Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection

Lewandrowski, Kai‐Uwe

doi:10.1016/j.clineuro.2018.07.015

Cited by 40 publications

(22 citation statements)

References 47 publications

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“…The procedural details employed by the authors have been described elsewhere. 1,2,17,18,53,54 All patients sought out the endoscopic spine surgeons who authored this study and provided informed consent. Patients were matched to age, gender, and diagnosis to avoid the introduction of additional confounding factors or unforeseen biases.…”

Section: Patientsmentioning

confidence: 99%

“…cation systems 55,56,57,58 previously employed by the authors. 17,53,54,59 In short, lumbar neuroforaminal height of 15 mm or less and a reduced neuroforaminal width (measured on the sagittal MRI cuts), lateral recess height of 3 mm or less (measured on the axial MRI cuts), and posterior intervertebral disc height of 3 or less were graded as abnormal. 58 Patients with multilevel disease were considered for additional interventional workup using a transforaminal selective nerve root block protocol described elsewhere to determine the most symptomatic level best suited for the transforaminal endoscopic decompression procedure.…”

Section: Inclusion/exclusion and Radiographic Criteriamentioning

confidence: 99%

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Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Lewandrowski

Carvalho

et al. 2020

Int J Spine Surg

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Background: Patient-reported outcome measures (PROMs) have become widely used to better measure patients' judgment of treatment benefits from surgical spine care. The concept of determining the minimal clinically important differences (MCIDs) of PROMs is aimed at assessing the benefits of lumbar spine care that are meaningful to the patient. The goal of this study was to validate the utility of MCIDs of the visual analog score (VAS) and Oswestry Disability Index (ODI) in patients with sciatica-type low back and leg pain due to lateral recess and foraminal stenosis who were treated with directly visualized transforaminal outpatient endoscopic decompression. Methods: The retrospective study population consisted of 406 patients on whom PROMs were obtained preoperatively, and again postoperatively at final follow-up. Employing an anchor-based approach with a patient satisfaction index based on the modified Macnab criteria, a receiver operating characteristics (ROC) and area under the curve (AUC) analysis was performed using IBM SPSS 25.0 to define the optimal MCID in VAS and ODI with the transforaminal endoscopy using the top-left-corner criteria and the Youden index. Improvements in walking endurance were recorded as an additional parameter of patient functioning and correlated with PROMs to test for statistical significance. Results: The patients' average age was 41.08 years, ranging from 30 to 84 years. The mean follow-up was 33.59 months, ranging from 24 to 85 months, with a standard deviation of 12.79. The MCIDs for VAS and ODI were 2.5 to 3.5 and 15 to 16.5, respectively. Patients were dichotomized as improved (377/406; 92.9%) if they reported excellent (224/406; 55.2%), good (112/406; 27.6%), and fair (41/406; 10.1%) Macnab outcomes. Patients were dichotomized as failed if they reported poor (29/406; 7.1%) Macnab outcomes. Preoperatively, only 32.5% (132/406) of patients had unlimited walking endurance compared to 77.6% (315/406) of patients postoperatively. The ROC and AUC analysis showed better accuracy with the single-integer VAS score (0.926) than with the 10-item ODI score (0.751). Conclusions: Transforaminal outpatient endoscopic decompression for symptomatic foraminal and lateral recess stenosis is an effective surgical treatment to alleviate sciatica-type and back symptoms in 92.9% of patients. Of the PROMs analyzed, the VAS provided a more meaningful and accurate reflection of patients' interpretation of outcome with the transforaminal endoscopic spinal decompression procedure than ODI. Understanding which patient expectations drive these MCIDs may aid in replacing open surgeries for sciatica-type low back and leg pain currently preferred by traditional spine surgeons with a personalized early-staged transforaminal endoscopic hybrid decompressive/ablative procedures favored by the authors. These may prove more cost effective by focusing on significant pain generators validated with a diagnostic interventional workup instead of employing image-based indication criteria for surgery.

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Section: Patientsmentioning

confidence: 99%

Section: Inclusion/exclusion and Radiographic Criteriamentioning

confidence: 99%

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Lewandrowski

Carvalho

et al. 2020

Int J Spine Surg

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“…The staged management approach 10 advocated for by the authors leads to highest patients' satisfaction with their clinical outcomes particularly when the final determination of the plan of care of their multilevel degenerative lumbar spine process is a shared decision between patient and provider based on a complex analysis of each patient' s painful patho-anatomy. 16,19,[49][50][51][52][53]…”

Section: Discussionmentioning

confidence: 99%

Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note

Lewandrowski

Yeung

2020

Neurospine

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This study aimed to showcase the authors' preferred technique of a hybrid of modern "inside-out" and "outside-in" endoscopic decompression. A case series of 411 patients consisting of 192 females (46.7%) and 219 males (53.3%) with an average age of 54.84 ± 16.32 years and an average of 43.2 ± 26.53 months are presented. Patients underwent surgery for low-grade spondylolisthesis (13 of 411, 3.2%), herniated disc (135 of 411, 32.8%), foraminal spinal stenosis (101 of 411, 24.6%), or a combination of the latter 2 conditions (162 of 411, 39.4%). The preoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) for leg pain were 49.8 ± 17.65 and 7.9 ± 1.55, respectively. Postoperative ODI and VAS leg were 12.2 ± 9.34 and 2.41 ± 5 1.55 at final follow-up (p < 0.0001). MacNab outcomes were excellent in 134 (32.6%), good in 228 (55.5%), fair in 40 (9.7%), and poor in 9 patients (2.2%), respectively. There was end-stage degenerative vacuum disc disease in 304 of the 411 patients (74%) of which had 37.5% had excellent and 50% good MacNab outcomes. Patients without vacuum discs had excellent and good 18.7% and 71.0% of the time. Direct visualization of pain generators in the epidural-and intradiscal space is the authors' preferred transforaminal decompression technique and is supported by their reliable clinical outcomes.

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“…Other literature also support the use of 0.5 mL for the diagnosis of SNRB. [19][20][21] Thus, 0.5 mL of liquid medicine (0.25 mL of 1% lidocaine and 0.25 mL of betamethasone) was selected for blocking as well as for achieving good results.…”

Section: Discussionmentioning

confidence: 99%

Accurate location and minimally invasive treatment of lumbar lateral recess stenosis with combined SNRB and PTED

Yue

Shen

et al. 2019

J Int Med Res

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Objective To establish a management strategy for multi-segment lumbar lateral recess stenosis. Methods A retrospective study was performed in patients in whom suspected responsible nerve roots underwent sequential selective nerve root block (SNRB). Based on pain remission rate after blocking, the contribution of nerve root compression to symptoms was classified as absolutely (≥70%) or relatively (30–70%) responsible or non-responsible (<30%). Conservative treatment was continued if visual analogue scale (VAS) at 3 days after blocking a single nerve root or VAS at 3 days after blocking multiple nerve roots was ≥50%; otherwise, percutaneous transforaminal endoscopic discectomy (PTED) was performed. Pain and functional scores were evaluated on day 3, 6 months and 1 year after SNRB or PTED. Results Fifty-seven of 80 patients had a single absolutely responsible root, 20 had 2 responsible roots, and 3 had 3 responsible roots. Among them, 41, 10, and 1 patient underwent PTED, respectively. Both the PTED and conservative groups improved significantly in VAS remission rate and functional scores compared with admission. Moreover, the PTED group had a better VAS remission rate compared with the conservative group. Conclusion A combination of SNRB with PTED was effective for diagnosing and treating multi-segment lumbar lateral recess stenosis.

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Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection

Cited by 40 publications

References 47 publications

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note

Accurate location and minimally invasive treatment of lumbar lateral recess stenosis with combined SNRB and PTED

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