Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA)

Hermansen, Erland; Moen, Gunnar; Barstad, Johan; Birketvedt, Rune; Indrekvam, Kari

doi:10.1007/s00586-013-2737-1

Cited by 11 publications

(11 citation statements)

References 36 publications

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“…In our study the rate of complications associated with lumbar microdecompression was lower than what has recently been reported for laminectomy and laminarthrectomy for spinal stenosis [20,21]. Smokers did not experience more complications or adverse events compared to nonsmokers in our study, possibly reflecting the minimally invasive nature of the procedure with small incisions, less muscle trauma and practically no need for bone healing.…”

Section: Discussioncontrasting

confidence: 73%

Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis? – A multicenter observational registry-based study

et al. 2015

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A total of 825 patients were included (619 nonsmokers and 206 smokers). For the whole patient population there was a significant difference between preoperative ODI and ODI at 1 year (17.3 points, 95% CI 15.93-18.67, p < 0.001). There was a significant difference in ODI change at 1 year between nonsmokers and smokers (4.2 points, 95% CI 0.98-7.34, p = 0.010). At 1 year 69.6% of nonsmokers had achieved a minimal clinically important difference (≥10 points ODI improvement) compared to 60.8% of smokers (p = 0.008). There was no difference between nonsmokers and smokers in the overall complication rate (11.6% vs. 9.2%, p = 0.34). There was no difference between nonsmokers and smokers in length of hospital stays for either single-level (2.3 vs. 2.2 days, p = 0.99) or two-level (3.1 vs. 2.3 days, p = 0.175) microdecompression. Smoking was identified as a negative predictor for ODI change in a multiple regression analysis (p = 0.001) CONCLUSIONS: Nonsmokers experienced a significantly larger improvement at 1 year following microdecompression for LSS compared to smokers. Smokers were less likely to achieve a minimal clinically important difference. However, it should be emphasized that considerable improvement also was found among smokers.

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Section: Discussioncontrasting

confidence: 73%

Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis? – A multicenter observational registry-based study

et al. 2015

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“…Unlike the poor correlation between preoperative DSCSA and clinical symptoms documented in previous articles, serial change of DSCSA after decompression and clinical symptom showed significant correlation in these articles. Hermansem et al reported a significant correlation between the expansion ratio of DSCSA and the patient self reported effect of surgery after laminarthrectomy for DLSS (Pearson -3.71; p=0.006) 6) . Yamazaki et al performed prospective study to evaluate the serial changes in clinical result and DSCSA on MRI after bilateral fenestration 22) .…”

Section: Discussionmentioning

confidence: 99%

“…There are some reports in the literature on serial changes of DSCSA after posterior decompression for DLSS 6 , 12 , 22) . Hiriki et al measured DSCSA preoperatively and in the early and late phases after various type of lumbar decompression surgery 12) .…”

Section: Discussionmentioning

confidence: 99%

“…To date, many studies have analyzed the relationship between DSCSA and the preoperative clinical symptoms, but it is still controversial 10 , 18 , 23) . Only a few studies have evaluated serial changes of DSCSA after posterior decompression for DLSS and to our knowledge, it is not published any studies that compare preoperative and postoperative DSCSA after ULBD 6 , 12 , 22) .…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Expansion of Dural Sac Cross-Sectional Area after Unilateral Laminotomy for Bilateral Decompression: Correlation with Clinical Symptoms

et al. 2014

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ObjectiveDural sac cross-sectional area (DSCSA) is a way to measure the degree of central spinal canal compression. The objective was to investigate the correlation between the expansion ratio of DSCSA after unilateral laminotomy for bilateral decompression (ULBD) and the clinical results for lumbar spinal stenosis.MethodsWe retrospectively reviewed the clinical data and radiographs of 103 patients who underwent ULBD for symptomatic spinal stenosis in one year. We compared preoperative and postoperative clinical data and DSCSA and evaluated the correlation between clinical and radiographic measurements.ResultsThere was a significant increase of DSCSA after ULBD (p=0.000) and mean expansion ratio of DSCSA was 203.7±147.2%(range -32.9-826.1%). Clinical outcomes, measured by VAS and ODI were improved significantly not only in early postoperative period, but also in the last follow-up. However, there were no statistically significant correlations between the preoperative DSCSA and clinical symptoms, Perioperative expansion ratio of DSCSA and clinical parameters were also not correlated to the improvement of clinical symptoms significantly in both early postoperative phase and last follow-up.ConclusionOur result indicates that the DSCSA itself has a definite limitation to be correlated to the clinical symptoms, and thus meticulous correlation between the clinical presentation and MRI imaging is essential in determination of surgical treatment.

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“…The DSCA evaluation has been suggested as a method to assess the compression (before surgery) and decompression (after surgery) of the dural sac by measuring the area of the spinal canal on pre-operative and post-operative imaging. [ 2 17 18 19 20 21 ] Actually, an increase of the DSCSA has been described as positively correlated to a better functional outcome,[ 31 ] but the postoperative nature of this measurements limits its clinical relevance. [ 22 ] Collectively, these data suggest that no other imaging methodologies apart from preoperative and postoperative CT/MRI scans have been identified so far to assess the compression and the decompression of the spinal canal after surgery for lumbar degenerative stenosis.…”

Section: Discussionmentioning

confidence: 99%

Navigated minimally invasive unilateral laminotomy with crossover for intraoperative prediction of outcome in degenerative lumbar stenosis

Cardali

Cacciola

Raffa

et al. 2018

J Craniovert Jun Spine

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Background:Different surgical techniques have been described for treatment of degenerative lumbar stenosis (DLS). Only postoperative measures have been identified as predictors of efficacy of decompression. The objective of this study is to assess the role of navigated unilateral laminotomy with crossover to achieve and predict a satisfying decompression and outcome in DLS.Materials and Methods:We enrolled patients with DLS who underwent navigation-assisted unilateral laminotomy with crossover. The extent of decompression was evaluated during surgery using neuronavigation. The outcome was assessed through the Oswestry disability index (ODI) and visual analog scale (VAS) for leg pain. Outcome correlation with the extent of the intraoperative bone decompression was analyzed. Finally, the outcome, surgical time, and in-hospital length-of-stay were compared with a control group treated through standard unilateral laminotomy.Results:Twenty-five patients were treated using the navigated technique (Group A), 25 using the standard unilateral laminotomy (Group B). In Group A, a cut-off value ≥0.9 cm for bone decompression revealed to be an intraoperative predictor of good outcome, both regarding the ODI and VAS scores (P = 0.0005; P = 0.002). As compared with Group B, patients operated using the navigated technique showed similar operative times, in-hospital length-of-stay, ODI scores, but improved VAS scores for leg pain (P = 0.04).Conclusions:The intraoperative navigated evaluation of the bone decompression could predict the outcome allowing satisfactory results in unilateral laminotomy for DLS. The navigated technique also could lead to an improved decompression of lateral recesses resulting in better control of leg pain as compared to standard unilateral laminotomy.

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Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA)

Cited by 11 publications

References 36 publications

Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis? – A multicenter observational registry-based study

Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis? – A multicenter observational registry-based study

Postoperative Expansion of Dural Sac Cross-Sectional Area after Unilateral Laminotomy for Bilateral Decompression: Correlation with Clinical Symptoms

Navigated minimally invasive unilateral laminotomy with crossover for intraoperative prediction of outcome in degenerative lumbar stenosis

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