Radiographic Risk Factors of Reoperation Following Minimally Invasive Decompression for Lumbar Canal Stenosis Associated With Degenerative Scoliosis and Spondylolisthesis

Abstract

Study Design:Prospective cohort study.Objective:Microsurgical bilateral decompression via a unilateral approach (MBDU), a minimally invasive surgical (MIS) decompression method, has been performed for numerous degenerative lumbar diseases, including degenerative lumbar scoliosis (DLS) or degenerative spondylolisthesis (DS), at our institution. In this study, we evaluated the appropriateness of MBDU for DLS or DS patients.Methods:A total of 207 patients treated by MBDU were included (88 women and 119 men; mean age, 70 [40-86] years). Thirty-seven cases were diagnosed as DLS (group A), 51 as DS (group B), and 119 as lumbar canal stenosis (group C). Patient clinical status assessed by JOA score was evaluated preoperatively and 2 years postoperatively. We evaluated the prevalence of cases that required reoperation among the groups and the radiographic risk factors related to reoperation.Results:There was no significant difference in recovery ratios of JOA scores among the groups. Reoperation after MBDU was needed in 13 cases (6.3%); the revision rate did not significantly differ among the groups. Reoperation was associated with poor clinical status, low visual analog scale score for low back pain, and low SF-36 mental component summary score. Reoperation was significantly associated with preoperative scoliotic disc wedging with Cobb’s angle ≥3° in L4-5 (odds ratio = 9.88) and lateral listhesis (odds ratio = 5.22 [total], 12.9 [L4-5]).Conclusions:When we are careful to indicate decompression for patients with these risk factors related to reoperation, MIS decompression alone can successfully improve DLS patients with a Cobb’s angle of ≤20° or DS patients.

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

“…Our univariate analysis was not able to identify any preoperative factors to predict poor outcome or reoperation. Previous studies, however, postulated that preoperative scoliotic disc wedging (Cobb angle ≥ 3°) and lateral listhesis 37,38 are associated with reoperation, while spur formation on the concave side of scoliotic curves may be a protective factor in curve progression. 35 Blumenthal et al reported that in patients with degenerative grade I lumbar spondylolisthesis who underwent conventional laminectomy, a facet angle > 50° was associated with a 39% rate of reoperation, and a disc height > 6.5 mm was associated with a 45% rate of reoperation.…”

“…38 The authors reported significant improvements in ODI scores in patients with deformity with no significant progression of scoliosis; however, there was a 25% reoperation rate, with 50% of these failures in patients with concurrent lateral listhesis. Conversely, a recent 2017 prospective study with 2-year follow-up compared outcomes in 207 patients with spinal stenosis with or without coexisting scoliosis (mean Cobb angle 14°) following tubular MIS-ULBD 37 and found significant increases in functional outcomes in all patients with an 8% reoperation rate, which was associated with preoperative scoliotic disc wedging (Cobb angle ≥ 3°) and lateral listhesis. Our tubular MIS-ULBD cohort was found to have a reoperation rate of 11%, which is consistent with rates reported in the literature.…”

“…26,28 Minimally invasive decompressive techniques seek to minimize collateral damage and preserve the posterior elements with the purported advantage of preventing iatrogenic instability and curve progression associated with open techniques. 3,22,52 While minimally invasive surgery using tubular-based unilateral laminotomy for bilateral decompression (MIS-ULBD) has been shown to be a clinically effective procedure in the treatment of a subset of LSS patients with degenerative scoliosis, 23,37,38 there is a paucity of data on the effectiveness of the lumbar endoscopic ULBD (LE-ULBD) technique for this same cohort.…”

Interlaminar decompression for patients with degenerative lumbar stenosis. Literature review and results of a prospective study

“…(2017), билатеральная интерламинарная декомпрессия с применением унилатерального доступа эффективна как при изолированном дегенеративном СПК, так и при СПК в сочетании со спондилолистезом и сколиозом. Авторы отмечают, что при сочетании дегенеративного СПК со сколиозом факторами риска неэффективности операции выступают латеральный спондилолистез и сколиотический угол >3° в сегменте L 4 -L 5 [35].…”

The effect of preoperative degenerative spondylolisthesis on postoperative outcomes of degenerative lumbar spinal stenosis

“…The key to this technique is to preserve the posterior elements of spine, for instance, intervertebral joints, intraspinal ligaments, supraspinatus ligaments, and paraspinal muscles, and may facilitate the preservation of stable spinal ligaments and the bone structures. [ 12 – 16 ] Because the preservation of the posterior component can minimize the damage to instability or scoliosis after the decompression, indications are extended to the lumbar diseases, involving DS or DLSS. Nevertheless, there is no consensus on these indications.…”