Biomechanical Assessment of Minimally Invasive Decompression for Lumbar Spinal Canal Stenosis

Hamasaki, Takahiko; Tanaka, Nobuhiro; Kim, Jinhwan; Okada, Motohiro; Ochi, Mitsuo; Hutton, William

doi:10.1097/bsd.0b013e31818d7dc9

Cited by 80 publications

(51 citation statements)

References 12 publications

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“…28 Biomechanical and laboratory results indicate that laminectomy via tubular retractors or bilateral laminotomies are associated with less destabilization than an open bilateral laminectomy. 1,5,6,12,23,34,57 In their biomechanical study, Lee et al demonstrated that bilateral laminotomy was associated with significantly less hypermobility and stiffness reduction than a full laminectomy, and they proposed that this could be attributed to preservation of the central posterior osteoligamentous structures in laminotomy. 34 In summary, minimally invasive laminectomy via tubular and similar retractors achieves effective neural decompression with simultaneous preservation of the stability of motion segments.…”

Section: 67mentioning

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

119

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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: 67mentioning

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

119

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show abstract

“…30 Maximal preservation of facet joints is of paramount importance to restrain progression of post-operative spinal instability. 30 Hamasaki et al, 15 within a biomechanical study based on cadaveric human lumbar spine, stated that microendoscopic ULBD approach could leave the spine more than 80% as stiff as the maiden spine. No reoperations done which may be attributable to short period of follow-up.…”

mentioning

confidence: 99%

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Kabil

Ebrahim

2017

Egyptian Spine Journal

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Background Data: Traditionally, lumbar canal stenosis (LCS) has been treated with conventional laminectomy involving wide resection of posterior supporting structures of the lumbar spine such as the supraspinous and inter-spinous ligamentum complex, the spinous process as well as wide areas of the lamina. In addition, this required a large incision of the skin and underlying musculoligamentous complex (posterior tension band). Purpose: The current study focuses on the clinical outcome and utility of minimally invasive microendoscopic decompression from a unilateral approach in surgical management of patients with single and multiple level lumbar canal stenosis. The objective is to describe the indications, significance and applications of endoscopic spine surgery in patients with single and multiple level LCS. Additionally, to highlight important anatomical perspectives of the technique and share surgical experience and results. Study Design: A retrospective clinical case study. Patients and Methods: From May 2008 to January 2016, 583 consecutive patients were treated for LCS and included in this study. Patients' main complaint was bilateral neurogenic claudication in addition to back pain and sciatic neuralgia. Single level decompression was performed in 468 (80%) patients and multiple level decompressions in 115 (20%) patients. Magnetic resonance imaging (MRI), computed tomography (CT) scan and plain X-rays were performed for all patients to confirm evidence of central stenosis and then repeated postoperatively. All patients were followed up for at least 3 months and their data collected. Clinical and functional outcomes were assessed using Visual Analogue Scale (VAS) and the Japanese Orthopedic Association Score (JOA) score for lumbar disease. Results: Compared to preoperative complaint, there was an improvement of back pain in 77.9% of patients and in radiating leg pain in 86.3%. With regards to functional outcomes, median preoperative JOA score was 14.93 ± 0.48 and improved postoperatively to 27.17 ± 1.45 (p < 0.001). The mean operating time per level was 78 minutes, and the mean intraoperative blood loss per level was 18 ml. Complications mainly included dural tears in 27 (4.6%) patients, transient postoperative dysesthesia in 46/583 (7.9%) patients and excess bony work in the form of unintended medial facetectomy in 38/583 (6.5%) patients and fracture of the spinous process in 3 (0.5%) patients.

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“…Besides the pure moment form of testing, previous biomechanical investigations of the role of the facets have used compressive loading [16,25,70], eccentric loading [15,16,25], and simultaneous shear and compressive loading [53]. Of all the previous biomechanical studies that have investigated the effect of facet removal by graded, medial, or total removal--only Hamasaki et al has examined the biomechanical implications of minimally-invasive procedures.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Of all the previous biomechanical studies that have investigated the effect of facet removal by graded, medial, or total removal--only Hamasaki et al has examined the biomechanical implications of minimally-invasive procedures. All studies observed increases in motion with sequential or total removal of facets [15,16,18,20,25,53], and Posner et al found that there was an increase in displacement with increased removal [53].…”

Section: Literature Reviewmentioning

confidence: 99%

“…Biomechanically, the aims of minimally-invasive procedures are that the decreased amount of tissue removal will reduce the impact on the normal motion segment's stability and function, and reduce the amount of adjacent level segment degeneration. The biomechanical evaluation of the role of facetectomies and traditional laminectomies have been studied before [15][16][17][18][19][20][21][22][23][24], but there have been few biomechanical studies on MI facetectomies [25].…”

Section: Chapter 1: Introductionmentioning

confidence: 99%

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Biomechanical Comparison of Traditional Laminectomy and Minimally‑Invasive Facetectomies

Sedacki¹

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Biomechanical Assessment of Minimally Invasive Decompression for Lumbar Spinal Canal Stenosis

Cited by 80 publications

References 12 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

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Biomechanical Comparison of Traditional Laminectomy and Minimally‑Invasive Facetectomies

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