Surgical therapy for lumbar spinal stenosis: evaluation of 300 cases

Çırak, Bayram; Alptekin, Mehmet; Palaoğlu, Selçuk; Özcan, Osman; Özgen, Tunçalp

doi:10.1007/pl00014585

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…The Spine Patient Outcomes Research Trial, the largest study of its kind, showed that patients with symptomatic spinal stenosis compared to those treated nonoperatively maintained greater improvement in pain and function through 4 years. Traditionally, standard decompressive procedures[ 8 9 10 ] involve total laminectomies and extensive removal of the accompanying spinous processes and posterior arches. However, microscopic interlaminar decompression involves focused decompression between adjacent laminae, with the spinous processes, and their attaching muscles kept intact.…”

Section: Discussionmentioning

confidence: 99%

Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression: An appraisal of prospectively collected patient outcomes

Khan

Bashir

Kumar

et al. 2015

J Craniovert Jun Spine

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Objectives:Our present study aims to assess the short and long-term postoperative outcome of microscopic interlaminar decompression from a neurosurgical center in a developing country and also aims to further determine any predictors of functional outcome.Materials and Methods:All patients with moderate to severe symptomatic stenosis undergoing elective posterior lumbar spinal decompression were prospectively enrolled in a database. Preoperative, 2 weeks and 2 years postoperative Oswestry Disability Index (ODI) scores were determined for all patients. These scores were retrospectively compared using repeated measures analysis of variance. Further, linear regression modelling was applied to determine the effect of preoperative ODI, body mass index, age, prior physiotherapy, duration of symptoms, and single or multiple level decompression on the change in ODI at 2 weeks and 2 years follow-up respectively.Results:A total of 60 consecutive patients (40 males, 20 females) were included for statistical analysis. The percentage of patients with a minimum clinically important difference (MCID), using an ODI threshold value of 10, was 86.7% (n = 52) at the 2 weeks postoperative follow-up. At the 2 years follow-up assessment, 3.3% (n = 2) patients who had earlier not achieved MCID did so, 78.3% (n = 47) of patients were found to have a change in ODI score of <10 or no change, while 18.3% (n = 11) reported a deterioration in their ODI scores. The preoperative ODI score was an independent predictor of change in ODI score at 2 weeks and 2 years respectively (P < 0.0005). The duration of symptoms prior to surgery was found to predict the change in ODI at 2 years follow-up (P = 0.04).Conclusion:The evidence regarding the long-term and short-term efficacy of microscopic interlaminar decompression in symptomatic lumbar stenosis is overwhelming. Preoperative ODI scores and duration of symptoms prior to surgery can predict postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression: An appraisal of prospectively collected patient outcomes

Khan

Bashir

Kumar

et al. 2015

J Craniovert Jun Spine

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“…14 Kalbarczyk and colleagues 13 performed a laminectomy accompanied by bilateral medial facetectomy in 70% of their patients with lumbar spinal stenosis. Cirak et al 6 concluded that in cases of lumbar spinal stenosis, decompressive laminectomy and extensive foraminotomy without instrumentation have good outcomes. Galiano and coworkers 10 showed that in the long term, decompressive laminectomies in selected octogenarians resulted in decreased disability, decline of analgesic use, and increased quality of life.…”

Section: Methods Of Decompression and Outcomementioning

confidence: 99%

“…Further long-term studies have demonstrated superior outcomes after surgery than after conservative management. 6 …”

Section: Conservative Versus Surgical Treatmentmentioning

confidence: 99%

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Morgalla¹,

Noak²,

Merkle³

et al. 2011

SPI

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Object For the treatment of lumbar spinal stenosis, less invasive procedures, which preserve maximal bony and ligamentous structures, have been recommended to reduce associated morbidity. The authors examined the outcome after decompression of spinal stenosis in the elderly by comparing 3 different surgical approaches. Their focus was whether a unilateral microsurgical decompression provided sufficient outcomes in the elderly population. Methods The authors investigated 108 elderly patients (age ≥ 60 years) with lumbar spinal stenosis (mean age 71 years [range 60–93 years]) who underwent surgery between 2004 and June 2006 at the authors' institution. Three different modes of decompression were analyzed in this study: a unilateral partial hemilaminectomy, a hemilaminectomy, and a laminectomy. The outcome was assessed 12 months postoperatively using the Quebec Back Pain Disability Scale and the Hannover Functional Back Pain Questionnaire. Results The authors performed a unilateral partial hemilaminectomy in 53 patients (49%). Patients who underwent unilateral partial hemilaminectomies achieved favorable results of at least 80% as assessed using the Quebec Back Pain Disability Scale and Hannover Functional Back Pain Questionnaire. Hemilaminectomies were performed in 45 patients (41.7%), and laminectomies were performed in 10 patients (9.3%). However, there was no statistically significant difference between the various techniques regarding the postoperative results (p < 0.05). Conclusions Laminectomies did not show any advantage when compared with unilateral transmedian approaches. A unilateral partial hemilaminectomy combined with a transmedian decompression sufficiently treated the stenosis. This method seemed advantageous in minimizing the procedure and associated morbidity in this elderly population. Further investigations with long-term results (> 5 years) are still necessary.

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“…The secondary development of degenerative changes that further narrow the lumbar spinal canal precipitated symptoms. 2 Lumbar spinal canal stenosis now is an accepted clinical entity. The symptoms and signs are due to narrow canal space.…”

Section: Introductionmentioning

confidence: 99%

Comparative study between functional outcome of lumbar canal stenosis treated with surgical decompression by laminectomy and unilateral partial hemi laminectomy approaches

Ramesh¹,

Vimalan²

2018

Int J Res Orthop

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Background: Lumbar spinal canal stenosis may eventually cause signs of intermittent neurogenic claudication. The surgical options include procedures such as midline decompression by laminectomy and different kinds of unilateral and bilateral fenestrations and partial or full hemi laminectomies. The aim of the study is to unilateral decompressive approach provides the sufficient decompression; less invasive unilateral procedure, which preserves posterior musculoligamentous complex and bony structures reduce associated morbidity.Methods: 41 patients underwent preoperative assessment of Japanese orthopaedic association score (JOA Score), Neurogenic claudication outcome scores (NCOS), visual analogy scale for back pain and neurogenic claudication. Patients were randomized to undergo either unilateral decompression by partial hemi laminectomy or CMD (CMD) by laminectomy. 20 patients was randomized into unilateral decompression by partial hemi laminectomy group and 21 patients into CMD (CMD) by laminectomy group.Results: The mean JOA recovery rate was 50.61% for the unilateral decompression group and 52.12% for the CMD group. Notably, 62% of CMD group had good or excellent outcome while 70% of unilateral decompression group had a good or excellent outcome.Conclusions: In our study, unilateral decompression by a partial hemi laminectomy provides minimal exposure for decompression in lumbar canal stenosis while preserving musculoligamentous attachments of the posterior elements of the spine and good postoperative results after one year with favorable outcomes of at least 70%.

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Surgical therapy for lumbar spinal stenosis: evaluation of 300 cases

Cited by 16 publications

References 19 publications

Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression: An appraisal of prospectively collected patient outcomes

Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression: An appraisal of prospectively collected patient outcomes

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Comparative study between functional outcome of lumbar canal stenosis treated with surgical decompression by laminectomy and unilateral partial hemi laminectomy approaches

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