Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal

Yasar, Baris; Simsek, Serkan; Er, Uyğur; Yiğitkanlı, Kazım; Ekşioğlu, Emel; Altuğ, Tibet; Belen, Deniz; Kars, Zafer; Bavbek, Murad

doi:10.3171/2009.3.spine08692

Cited by 23 publications

(12 citation statements)

References 24 publications

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“…Other studies in the literature do not show a significant effect of preoperative DOS on outcome of treatment of SS or DS 1,4,6,9,15,16,23 or did not examine DOS as a possible predictor of outcome of treatment on SS or DS. 5,8,12,14,2021,22 Yasar et al report the results of a prospective study of 125 patients with spinal stenosis with 2 year followup.…”

Section: Discussionmentioning

confidence: 92%

“…The authors found no correlation between DOS and outcome of treatment, although the incidence of DS is not specified in the population. 23 Jönsson and colleagues report on a series of 105 patients approximately 33% DS and 66% SS who underwent decompressive laminectomy for spinal stenosis. The authors report a nonsignificant trend toward a worse outcome associated with DOS > 4 years.…”

Section: Discussionmentioning

confidence: 99%

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Does the Duration of Symptoms in Patients With Spinal Stenosis and Degenerative Spondylolisthesis Affect Outcomes?

Radcliff¹,

Rihn²,

Hilibrand³

et al. 2011

Spine

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Study Design Retrospective subgroup analysis of prospectively collected data according to treatment received. Objective The purpose of this study is to determine if the duration of symptoms affects outcomes following the treatment of spinal stenosis (SS) or degenerative spondylolisthesis (DS). Summary of Background Data The Spine Outcomes Research Trial (SPORT) study was designed to provide scientific evidence on the effectiveness of spinal surgery versus a variety of non-operative treatments. Methods An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of SS or DS. A comparison was made between patients with SS with ≤12 months (n=405) and those with >12 months (n=227) duration of symptoms. A comparison was also made between patients with DS with ≤12 months (n=397) and those with >12 months (n=204) duration of symptoms. Baseline patient characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to 4 years. The difference in improvement among patients whose surgical or nonsurgical treatment began less than or greater than 12 months after the onset of symptoms was measured. In addition, the difference in improvement with surgical versus nonsurgical treatment (treatment effect) was determined at each follow-period for each group. Results At final followup, there was significantly less improvement in primary outcome measures in SS patients with >12 months symptom duration. Primary and secondary outcome measures within the DS group did not differ according to symptom duration. There were no statistically significant differences in treatment effect of surgery in SS or DS patients. Conclusions Patients with spinal stenosis with fewer than twelve months of symptoms experienced significantly better outcomes with surgical and nonsurgical treatment relative to those with symptom duration greater than twelve months. There was no difference in outcome of patients with degenerative spondylolisthesis according to symptom duration.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Does the Duration of Symptoms in Patients With Spinal Stenosis and Degenerative Spondylolisthesis Affect Outcomes?

Radcliff¹,

Rihn²,

Hilibrand³

et al. 2011

Spine

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“…51 Despite all the variations in outcome among the different decompressive procedures, minimally invasive laminectomy through tubular retractors seems to result in clinical outcome and reoperation rates comparable to those for other decompressive procedures. [8][9][10][11]25,32,36,40,46,53,54,58,[60][61][62][63][64][65][66] However, the radiographic results suggest that this technique is associated with a lower instability rate than the full-open procedures, probably because of the preservation of posterior elements of the lumbar spine. Results from a cost-utility study showed that tubular retractorguided decompression without fusion in this setting is more cost-effective than conventional decompression and fusion (Table 9).…”

Section: Lumbar Spinal Stenosis and Spondylolisthesismentioning

confidence: 99%

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

Alimi¹,

Hofstetter²,

Pyo³

et al. 2015

SPI

122

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OBJECT Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure, but minimally invasive laminectomy through tubular retractors is an alternative. The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of this procedure in patients who underwent LSS and to compare outcomes in patients with and without preoperative spondylolisthesis. METHODS Patients with LSS without spondylolisthesis and with stable Grade I spondylolisthesis who had undergone minimally invasive tubular laminectomy between 2004 and 2011 were included in this analysis. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, as well as Macnab's criteria. RESULTS Among 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. At a mean follow-up of 28.8 months, scoring revealed a median improvement of 16% on the ODI, 2.75 on the VAS back, and 3 on the VAS leg, compared with the preoperative baseline (p < 0.0001). The reoperation rate requiring fusion at the same level was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or reoperation rate. CONCLUSIONS Minimally invasive laminectomy is an effective procedure for the treatment of LSS. Reoperation rates for instability are lower than those reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be an alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis.

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“…The mean age of subjects who participated in an exercise intervention was 59.4 (SD 6.1) years. Eight studies were identified that included decompressive surgery [10,23,29-34]. Table 3 also summarises the ten decompressive surgical intervention arms identified.…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review

Jarrett

Orlando

Grimmer

2012

BMC Musculoskelet Disord

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Background Lumbar spinal stenosis (LSS) is prevalent in those over the age of 65 years and the leading cause of spinal surgery in this population. Recent systematic reviews have examined the effectiveness of conservative management for LSS, but not relative to surgical interventions. The aim of this review was to systematically examine the effectiveness of land based exercise compared with decompressive surgery in the management of patients with LSS. Methods A systematic review of randomised controlled trials and clinical trials was undertaken. The databases MEDLINE, Embase, CINAHL, PEDro and Cochrane Library Register of Controlled Trials were searched from January 2000 to June 2011. Only studies that included subjects with lumbar spinal canal stenosis were considered in this review. Studies also had to use a patient reported functional outcome measure for a land based exercise intervention or lumbar decompressive surgery. Results Only one study compared the effectiveness of exercise and decompressive surgery for LSS. Surgery demonstrated statistically significant improvements in patient reported functional outcome scores at 6, 12 and 24-months post-intervention ( p < 0.01). To facilitate further analysis, the results from 12 exercise and 10 surgical intervention arms were compared using percentage change in patient reported functional outcome measure scores. Exercise interventions showed initial improvements, ranging from 16 to 29% above baseline. All decompressive surgical interventions demonstrated greater and sustained improvements over 2-years (range 38-67% improvement) with moderate to large effect sizes. The most commonly reported complications associated with surgery were dural tears, while details of adverse effects were lacking in exercise interventions. Conclusions This systematic review of the recent literature demonstrates that decompressive surgery is more effective than land based exercise in the management of LSS. However, given the condition's slowly progressive nature and the potential for known surgical complications, it is recommended that a trial of conservative management with land based exercise be considered prior to consideration of surgical intervention.

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Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal

Cited by 23 publications

References 24 publications

Does the Duration of Symptoms in Patients With Spinal Stenosis and Degenerative Spondylolisthesis Affect Outcomes?

Does the Duration of Symptoms in Patients With Spinal Stenosis and Degenerative Spondylolisthesis Affect Outcomes?

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review

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