminectomy according to the level of stenosis in the period between October 2018 and October 2020 in the neurosurgery department at Cairo university hospitals. Mesial facetectomy was added according to the degree of stenosis if needed. Some patients needed discectomy if sciatica was an eminent symptom. RESULTS: Out of 50 patients included: 9 patients (18%) developed postoperative instability. The number of levels operated on and the degree of mesial facetectomy were found to be variables that may affect postoperative stability. CONCLUSION: Iatrogenic instability may result from large laminectomy and extensive facetectomy for lumbar stenosis in patients who do not have obvious pre-existing instability. Key words: Iatrogenic spinal instability - Laminectomy - conventional open discectomy - Mesial facetectomy.

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“…[ 22 ] Muscular atrophy is another complication of open laminectomy which may occur due to the damage of the paraspinal muscles. [ 23 ] In addition, asymmetry of the paraspinal muscle may also influence the occurrence of postoperative instability, [ 24 ] preservation of paraspinal muscle and decrease the incidence of muscular injury—the most important factors associated with a positive long-term clinical outcome. [ 25 , 26 ] Marjan Alimi et al have also reported that minimally invasive laminectomy has a lower rate of postoperative instability, reduced blood loss, and a shorter hospital stay than the conventional open laminectomy method.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous spinal epidural hematoma management with minimally invasive surgery through tubular retractors

Zhuang

Chen

et al. 2016

Medicine

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To report a minimally invasive paraspinal approach in the treatment of a case of spontaneous spinal epidural hematoma (SSEH). We additionally aim to review the relevant literature to enhance our knowledge of this disease. SSEH is an uncommon but potentially catastrophic disease. Currently, most appropriate management is emergence decompression laminectomy and hematoma evacuation. An 81-year-old woman was admitted to the neurology department with a chief complaint of bilateral numbness and weakness of the lower limbs and difficulty walking for 4 days with progressive weakness developed over the following 3 days accompanied with pain in the lower limbs and lower back. No history of trauma was reported. Magnetic resonance imaging of the thoracolumbar spine demonstrated an epidural hematoma extending from T-12 to L-5 with thecal sac and cauda equina displacement anterior. The patient was treated in our department with a minimally invasive approach. This operation method had been approved by Chinese Independent Ethics Committee. Three months following the operation, the patient had regained the ability to walk with the aid of a cane and myodynamia tests revealed normal results for the left lower limb and a 4/5 grade for the right limb. Importantly, no complications were exhibited from the surgical operation. The minimally invasive paraspinal approach through tubular retractors is demonstrated here as an effective alternative method for the treatment of SSEH.

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Analysis of Factors Contributing to Postoperative Spinal Instability after Lumbar Decompression for Spinal Stenosis

Cited by 21 publications

References 19 publications

Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment

Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment

Incidence of Iatrogenic Lumbar Spinal Instability after Laminectomy, Discectomy or Facetectomy

Spontaneous spinal epidural hematoma management with minimally invasive surgery through tubular retractors

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