Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis

Müslüman, Ahmet Murat; Cansever, Tufan; Yılmaz, Adem; Çavuşoğlu, Halit; Yüce, İsmail; Aydın, Yunus

doi:10.3171/2011.7.spine11222

Cited by 64 publications

(42 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Findings in the current study are consistent with those of Pao et al and Müslüman et al, who reported no progression of spondylolisthesis following a microsurgical unilateral approach for tubular bilateral decompression after 2 years' follow-up. 39,44 The reoperation rates in our study compare favorably with those of Kim et al, who reported a 15% total reoperation rate and 7.1% reoperation rate with fusion following bilateral tubular decompressive surgery via a unilateral approach using tubular retractors. 30 Those authors concluded that decompression without fusion is more cost-effective than instrumented fusion for a selected group of patients whom they defined as those with leg-dominant pain and stable Grade I spondylolisthesis.…”

Section: Lumbar Spinal Stenosis and Spondylolisthesissupporting

confidence: 88%

See 1 more Smart Citation

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

119

View full text Add to dashboard Cite

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.

show abstract

Section: Lumbar Spinal Stenosis and Spondylolisthesissupporting

confidence: 88%

“…8,30,39,[41][42][43][44][45] In the present study we evaluated the outcome of this procedure in a larger group of patients with a longer duration of follow-up. The results were compared with those of other decompressive procedures published in the literature (Table 8).…”

Section: Minimally Invasive Decompression Of Lssmentioning

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

119

View full text Add to dashboard Cite

show abstract

“…These results are in accordance with various studies reporting improvement in functional disability and pain after surgery for DLSS. 5,6,11,14,38,41,49,51 There were no significant differences in disability (ODI, RMDQ) or leg and back pain (VAS) between treatment groups. However, somewhat surprisingly, a significant difference was found in the percentage of patients who claimed a marked reduction in leg symptoms after surgery (e.g., pain, sensory disturbances, heavy legs, paresthesias).…”

Section: Primary Outcome Assessmentsmentioning

confidence: 97%

“…Both the bilateral interlaminar approach for bilateral decompression, 4,22,43,46,58,59,64 as well as the unilateral ap proach, 11,14,22,26,40,41,43,51,55,62 have been extensively researched and have shown promising results. Most of these studies, however, were limited by the size of the study population and choice of intervention.…”

Section: Discussionmentioning

confidence: 99%

Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

Boogert

Keers²,

Oterdoom

et al. 2015

SPI

View full text Add to dashboard Cite

OBJECT The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two popular techniques are rare. To address this shortcoming, this study compares postoperative functional disability, pain, and patient satisfaction among patients with single-level DLSS who underwent bilateral decompression using either a bilateral or unilateral approach. METHODS This retrospective study included patients who underwent operations between November 1, 2009, and October 1, 2011. These patients underwent single-level bilateral decompressive surgery using either the bilateral or unilateral interlaminar approach at one of 5 participating hospitals. Exclusion criteria included previous lumbar surgery, additional disc surgery, and spondylolisthesis requiring fusion surgery. Primary outcome measures included bodily pain (as reported using the visual analog scale [VAS]), the Roland-Morris Disability Questionnaire (RMDQ), and the Oswestry Disability Index (ODI). In addition, reductions in leg and back symptoms and the patient’s general evaluation of the procedure were queried. Finally, patient satisfaction and surgical parameters were evaluated. Questionnaires were sent to each patient’s home, and electronic patient files were used to collect the data. RESULTS One hundred and seventy-five patients returned the questionnaire (74.4% response rate; 68 and 107 patients who underwent the bilateral or unilateral approach, respectively). Mean age at surgery was 68 years (range 34–89 years), and the mean follow-up period was 14.2 months (range 3.3–27.4 years). There were no significant differences in ODI (20.3 vs 22.6 for the bilateral and unilateral approaches, respectively), RMDQ (3.99 vs 4.8, respectively), or pain scores between treatment groups. Back symptoms were reduced in 74.8% (bilateral: 74.6% vs unilateral: 75%; not significant), and leg symptoms in 80.6% of the patients (bilateral: 73.1% vs unilateral: 85.4%; p = 0.048). In total, 72.1% (bilateral) and 80.0% (unilateral) of patients reported good overall treatment results (p = 0.226). Significantly more patients in the unilateral group reported a better overall satisfaction with the procedure (82.1% vs 69.1%; p = 0.047). CONCLUSIONS There were no differences in postoperative functional disability and pain between the surgical techniques. The significant differences in patient satisfaction and reduction in leg symptoms were unrelated to surgical technique. The overall treatment results were satisfactory. Both techniques are safe and effective options for treating patients with single-level DLSS.

show abstract

“…After unsuccessful medical management, a surgical intervention should be considered [5]. Several surgical techniques exist including uni-or bilateral decompression, associated or not with a posterior or circumferential fusion [6][7][8][9]. Experienced surgeons appreciate the large variability of time required for inpatient and outpatient visits and surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Time spent per patient in lumbar spinal stenosis surgery

Kaminski

Banse

2013

Eur Spine J

View full text Add to dashboard Cite

Purpose To examine the time needed from a surgeon's viewpoint to treat a patient operated for lumbar spinal stenosis. We firstly aimed to give evidence of the wide ranging duration of standardized procedure. Secondly, we investigated factors affecting the time allocated to each patient. Methods 438 medical records of patients operated on for lumbar decompression without fusion (2005)(2006)(2007)(2008)(2009)(2010)(2011) were retrospectively examined. Primary data were operative time (OT, min), length of stay (LoS, days) and number of postoperative visits. A fourth parameter was calculated, the time spent per patient (TSPP, min) by summing the time spent in surgery, during inpatient and outpatient follow-up visits. Factors that influenced these medical resources were examined. Results Median (5th-95th percentile) LoS was 5 days (2-15), , number of medical visits 5 (2-11) and TSPP 329 min (206-533). In descending order, factors predicting LoS were age, no. of levels, sex, operative technique, cardiovascular risk index, dural tear and haematoma. Factors predicting OT were number of levels, dural tear, foraminotomy, synovial cyst and body mass index. The statistical model could predict 36 % of the TSPP variance. We recommend that surgeons add 35 min for each level, 29 min for patients over 65 years, 30 min for women, 132 min for dural tear and 108 min for epidural haematoma.Conclusion TSPP treated for lumbar spinal stenosis is highly variable, yet partially predictable. These data may help individual surgeons or heads of departments to plan their activities.

show abstract

Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis

Cited by 64 publications

References 29 publications

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

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

Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

Time spent per patient in lumbar spinal stenosis surgery

Contact Info

Product

Resources

About