Success and Failure of Minimally Invasive Decompression for Focal Lumbar Spinal Stenosis in Patients With and Without Deformity

Kelleher, Michael O.; Timlin, Marcus; Persaud, Oma; Rampersaud, Y. Raja

doi:10.1097/brs.0b013e3181c46fb4

Cited by 119 publications

(74 citation statements)

References 33 publications

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“…10,14,19,20,27,[38][39][40][41] Postoperative instability was defined variably across studies, including increase in sagittal translation between flexion-extension radiographs by 2 mm, 1,8,14 3 mm, 16 5 mm, 47 5%, 21 or 8%, 19 or an increase in sagittal angulation by more than 15° between flexion and extension. 41 Reoperation rates were considered positive if the procedure was explicitly cited to be a fusion for instability, although studies rarely stated the specific indication motivating such fusion.…”

Section: Study Characteristicsmentioning

confidence: 99%

Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts

Guha

Heary

Shamji

2015

FOC

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OBJECT Decompression without fusion for degenerative lumbar stenosis is an effective treatment for both the pain and disability of neurogenic claudication. Iatrogenic instability following decompression may require further intervention to stabilize the spine. The authors review the incidence of postsurgical instability following lumbar decompression, and assess the impact of surgical technique as well as study design on the incidence of instability. METHODS A comprehensive literature search was performed to identify surgical cohorts of patients with degenerative lumbar stenosis, with and without preexisting spondylolisthesis, who were treated with laminectomy or minimally invasive decompression without fusion. Data on patient characteristics, surgical indications and techniques, clinical and radiographic outcomes, and reoperation rates were collected and analyzed. RESULTS A systematic review of 24 studies involving 2496 patients was performed, assessing both open laminectomy and minimally invasive bilateral canal enlargement. Postoperative pain and functional outcomes were similar across the various studies, and postoperative radiographie instability was seen in 5.5% of patients. Instability was seen more frequently in patients with preexisting spondylolisthesis (12.6%) and in those treated with open laminectomy (12%). Reoperation for instability was required in 1.8% of all patients, and was higher for patients with preoperative spondylolisthesis (9.3%) and for those treated with open laminectomy (4.1%). CONCLUSIONS Instability following lumbar decompression is a common occurrence. This is particularly true if decompression alone is selected as a surgical approach in patients with established spondylolisthesis. This complication may occur less commonly with the use of minimally invasive techniques; however, larger prospective cohort studies are necessary to more thoroughly explore these findings.

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Section: Study Characteristicsmentioning

confidence: 99%

Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts

Guha

Heary

Shamji

2015

FOC

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“…Since this pathology occurs mainly in elderly patients, comorbidities are commonly present, with increasing perioperative risk in the case of fusion surgery. To avoid these risks, less invasive surgical therapies such as decompression alone have been advocated, especially in the face of predominantly stenotic or radiating pain symptoms [8,23].…”

Section: Introductionmentioning

confidence: 99%

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

et al. 2011

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Introduction Clinical symptoms in lumbar degenerative spondylolisthesis (LDS) vary from predominantly radiating pain to severe mechanical low back pain. We examined whether the outcome of surgery for LDS varied depending on the predominant baseline symptom and the treatment administered [decompression with fusion (D&F) or decompression alone (D)]. Methods 213 consecutive patients (69 ± 9 years; 155f, 58 m) participated. Inclusion criteria were LDS, maximum three affected levels, no previous surgery at the affected level, and D (N = 56) or D&F (N = 157) as the operative procedure. Pre-op and at 12 months' follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI) including 0-10 leg-pain (LP) and LBP scales. At 12 months' FU, patients rated global outcome which was then dichotomised into ''good'' and ''poor''. Results Pre-operatively, LBP and COMI scores were significantly worse (p \ 0.05) in the D&F group than in the D group. The improvement in COMI at 12 months' FU was significantly greater for D&F than for D (p \ 0.001) and was not influenced by the patient's declared ''main problem'' at baseline (back pain, leg pain, or neurological disturbances) (p [ 0.05). There was a higher proportion (p = 0.01) of ''good'' outcomes at 12 months' FU in D&F (86%) than in D (70%). Multiple regression analysis, controlling for possible confounders, revealed treatment group to be the only significant predictor of outcome (adding fusion = better outcome). DiscussionOur study indicated that LDS patients showed better patient-based outcome with instrumented fusion and decompression than with decompression alone, regardless of baseline symptoms. This may be due to the fact that the underlying slippage as the cause of the stenosis is better addressed with fusion.

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“…A unilateral approach for bilateral spinal canal decompression using a microscope or a microendoscope has been reported as one such effective strategy, and is less invasive than conventional decompression surgery. This surgery can often preserve not only central spinal structures, including spinous processes and interspinal ligaments, but also the paravertebral muscles and facet joints on the unapproached side [7,21,24]. On the other hand, Hatta et al [17] reported a muscle-preserving interlaminar decompression technique that can minimize damage to posterior stabilizing structures, such as the intervertebral facet joints, paravertebral muscles, dorsolumbar fascia, supra-and interspinous ligaments, while preserving the function of the spinous processes as lever arms for lumbar extension.…”

Section: Discussionmentioning

confidence: 99%

Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF

et al. 2013

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Purpose Adjacent segment degeneration (ASD) is one of the major complications of lumbar fusion. Several previous retrospective studies reported ASD after PLIF. However, few reports evaluated whether decompression surgery combined with fusion surgery increases the rate of complications in adjacent segments. The purpose of the current study was to investigate the degeneration in decompressed adjacent segments after PLIF. Methods A total of 23 patients (12 men, 11 women; average age, 58.6) who underwent PLIF surgery [1 level (n = 9), 2 levels (n = 8), 3 levels (n = 4), 4 levels (n = 2)] were included. Additional adjacent decompression above or below the level of interbody fusion was performed at 25 levels and no adjacent decompression was performed at 15 levels. We retrospectively investigated ASD by X-ray films of all 40 adjacent segments (above and below fusion level) and clinical outcomes of all 23 cases.Results Of the 40 adjacent segments, 19 (47.5 %) showed ASD and 9 (22.5 %) showed symptomatic ASD. In the 19 segments with ASD, ASD occurred in 16 of 25 (64.0 %) segments at decompressed sites compared with 3 of 15 (20.0 %) non-decompressed sites. The ratio of ASD in adjacent segments was significantly higher at decompressed sites than at non-decompressed sites (p \ 0.01). Conclusion ASD occurs frequently in association with additional decompression above or below the level of PLIF. In cases in which the adjacent segments require decompression, a surgical strategy that preserves as much of the posterior complex as possible should be selected.

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Success and Failure of Minimally Invasive Decompression for Focal Lumbar Spinal Stenosis in Patients With and Without Deformity

Cited by 119 publications

References 33 publications

Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts

Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF

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