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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 &lt; 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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Microsurgical decompression for central lumbar spinal stenosis: a single-center observational study

“…Further, microsurgical decompression was associated with a low rate of complications and no severe complications. This study adds to the growing evidence that microsurgical decompression is an effective and safe treatment for LSS [1,21,22,32]. The outcomes reported in our study are similar to what was recently reported in a multicenter observational study comparing microsurgical decompression and laminectomy for central LSS using NORspine data [22].…”

“…The randomized design of the SPORT study with its inherent stricter inclusion criteria and higher baseline ODI could possibly account for some of this difference [25,33]. Interestingly, a recent study reported similar favorable outcomes following microsurgical decompression for LSS in patients with and without preoperative grade I spondylolisthesis [1].…”

Relief of Lower Back and Leg Pain after Myelography

“…Alimi et al . reported that the lower back pain of 50% of patients with lumbar spinal stenosis was improved after decompression surgery [3]. In the present study, lower back pain might have improved due to the decompression-like effect of contrast medium, but it is very hard to prove this scientifically.…”

Evaluation of Effect of Posterior Dynamic Stabilization IntraSPIN System on Sagittal Spinal Balance using EOS® X-Ray Imaging System

“…In the case of failure of the conservative treatment, a surgical approach is indicated and a direct surgical decompression has been shown significantly improvement in pain, function and satisfaction in a remarkable number of cases with durable effects [3]. Traditional approaches include open laminectomy or laminotomy and more recently, excellent results came from the minimally invasive decompression through a mono-lateral approach with undercutting [4][5][6]. In cases of vertebral instability or spondylolisthesis the procedure can be completed with a fusion.…”