Clinical Outcome of Microsurgical Bilateral Decompression via Unilateral Approach for Lumbar Canal Stenosis

Toyoda, Hiromitsu; Nakamura, Hiroaki; Konishi, Sadahiko; Dohzono, Sho; Kato, Minori; Matsuda, Hideki

doi:10.1097/brs.0b013e3181d25829

Cited by 68 publications

(65 citation statements)

References 28 publications

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“…8,13,15 The radiographic changes that occur after this procedure are similar to those that occur naturally over time in LSS. 22 Therefore, clinical outcomes after this procedure can provide useful information about the pathology of LSS.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis

Dohzono

Toyoda

Takahashi

et al. 2016

SPI

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OBJECTIVE Little is known about the relationship between sagittal spinal alignment in patients with lumbar spinal canal stenosis (LSS) and objective findings such as spinopelvic parameters, lumbar back muscle degeneration, and clinical data. The purpose of this study was to identify the preoperative clinical and radiological factors that predict improvement in sagittal spinal alignment after decompressive surgery in patients with LSS. METHODS The records of 61 patients with LSS who underwent microendoscopic laminotomy and had pre- and postoperative clinical data collected were retrospectively reviewed. Spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), sacral slope, pelvic tilt, and pelvic incidence (PI), were evaluated. On T2-weighted MRI, the cross-sectional area and the percentage of fat infiltration of the paravertebral muscles (PVMs) before surgery were calculated. For patients with preoperative SVA > 40 mm (n = 30), the correlation between SVA improvement and preoperative clinical and radiographic parameters was calculated. RESULTS SVA improvement correlated with preoperative LL (r = −0.39) and PI –LL (r = 0.54). Multiple regression analysis showed that preoperative PI –LL (beta = 0.62; p < 0.01) and symptom duration (beta = −0.40; p < 0.05) were independently associated with SVA improvement. The percentage of fat infiltration of the PVM at L4–5 was significantly greater in patients with preoperative SVA ≥ 40 mm than in those patients with SVA < 40 mm. CONCLUSIONS Preoperative PI –LL and symptom duration were independently associated with SVA improvement in LSS patients with forward-bending posture. PVM degeneration at the lower lumbar level was significantly greater among patients with preoperative SVA ≥ 40 mm than in patients with SVA < 40 mm.

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Section: Discussionmentioning

confidence: 99%

Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis

Dohzono

Toyoda

Takahashi

et al. 2016

SPI

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“…10, 47 Moreover, higher incidence of failed-back syndrome owing to extensive surgical resection is considered another major drawback. 24 Coinciding with tendency towards minimizing iatrogenic tissue injury over the last decade, Spetzger et al, 44 introduced the microsurgical bilateral decompression via a unilateral approach which was further modified in 1998 by McCulloch and Young.…”

Section: Introductionmentioning

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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“…Since this pathology occurs mainly in elderly patients, comorbidities are commonly present, with increasing perioperative risk in the case of fusion surgery. To avoid these risks, less invasive surgical therapies such as decompression alone have been advocated, especially in the face of predominantly stenotic or radiating pain symptoms [8,23].…”

Section: Introductionmentioning

confidence: 99%

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

et al. 2011

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Introduction Clinical symptoms in lumbar degenerative spondylolisthesis (LDS) vary from predominantly radiating pain to severe mechanical low back pain. We examined whether the outcome of surgery for LDS varied depending on the predominant baseline symptom and the treatment administered [decompression with fusion (D&F) or decompression alone (D)]. Methods 213 consecutive patients (69 ± 9 years; 155f, 58 m) participated. Inclusion criteria were LDS, maximum three affected levels, no previous surgery at the affected level, and D (N = 56) or D&F (N = 157) as the operative procedure. Pre-op and at 12 months' follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI) including 0-10 leg-pain (LP) and LBP scales. At 12 months' FU, patients rated global outcome which was then dichotomised into ''good'' and ''poor''. Results Pre-operatively, LBP and COMI scores were significantly worse (p \ 0.05) in the D&F group than in the D group. The improvement in COMI at 12 months' FU was significantly greater for D&F than for D (p \ 0.001) and was not influenced by the patient's declared ''main problem'' at baseline (back pain, leg pain, or neurological disturbances) (p [ 0.05). There was a higher proportion (p = 0.01) of ''good'' outcomes at 12 months' FU in D&F (86%) than in D (70%). Multiple regression analysis, controlling for possible confounders, revealed treatment group to be the only significant predictor of outcome (adding fusion = better outcome). DiscussionOur study indicated that LDS patients showed better patient-based outcome with instrumented fusion and decompression than with decompression alone, regardless of baseline symptoms. This may be due to the fact that the underlying slippage as the cause of the stenosis is better addressed with fusion.

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Clinical Outcome of Microsurgical Bilateral Decompression via Unilateral Approach for Lumbar Canal Stenosis

Cited by 68 publications

References 28 publications

Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis

Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis

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

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

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