Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study

Abstract

Purpose To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. Clinical trial registration The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis

“…A secondary radiological study from this trial reported that UL, BL, and SPO provided a similar increase of the dural sac cross-sectional area (DSCA). 37 Hence, both radiological and clinical outcomes seem similar in the surgical techniques compared 2 years postoperatively. The outcome for these patients will be followed up with for 10 years to investigate eventual changes over time.…”

“…A decompressive procedure is performed to relieve the dural compression at the affected level of the spine and be comprehensive enough to achieve sufficient symptom relief. A secondary radiological study from this trial reported that UL, BL, and SPO provided a similar increase of the dural sac cross-sectional area (DSCA) . Hence, both radiological and clinical outcomes seem similar in the surgical techniques compared 2 years postoperatively.…”

Postoperative Dural Sac Cross-Sectional Area as an Association for Outcome After Surgery for Lumbar Spinal Stenosis

“…Unilateral laminotomy with bilateral decompression is considered to be the least invasive of the three procedures. No difference in clinical outcomes were found between the three techniques in prior work,16 and all three resulted in the same increase in DSCA 13. The trial protocol (supplement appendix 1) was approved by The Regional Committee for Medical and Health Research Ethics of Central Norway (REC Central), project identifier 2011/2034.…”

“…In the NORDSTEN Spinal Stenosis Trial (SST) it was found that three commonly used minimally invasive midline-retaining posterior decompression techniques resulted in a similar increase in DSCA. 13 In the present study, our sample is more than four times greater than those considered in previous studies, and our analyses focused specifically on the increase in DSCA following surgical decompression.…”