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

Hermansen, Erland; Austevoll, Ivar Magne; Hellum, Christian; Storheim, Kjersti; Myklebust, Tor Åge; Aaen, Jørn; Banitalebi, Hasan; Anvar, Masoud; Rekeland, Frode; Brox, Jens Ivar; Franssen, Eric J. F.; Weber, Clemens; Furunes, Håvard; Grundnes, Oliver; Brisby, Helena; Indrekvam, Kari

doi:10.1001/jamanetworkopen.2022.4291

Cited by 25 publications

(18 citation statements)

References 40 publications

(78 reference statements)

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“…The patients were randomized and treated with three commonly used surgical techniques for LSS. All three techniques resulted in similar success rates [19]. The included patients answered the questionnaires preoperatively and at the 2-year follow up.…”

Section: Inclusion Process and Patient Recruitmentmentioning

confidence: 94%

The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial

et al. 2022

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Purpose To investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS). Methods The NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to ≥ 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients’ gender, age, smoking status and BMI. Results The primary analysis showed that severe disc degeneration (Pfirrmann score 4–5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations. Conclusion Severe disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.

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Section: Inclusion Process and Patient Recruitmentmentioning

confidence: 94%

The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial

et al. 2022

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“…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.…”

Section: Methodsmentioning

confidence: 99%

“…A detailed description of the patients included in the NORDSTEN-SST, with inclusion and exclusion criteria, is available in a previous publication 16 and in the study protocol. 14 All patients included in the NORDSTEN-SST who had representative magnetic resonance imaging (MRI) at baseline and at three months follow-up, as well as who had completed the patient-reported outcome measures (PROMs) at baseline and after two years, were eligible for inclusion in the present study.…”

Section: Methodsmentioning

confidence: 99%

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

Hermansen

Myklebust

Weber³

et al. 2023

Spine

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Study Design. Prospective cohort study. Objective. The aim was to investigate the association between postoperative dural sac cross-sectional area (DSCA) after decompressive surgery for lumbar spinal stenosis and clinical outcome. Furthermore, to investigate if there is a minimum threshold for how extensive a posterior decompression needs to be to achieve a satisfactory clinical result. Summary of Background Data. There is limited scientific evidence for how extensive lumbar decompression needs to be to obtain a good clinical outcome in patients with symptomatic lumbar spinal stenosis. Materials and Methods. All patients were included in the Spinal Stenosis Trial of the NORwegian Degenerative spondylolisthesis and spinal STENosis (NORDSTEN)-study. The patients underwent decompression according to three different methods. DSCA measured on lumbar magnetic resonance imaging at baseline and at three months follow-up, and patient-reported outcome at baseline and at two-year follow-up were registered in a total of 393 patients. Mean age was 68 (SD: 8.3), proportion of males were 204/393 (52%), proportion of smokers were 80/393 (20%), and mean body mass index was 27.8 (SD: 4.2). The cohort was divided into quintiles based on the achieved DSCA postoperatively, the numeric, and relative increase of DSCA, and the association between the increase in DSCA and clinical outcome were evaluated. Results. At baseline, the mean DSCA in the whole cohort was 51.1 mm2 (SD: 21.1). Postoperatively the area increased to a mean area of 120.6 mm2 (SD: 46.9). The change in Oswestry disability index in the quintile with the largest DSCA was −22.0 (95% CI: −25.6 to −18), and in the quintile with the lowest DSCA the Oswestry disability index change was −18.9 (95% CI: −22.4 to −15.3). There were only minor differences in clinical improvement for patients in the different DSCA quintiles. Conclusion. Less aggressive decompression performed similarly to wider decompression across multiple different patient-reported outcome measures at two years following surgery.

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“…S pine surgery for degenerative conditions is generally considered "lifestyle" surgery, focused on improving pain and function in the hopes of increasing quality of life [1][2][3][4][5] . However, the impact of spine surgery on all-cause mortality has not been as well studied.…”

Section: Mortalitymentioning

confidence: 99%

“…Spine surgery in this setting has demonstrated cost-effectiveness in reducing pain and restoring function 1-4 . In a recent study, approximately 70% of patients reported clinically important reductions in disability for up to 2 years following decompression surgery 5 . Such improvements can facilitate self-care and greater physical activity.…”

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confidence: 99%

Surgical Treatment of Single-Level Lumbar Stenosis Is Associated with Lower 2-Year Mortality and Total Cost Compared with Nonsurgical Treatment

Hwang

Briggs²,

Greenwald³

et al. 2023

Journal of Bone and Joint Surgery

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Background: Spine surgery has demonstrated cost-effectiveness in reducing pain and restoring function, but the impact of spine surgery relative to nonsurgical care on longer-term outcomes has been less well described. Our objective was to compare single-level surgical treatment for lumbar stenosis, with or without spondylolisthesis, and nonsurgical treatment with respect to patient mortality, resource utilization, and health-care payments over the first 2 years following initial treatment.Methods: A retrospective review of the Medicare National Database Fee for Service Files from 2011 to 2017 was performed.A 2-year prediction of mortality risk (risk stratification index, RSI) was used as a measure of patient baseline health. Patients (88%) were matched by RSI and demographics. Mortality, spine-related health-care utilization, and 2-year total Medicare payments for patients undergoing surgical treatment were compared with matched patients undergoing nonsurgical treatment.Results: We identified 61,534 patients with stenosis alone and 83,813 with stenosis and spondylolisthesis. Surgical treatment was associated with 28% lower 2-year mortality compared with matched patients undergoing nonsurgical treatment. Total Medicare payments were significantly lower for patients with stenosis alone undergoing laminectomy alone and for patients with stenosis and spondylolisthesis undergoing laminectomy with or without fusion compared with patients undergoing nonsurgical treatment. There was no significant difference in mortality when fusion or laminectomy was compared with combined fusion and laminectomy. However, laminectomy alone was associated with significantly lower 2-year payments when treating stenosis with or without spondylolisthesis.Conclusions: Surgical treatment for stenosis with or without spondylolisthesis within the Medicare population was associated with significantly lower mortality and total medical payments at 2 years compared with nonsurgical treatment, although residual confounding could have contributed to these findings.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Degenerative lumbar conditions are common causes of disability. Spine surgery in this setting has demonstrated cost-effectiveness in reducing pain and restoring function [1][2][3][4] . In a recent study, approximately 70% of patients reported clinically important reductions in disability for up to 2 years following decompression surgery 5 . Such improvements can facilitate self-care and greater physical activity. Improving quality of life in this manner may promote general health, reduce future medical payments, and reduce all-cause mortality 6 . However, the effect of spine surgery relative to nonsurgical management on these important outcomes has not been well described.Spine surgical approaches generally involve decompression alone (e.g., laminectomy) or decompression with fusion. While spine surgery has proven effectiveness with regard to improving short-term quality ...

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

Abstract: This randomized clinical trial compares the effectiveness of 3 minimally invasive posterior decompression techniques for lumbar spinal stenosis at 16 public hospitals in Norway.

Cited by 25 publications

References 40 publications

The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial

The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial

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

Surgical Treatment of Single-Level Lumbar Stenosis Is Associated with Lower 2-Year Mortality and Total Cost Compared with Nonsurgical Treatment

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