Decompression alone vs. decompression plus fusion for claudication secondary to lumbar spinal stenosis

Thomas, Kenneth; Faris, Peter; McIntosh, Greg; Manners, Simon; Abraham, Edward; Bailey, Chris; Paquet, Jérôme; Cadotte, David W.; Jacobs, W. Bradley; Rampersaud, Y. Raja; Manson, Neil; Hall, Hamilton; Fisher, Charles G.

doi:10.1016/j.spinee.2019.06.003

Cited by 30 publications

(34 citation statements)

References 23 publications

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“…Therefore, various minimally invasive techniques were developed to minimize the surgical trauma [7,9,23]. Patients with neurogenic claudication secondary to LSS without degenerative spondylolisthesis or deformity could be treated by both decompression alone and decompression with instrumented fusion [12,18,19]. FEV-ULBD and MIS-TLIF are two common minimally invasive procedures to treat LSS, and typical representative of decompression alone technique and decompression plus instrumented fusion technique, respectively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Full-Endoscopic Visualized Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis

Hua

Wang

et al. 2020

Preprint

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Background: The aim of the present study is to compare the clinical outcomes and postoperative complications of full-endoscopic visualized unilateral laminotomy bilateral decompression (FEV-ULBD) and minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) to treat one-level lumbar spinal stenosis (LSS) without degenerative spondylolisthesis or deformity. Methods: A retrospective analysis of 112 consecutive patients of one-level LSS undergoing either FEV-ULBD or MIS-TLIF was performed. Patient demographics, operation time, estimated blood loss, time to ambulation, length of hospitalization, intraoperative and postoperative complications were recorded. The visual analog scale (VAS) score for leg and back pain, the Oswestry Disability Index (ODI) score, and the Macnab criteria were used to evaluate the clinical outcomes. The healthcare cost was also recorded.Results: The operation time, estimated blood loss, time to ambulation and length of hospitalization of FEV-ULBD group were shorter than MIS-TLIF group. The postoperative mean VAS and ODI scores decreased significantly in both groups. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 90.6% and 93.8% in the two groups. The mean VAS scores, ODI scores and outcomes of the modified Macnab criteria of both groups were of no significant difference. The healthcare cost of FEV-ULBD group was lower than MIS-TLIF group. Two cases of intraoperative epineurium injury were observed in the FEV-ULBD group. One case of cauda equina injury was observed in the FEV-ULBD group. No nerve injury, dural injury or cauda equina syndrome was observed in MIS-TLIF group. However, one case with transient urinary retention, one case with pleural effusion, one case with incision infection and one case with implant dislodgement were observed in MIS-TLIF group. Conclusions: Both FEV-ULBD and MIS-TLIF are safe and effective to treat one-level LSS without degenerative spondylolisthesis or deformity. FEV-ULBD is a more minimally invasive option and of less economic burden compared with MIS-TLIF. Decompression plus instrumented fusion may be not necessary for one-level LSS without degenerative spondylolisthesis or deformity.

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Section: Discussionmentioning

confidence: 99%

Comparison of Full-Endoscopic Visualized Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis

Hua

Wang

et al. 2020

Preprint

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“…Decompression with fusion does not appear to be more effective than decompression alone when considering pain relief, walking ability, or disability status. [27,28] The gold standard method of the decompression of lumbar spinal stenosis is laminectomy with or without lateral recess and foraminal decompression. A laminectomy removes the entire lamina and the underlying ligamentum avum, while a laminotomy removes only a small bone window from the lamina, unilaterally or bilaterally, which could be accomplished through minimally invasive surgery, such as percutaneous endoscope technique.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

Lin

Chang

et al. 2020

Preprint

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Background: The aim of this study is to introduce a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who with multiple comorbidities. Decompression alone using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. The O-arm/StealthStation system is popular for its ability to provide automated registration with intraoperative, postpositioning computed tomography (CT) with no radiation exposure to operative staffs.Methods: In this study, we presented four cases. All patients were over seventy years old female with variable degrees of kyphoscoliosis and multiple comorbidities who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed. Patients’ demographics, image study parameters, and outcome measurements including pre- and post-operative serial Visual analog scale (VAS), and Oswestry Disability Index (ODI) were well documented. The follow-up time was one year.Results: Pre- and post-operative MRI showed average dural sac cross sectional area (DSCSA) improved from 81.62 (range 67.34-89.07) to 153.27 (range 127.96-189.73). Preoperative neurological symptoms including radicular leg pain improved postoperatively. The mean ODI (%) were 85 (range 82.5-90) at initial visit, 35.875 (range 25-51) at 1 month post-operatively, 26.875 (range 22.5-35) at 6 months post-operatively and 22.5 (range 17.5-30) at 12 months post-operatively (p <0.05). The mean VAS score were 9 (range 8-10) at initial visit, 2.25 (range 2-3) at 1 month post-operatively, 1.75 (range 1-2) at 6 months post-operatively and 0.25 (range 0-1) at 12 months post-operatively (p <0.05). There was no surgery-related complication.Conclusions: To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique may serve as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.

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“…Decompression with fusion does not appear to be more effective than decompression alone when considering pain relief, walking ability, or disability status. [21,22] The gold standard method of the decompression of lumbar spinal stenosis is laminectomy with or without lateral recess and foraminal decompression. A laminectomy removes the entire lamina and the underlying ligamentum avum, while a laminotomy removes only a small bone window from the lamina, unilaterally or bilaterally, which could be accomplished through minimally invasive surgery, such as percutaneous endoscope technique.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

Lin

Chang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The aim of this study is to introduce a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who with multiple comorbidities. Decompression alone using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. The O-arm/StealthStation system is popular for its ability to provide automated registration with intraoperative, postpositioning computed tomography (CT) which results in superior accuracy in spine surgery.Methods: In this study, we presented four cases. All patients were over seventy years old female with variable degrees of kyphoscoliosis and multiple comorbidities who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed. Patients’ demographics, image study parameters, and outcome measurements including pre- and post-operative serial Visual analog scale (VAS), and Oswestry Disability Index (ODI) were well documented. The follow-up time was one year.Results: Pre- and post-operative MRI showed average dural sac cross sectional area (DSCSA) improved from 81.62 (range 67.34-89.07) to 153.27 (range 127.96-189.73). Preoperative neurological symptoms including radicular leg pain improved postoperatively. The mean ODI (%) were 85 (range 82.5-90) at initial visit, 35.875 (range 25-51) at 1 month post-operatively, 26.875 (range 22.5-35) at 6 months post-operatively and 22.5 (range 17.5-30) at 12 months post-operatively (p <0.05). The mean VAS score were 9 (range 8-10) at initial visit, 2.25 (range 2-3) at 1 month post-operatively, 1.75 (range 1-2) at 6 months post-operatively and 0.25 (range 0-1) at 12 months post-operatively (p <0.05). There was no surgery-related complication.Conclusions: To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique may serve as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.

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Decompression alone vs. decompression plus fusion for claudication secondary to lumbar spinal stenosis

Cited by 30 publications

References 23 publications

Comparison of Full-Endoscopic Visualized Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis

Comparison of Full-Endoscopic Visualized Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

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