Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study

Nerland, Ulf S.; Jakola, Asgeir Store; Solheim, Ole; Weber, Clemens; Rao, Vidar; Lønne, Greger; Solberg, Tore; Salvesen, Øyvind; Carlsen, Sven Magnus; Nygaard, Øystein P.; Gulati, Sasha

doi:10.1136/bmj.h1603

Cited by 143 publications

(146 citation statements)

References 39 publications

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“…Another population‐based study from Scotland on patients with unruptured brain arteriovenous malformations showed that conservative management was associated with better clinical outcomes than treatment interventions (Salman et al., 2014). Using prospectively collected data from the Norwegian Registry for Spine Surgery, Nerland and coauthors were able to demonstrate that the effectiveness of laminectomy and microdecompression was equivalent in the management of lumbar spinal stenosis (Nerland et al., 2015). Another important aspect is that clinical registries and administrative databases allow inclusion of large patient groups that are ineligible for inclusion in randomized trials due to age and comorbidity (Giannadakis et al., 2016; Madsbu, Solberg, Salvesen, Nygaard, & Gulati, 2017).…”

Section: Discussionmentioning

confidence: 99%

Validation of intracranial hemorrhage in the Norwegian Patient Registry

et al. 2018

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ObjectivesAdministrative health registries need to have accurate diagnoses and sufficient coverage in the population they serve in order to be useful in research. In this study, we investigated the proportion of discharge diagnoses of intracranial hemorrhage (ICH) that were coded correctly in the Norwegian Patient Registry (NPR).Materials and MethodsWe reviewed the electronic medical records and diagnostic imaging of all admissions to St. Olavs University Hospital, Trondheim, Norway, between January 1, 2008, to December 31, 2014, with a discharge diagnosis of ICH in the NPR, and estimated positive predictive values (PPVs) for primary and secondary diagnoses. Separate calculations were made for inpatient and outpatient admissions.ResultsIn total, 1,419 patients with 1,458 discharge diagnoses of ICH were included in our study. Overall, 1,333 (91.4%) discharge diagnoses were coded correctly. For inpatient admissions, the PPVs for primary discharge codes were 96.9% for hemorrhagic stroke, 95.3% for subarachnoid hemorrhage, and 97.9% for subdural hemorrhage. The most common cause of incorrect diagnosis was previous stroke that should have been coded as rehabilitation or sequela after stroke. There were more false‐positive diagnoses among outpatient consultations and secondary diagnoses.ConclusionCoding of ICH discharge diagnoses in the NPR is of high quality, showing that data from this registry can safely be used for medical research.

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Section: Discussionmentioning

confidence: 99%

Validation of intracranial hemorrhage in the Norwegian Patient Registry

et al. 2018

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“…Nerland and colleagues' study compares the ''traditional'' surgical treatment for spinal stenosis, open laminectomy, with a newer and less invasive alternative technique, thē microdecompression [4]. Patients with a central stenosis of the lumbar spine at one or two lumbar levels underwent either an open laminectomy with resection of the spinous process, laminas and medial aspects of the facet joints, or a microdecompression.…”

Section: Open Laminectomy Versus Microdecompressionmentioning

confidence: 99%

“…Widespread adoption of these techniques should always be preceded by careful evaluation to ensure safety and determine added value of such so-called surgical innovation [2,3]. Actual and controversial topics concerning MIS for lumbar spinal stenosis (LSS) were recently addressed in high-quality studies: open laminectomy versus microdecompression by Nerland et al and decompression versus interspinous process implant by our group [4,5]. In some way, the opposite of MIS was addressed in a recent landmark study by Försth et al; does decompression versus decompression plus instrumented fusion for LSS yield better outcomes [6]?…”

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confidence: 99%

Minimally invasive surgery for lumbar spinal stenosis

Moojen

Gaag

2016

Eur J Orthop Surg Traumatol

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Recent trends in spine surgery, such as endoscopic and other ''micro'' techniques, promise less invasive procedures with better outcomes compared to conventional open techniques for decompressing nerves. Minimally invasive surgery (MIS), highly promoted by commercial parties for instrumented cases in particular, is popular with patients and physicians [1]. Widespread adoption of these techniques should always be preceded by careful evaluation to ensure safety and determine added value of such so-called surgical innovation [2,3]. Actual and controversial topics concerning MIS for lumbar spinal stenosis (LSS) were recently addressed in high-quality studies: open laminectomy versus microdecompression by Nerland et al. and decompression versus interspinous process implant by our group [4,5]. In some way, the opposite of MIS was addressed in a recent landmark study by Försth et al.; does decompression versus decompression plus instrumented fusion for LSS yield better outcomes [6]? The three studies address very relevant issues of the neurosurgical daily practice and will be discussed hereafter. The authors analyze data from a large, well-maintained and comprehensive national registry in Norway (the Norwegian Registry for Spine Surgery, NORspine). Thirty six out of 40 centers performing lumbar spine surgery in Norway record data prospectively in NORspine, making it a one of the unique national resource for spine research. Nerland and colleagues identified 885 eligible patients (out of 2745 screened) of whom 81 % completed the 1-year follow-up. Open laminectomy versus microdecompressionOpen laminectomy and microdecompression were associated with similar and statistically equivalent improvements in Oswestry disability scores and quality of life (EuroQol EQ-5D) at 1-year follow-up. Furthermore, the techniques did not differ in older people and obese patients in predefined subgroup analyses. The number of patients with complications was higher in the open laminectomy group (15.0 vs. 9.8 %, P = 0.018), but this difference did not hold after propensity matching (P = 0.23). Patients in the microdecompression group had shorter hospital stays, both for single-level decompression (difference 1.5 days, 95 % confidence interval 1.7-2.6, P \ 0.001) and two-level decompression (0.8 days, 1.0-2.2, P = 0.003).The authors concluded that microdecompression is the treatment of choice for patients with stenosis of the lumbar spine for the technique shows good clinical results, equal to open laminectomy at 1-year follow-up. Theoretically,

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“…Microinstability has clinical relevance and may be helpful to distinguish patients who require decompression alone from those who require decompression plus fixation [1]. Giannadakis et al reported low complication rates in microsurgical decompression for central lumbar stenosis in patients without radiological instability; however, an equivalent outcome was previously demonstrated in microsurgical decompression or laminectomy [4]. It would be interesting to assess microsurgical decompression in patients affected by microinstability, since in these patients a standard laminectomy may aggravate the instability, and fixation is probably too aggressive a treatment.…”

mentioning

confidence: 99%