Decompressive lumbar laminectomy for spinal stenosis

Silvers, H R; Lewis, Paul; Asch, Harold L.

doi:10.3171/jns.1993.78.5.0695

Cited by 152 publications

(87 citation statements)

References 29 publications

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“…Silvers et al specifically investigated outcomes following decompressive laminectomy for patients with DLS. 44 Two hundred fifty-eight patients were included, 12 of whom had DLS. The mean age of the 12 patients undergoing laminectomy for DLS was 69 years, and there was a 100% relief in pain and 100% return to normal activity reported in the short-term follow-up (mean 8.4 months).…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive spine surgery for adult degenerative lumbar scoliosis

Dangelmajer

Zadnik

Rodríguez

et al. 2014

FOC

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Object Historically, adult degenerative lumbar scoliosis (DLS) has been treated with multilevel decompression and instrumented fusion to reduce neural compression and stabilize the spinal column. However, due to the profound morbidity associated with complex multilevel surgery, particularly in elderly patients and those with multiple medical comorbidities, minimally invasive surgical approaches have been proposed. The goal of this meta-analysis was to review the differences in patient selection for minimally invasive surgical versus open surgical procedures for adult DLS, and to compare the postoperative outcomes following minimally invasive surgery (MIS) and open surgery. Methods In this meta-analysis the authors analyzed the complication rates and the clinical outcomes for patients with adult DLS undergoing complex decompressive procedures with fusion versus minimally invasive surgical approaches. Minimally invasive surgical approaches included decompressive laminectomy, microscopic decompression, lateral and extreme lateral interbody fusion (XLIF), and percutaneous pedicle screw placement for fusion. Mean patient age, complication rates, reoperation rates, Cobb angle, and measures of sagittal balance were investigated and compared between groups. Results Twelve studies were identified for comparison in the MIS group, with 8 studies describing the lateral interbody fusion or XLIF and 4 studies describing decompression without fusion. In the decompression MIS group, the mean preoperative Cobb angle was 16.7° and mean postoperative Cobb angle was 18°. In the XLIF group, mean pre- and postoperative Cobb angles were 22.3° and 9.2°, respectively. The difference in postoperative Cobb angle was statistically significant between groups on 1-way ANOVA (p = 0.014). Mean preoperative Cobb angle, mean patient age, and complication rate did not differ between the XLIF and decompression groups. Thirty-five studies were identified for inclusion in the open surgery group, with 18 studies describing patients with open fusion without osteotomy and 17 papers detailing outcomes after open fusion with osteotomy. Mean preoperative curve in the open fusion without osteotomy and with osteotomy groups was 41.3° and 32°, respectively. Mean reoperation rate was significantly higher in the osteotomy group (p = 0.008). On 1-way ANOVA comparing all groups, there was a statistically significant difference in mean age (p = 0.004) and mean preoperative curve (p = 0.002). There was no statistically significant difference in complication rates between groups (p = 0.28). Conclusions The results of this study suggest that surgeons are offering patients open surgery or MIS depending on their age and the severity of their deformity. Greater sagittal and coronal correction was noted in the XLIF versus decompression only MIS groups. Larger Cobb angles, greater sagittal imbalance, and higher reoperation rates were found in studies reporting the use of open fusion with osteotomy. Although complication rates did not significantly differ between groups, these data are difficult to interpret given the heterogeneity in reporting complications between studies.

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Section: Discussionmentioning

confidence: 99%

“…24,35,43,44,46 Previous studies have indicated that laminectomies (Fig. 1C) can cause impairment of the facet joints, resulting in segmental instability.…”

Section: ©Aans 2014mentioning

confidence: 99%

Minimally invasive spine surgery for adult degenerative lumbar scoliosis

Dangelmajer

Zadnik

Rodríguez

et al. 2014

FOC

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“…Silvers et al in a retrospective study of 258 consecutive patients that underwent decompressive lumbar laminectomies observed no significant correlation between employment status and clinical outcomes (9). Similarly, Bourne et al in another retrospective study of 1,703 patients who underwent primary total knee arthroplasty, found no significant differences in postoperative satisfaction based on perioperative employment status (10).…”

Section: Discussionmentioning

confidence: 93%

Effect of employment status on length of hospital stay, 30-day readmission and patient reported outcomes after spine surgery

et al. 2017

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Background: Growing scrutiny has placed hospitals at the center of readmission prevention. The relationship between pre-operative employment status, length of hospital stays (LOS) and 30-day readmission rates after elective spine surgery remains unclear.Methods: The medical records of 360 patients (employed: n=174, unemployed: n=70, retired: n=40, disabled: n=76) undergoing elective spine surgery at a major academic medical center were reviewed.Patient demographics, comorbidities, and post-operative complication rates were recorded. All patients had comprehensive 1-year patient reported outcomes (PROs) measures. We hypothesized that employment status is associated with decreased LOS and decreased risk of 30-day readmission after elective spine surgery.All-cause readmissions within 30 days of discharge was the primary outcome variable.Results: Baseline characteristics were similar in all cohorts. There was no difference in operative time, estimated blood loss (EBL), or number of fusion levels between all patient cohorts. There were no significant differences in peri-operative complication rates between patient cohorts. On average, the LOS was shorter for the employed compared to non-employed patients (4.89 vs. 5.26 days). The rate of 30-day readmission was 2-fold greater unemployed compared to employed patients (5.17% vs. 10%). At 1-year after surgery, employed patients were more likely to express functional improvement (change in ODI score) compared to unemployed patients (ODI: employed: 33.80 vs. unemployed: 41.93).Conclusions: Our study suggests that employment status may be associated with shorter duration of hospital stay, lower 30-day readmission rates and greater functional improvement. Future interventions to reduce unplanned hospital readmissions should consider pre-operative employment status.

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“…In a retrospective study of 244 patients with LSS between 30 and 87 years treated with laminectomy, Silver et al reported a complication rate of 22%. The authors found no age-related differences in outcomes [23]. Ragab et al compared their results from a retrospective analysis of 118 patients (over 70 years of age) with the results in other reports.…”

Section: Discussionmentioning

confidence: 95%

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

et al. 2011

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Introduction Published opinions regarding the outcomes and complications in older patients have a broad spectrum and there is a disagreement whether surgery in older patients entails a higher risk. Therefore this study examines the risk of surgery for lumbar spinal stenosis relative to age in the pooled data set of the Spine Tango registry. Materials and methods Between May 2005 and February 2010 the database query resulted in 1,764 patients. The patients were subdivided into three socio-economically relevant age groups: \65 years, 65-74 years, C75 years. Frequencies for occurred surgical, general and follow-up complications were assessed. Multivariate and univariate logistic regressions were performed to reveal predictors for respective complication types. Results and discussion Our study found that age, ASA status and blood loss were significant co-varieties for the occurrence of general complications. The risk of general complications is increased in older versus younger patients. Fusion or rigid stabilization does not lead to more complications. Surgical complications as well as complication rates at follow-up showed no significant age-related variation. Physician-based outcome was good or excellent in over 80% of patients in all age groups.

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Decompressive lumbar laminectomy for spinal stenosis

Cited by 152 publications

References 29 publications

Minimally invasive spine surgery for adult degenerative lumbar scoliosis

Minimally invasive spine surgery for adult degenerative lumbar scoliosis

Effect of employment status on length of hospital stay, 30-day readmission and patient reported outcomes after spine surgery

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

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