Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system

Palmer, Sylvain; Turner, R. S.; Palmer, Rosemary

doi:10.3171/foc.2002.13.1.5

Cited by 49 publications

(37 citation statements)

References 26 publications

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“…Palmer et al, who studied the feasibility of minimally invasive laminectomy via tubular retractors in 2002, also reported no radiographic progression of the slippage at 3 months' follow-up in 8 patients with preoperative slippage. 42,43 Given the small sample size and the short follow-up, conclusions for that study were limited. Findings in the current study are consistent with those of Pao et al and Müslüman et al, who reported no progression of spondylolisthesis following a microsurgical unilateral approach for tubular bilateral decompression after 2 years' follow-up.…”

Section: Lumbar Spinal Stenosis and Spondylolisthesismentioning

confidence: 98%

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Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

Alimi¹,

Hofstetter²,

Pyo³

et al. 2015

SPI

115

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OBJECT Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure, but minimally invasive laminectomy through tubular retractors is an alternative. The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of this procedure in patients who underwent LSS and to compare outcomes in patients with and without preoperative spondylolisthesis. METHODS Patients with LSS without spondylolisthesis and with stable Grade I spondylolisthesis who had undergone minimally invasive tubular laminectomy between 2004 and 2011 were included in this analysis. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, as well as Macnab's criteria. RESULTS Among 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. At a mean follow-up of 28.8 months, scoring revealed a median improvement of 16% on the ODI, 2.75 on the VAS back, and 3 on the VAS leg, compared with the preoperative baseline (p < 0.0001). The reoperation rate requiring fusion at the same level was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or reoperation rate. CONCLUSIONS Minimally invasive laminectomy is an effective procedure for the treatment of LSS. Reoperation rates for instability are lower than those reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be an alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis.

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Section: Lumbar Spinal Stenosis and Spondylolisthesismentioning

confidence: 98%

“…8,30,39,[41][42][43][44][45] In the present study we evaluated the outcome of this procedure in a larger group of patients with a longer duration of follow-up. The results were compared with those of other decompressive procedures published in the literature (Table 8).…”

Section: Minimally Invasive Decompression Of Lssmentioning

confidence: 99%

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

Alimi¹,

Hofstetter²,

Pyo³

et al. 2015

SPI

115

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“…Percutaneous Kwireless pedicle screws were inserted first at L-4 ( was completed with reduction and pedicle screw insertion through the retractor. 33 A bilateral decompression of her severe canal stenosis was achieved from a unilateral approach through the tubular retractor by undercutting the inner aspect of the contralateral lamina and medial facet joint 15,18,31,51 (Fig. 2E).…”

Section: Illustrative Cases Casementioning

confidence: 99%

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Spitz¹,

Sandhu²,

Voyadzis³

2015

SPI

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OBJECT Percutaneous pedicle screws are used to provide rigid internal fixation in minimally invasive spinal procedures and generally require the use of Kirchner wires (or K-wires) as a guide for screw insertion. K-wires can bend, break, advance, or pull out during the steps of pedicle preparation and screw insertion. This can lead to increased fluoroscopic and surgical times and potentially cause neurological, vascular, or visceral injury. The authors present their experience with a novel “K-wireless” percutaneous pedicle screw system that eliminates the inherent risks of K-wire use. METHODS A total of 100 screws were placed in 28 patients using the K-wireless percutaneous screw system. Postoperative dedicated spinal CT scans were performed in 25 patients to assess the accuracy of screw placement. Screw placement was graded A through D by 2 independent radiologists: A = within pedicle, B = breach < 2 mm, C = breach of 2–4 mm, and D = breach > 4 mm. Screw insertion and fluoroscopy times were also recorded in each case. Clinical complications associated with screw insertion were documented. RESULTS A total of 100 K-wireless percutaneous pedicle screws were placed into the lumbosacral spine in 28 patients. Postoperative CT was performed in 25 patients, thus the placement of only 90 screws was assessed. Eighty-seven screws were placed within the pedicle confines (Grade A), and 3 violated the pedicle (2 Grade B [1 lateral, 1 medial] and 1 Grade D [medial]) for an overall accuracy rate of 96.7%. One patient required reoperation for screw repositioning due to a postoperative L-5 radiculopathy secondary to a Grade D medial breach at L-5. This patient experienced improvement of the radiculopathy after reoperation. Average screw insertion and fluoroscopy times were 6.92 minutes and 22.7 seconds per screw, respectively. CONCLUSIONS The results of this study demonstrate that the placement of K-wireless percutaneous pedicle screws is technically feasible and can be performed accurately and safely with short procedure and fluoroscopy times.

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“…[9][10][11][12][13] The development of less destructive midline anatomysparing decompressive techniques have created renewed interest in D rather than DF for certain patients with "stable" DLS. 14 The literature to date has demonstrated good efficacy of the less invasive decompressive techniques in treating simple lumbar spinal stenosis (LSS), [15][16][17][18][19][20][21][22][23][24][25] but to our knowledge no comparative study in a pure cohort of patients with DLS has been conducted. The purpose of the present study was to assess the outcomes of anatomy-preserving D in a select subgroup of patients with DLS compared with those of a multicentre cohort of patients with DLS who underwent DF.…”

mentioning

confidence: 99%

Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study

Rampersaud

Fisher

Yee

et al. 2014

cjs

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Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study Background: Decompression alone (D) is a well-accepted treatment for patients with lumbar spinal stenosis (LSS) causing neurogenic claudication; however, D is controversial in patients with LSS who have degenerative spondylolisthesis (DLS). Our goal was to compare the outcome of anatomy-preserving D with decompression and fusion (DF) for patients with grade I DLS. We compared patients with DLS who had elective primary 1-2 level spinal D at 1 centre with a cohort who had 1-2 level spinal DF at 5 other centres. Methods:Patients followed for at least 2 years were included. Primary analysis included comparison of change in SF-36 physical component summary (PCS) scores and the proportion of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Results:There was no significant difference in baseline SF-36 scores between the groups. The average change in PCS score was 10.4 versus 11.4 (p = 0.61) for the D and DF groups, respectively. Sixty-seven percent of the D group and 71% of the DF group attained MCID, while 64% of both D and DF groups attained SCB. There was no significant difference between D and DF for change in PCS score (p = 0.74) or likelihood of reaching MCID (p = 0.81) or SCB (p = 0.85) after adjusting for other variables. Conclusion:In select patients with DLS, the outcome of D is comparable to DF at a minimum of 2 years.Contexte : La décompression seule est un traitement bien accepté pour la sténose lombaire (SL) causant une claudication neurogène. Son utilisation ne fait cependant pas l'unanimité chez les patients atteints de SL qui souffrent d'un spondylolisthésis dégénératif (SLD). Notre objectif était de comparer l'issue d'une décompression avec préservation anatomique à celle d'une décompression-arthrodèse (DA) chez des patients atteints de SLD de grade 1. Nous avons comparé les patients atteints de SLD ayant subi une décompression élective primaire de niveau 1-2 dans un centre à une cohorte ayant subi une DA de niveau 1-2 effectuée dans 5 autres centres.Méthodes : Nous avons inclus les patients qui ont été suivis pendant au moins 2 ans. L'analyse primaire comportait une comparaison des changements aux scores sommaires pour la composante physique (CP) du questionnaire SF-36 et la proportion de patients ayant obtenu une différence minimale cliniquement importante (DMCI) et en ayant tiré un bienfait clinique substantiel (BCS). Résultats :Il n'y avait pas de différence significative entre les scores SF-36 des 2 groupes au départ. Le changement moyen du score pour la CP a été de 10,4 c. 11,4 (p = 0,61) dans les groupes soumis à la décompression et à la DA, respectivement. Soixante-sept pour cent des patients du groupe soumis à la décompression et 71 % du groupe soumis à la DA ont obtenu une DMCI, tandis que 64 % des 2 groupes ont obtenu un BCS. On n'a noté aucune différence significative entr...

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Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system

Cited by 49 publications

References 26 publications

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study

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