Lumbar Spinal Stenosis: Conservative or Surgical Management?

Amundsen, Tom; Weber, Henrik; Nordal, H. J.; Magnaes, B; Abdelnoor, Michael; Lilleås, Finn

doi:10.1097/00007632-200006010-00016

Cited by 616 publications

(473 citation statements)

References 45 publications

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“…Increasingly long-term outcomes are being expected of many clinical trials in back pain and spinal surgery as well as for clinical cohorts; however, this study adds credence to previous work on the outcome of decompression surgery which suggests that many of the key outcome namely function and pain demonstrate an initial dramatic reduction in the first 6-12 weeks followed by a plateaux in these outcomes [1,2], thus questioning the need for follow up beyond 1 year which can be costly and time consuming. This paper is important as it strengthens this argument particularly due to the low loss to follow up at 1 year, less than 5%, which is impressive and the authors should be commended on this and perhaps offer some advice to others on how to achieve such high rates of return.…”

supporting

confidence: 53%

Reviewer’s comment on “Five-year outcome of surgical decompression of the lumbar spine without fusion” by Mannion AF, Denzler R, Dvorak J, Grob D (doi:10.1007/s00586-010-1535-2)

McGregor

2010

Eur Spine J

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supporting

confidence: 53%

Reviewer’s comment on “Five-year outcome of surgical decompression of the lumbar spine without fusion” by Mannion AF, Denzler R, Dvorak J, Grob D (doi:10.1007/s00586-010-1535-2)

McGregor

2010

Eur Spine J

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“…Although reduced walking distance is an important component of the symptom complex of lumbar stenosis, the assessment of walking distance is relatively insensitive to change. Studies comparing surgery with conservative treatment for lumbar stenosis also found no differences between treatment groups regarding walking distance, although other outcome measures differed significantly between treatment groups [56,57].…”

Section: Discussionmentioning

confidence: 97%

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

et al. 2015

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Purpose To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facetpreserving laminectomy for the treatment of patients with degenerative lumbar stenosis. Methods A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MED-LINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014. Results A total of four high-quality RCTs and six lowquality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy. Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in patients that underwent bilateral laminotomy compared with conventional laminectomy. Unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low. The difference in severity of postoperative low back pain following bilateral laminotomy and split-spinous process laminotomy was significantly less, but was too small to be clinically important. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. Conclusion The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies.

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“…The most commonly used therapy is a decompressive surgery. The success of this therapy reported in the literature varies from moderate to excellent results, depending on the point of interest for example pain reduction or neurological deficit [1,10,12]. One of the problems associated with decompression surgery is the creation of an instability as a consequence of the degeneration of the disc, the facetectomy or a combination of both [3].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure

et al. 2008

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Interspinous implants are used to treat lumbar spinal stenosis or facet joint arthritis. The aims of implanting interspinous devices are to unload the facet joints, restore foraminal height and provide stability especially in extension but still allow motion. The aim of this in vitro study was to compare four different interspinous implants--Colfex, Wallis, Diam and X-Stop--in terms of their three-dimensional flexibility and the intradiscal pressure. Twenty-four human lumbar spine specimens were divided into four equal groups and tested with pure moments in flexion/extension, lateral bending and axial rotation: (1) intact, (2) defect, (3) after implantation. Range of motion and the intradiscal pressure were determined.In each implant-group the defect caused an increase in range of motion by about 8% in lateral bending to 18% in axial rotation. Implantation had similar effects with all four implants. In extension, Coflex, Wallis, Diam, and X-Stop all overcompensated the instability caused by the defect and allowed about 50% of the range of motion of the intact state. In contrast, in flexion, lateral bending and axial rotation the values of the range of motion stayed about the values of the defect state. Similarly the intradiscal pressure after implantation was similar to that of the intact specimens in flexion, lateral bending and axial rotation but much smaller during extension. All tested interspinous implants had a similar effect on the flexibility: they strongly stabilized and reduced the intradiscal pressure in extension, but had almost no effect in flexion, lateral bending and axial rotation.

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Lumbar Spinal Stenosis: Conservative or Surgical Management?

Abstract: The outcome was most favorable for surgical treatment. However, an initial conservative approach seems advisable for many patients because those with an unsatisfactory result can be treated surgically later with a good outcome.

Cited by 616 publications

References 45 publications

Reviewer’s comment on “Five-year outcome of surgical decompression of the lumbar spine without fusion” by Mannion AF, Denzler R, Dvorak J, Grob D (doi:10.1007/s00586-010-1535-2)

Reviewer’s comment on “Five-year outcome of surgical decompression of the lumbar spine without fusion” by Mannion AF, Denzler R, Dvorak J, Grob D (doi:10.1007/s00586-010-1535-2)

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure

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