Treatment of restenosis after lumbar decompression surgery: decompression versus decompression and fusion

Abstract

OBJECTIVE The aim of this study was to compare perioperative complications and postoperative outcomes between patients with lumbar recurrent stenosis without lumbar instability and radiculopathy who underwent decompression surgery and those who underwent decompression with fusion surgery. METHODS For this retrospective study, the authors identified 2606 consecutive patients who underwent posterior surgery for lumbar spinal canal stenosis at eight affiliated hospitals between April 2017 and June 2019. Among these patients, those with a history of prior decompression surgery and central canal restenosis with cauda equina syndrome were included in the study. Those patients with instability or radiculopathy were excluded. The patients were divided between the decompression group and decompression with fusion group. The demographic characteristics, numerical rating scale score for low-back pain, incidence rates of lower-extremity pain and lower-extremity numbness, Oswestry Disability Index score, 3-level EQ-5D score, and patient satisfaction rate were compared between the two groups using the Fisher’s exact probability test for nominal variables and the Student t-test for continuous variables, with p < 0.05 as the level of statistical significance. RESULTS Forty-six patients met the inclusion criteria (35 males and 11 females; 19 patients underwent decompression and 27 decompression and fusion; mean ± SD age 72.5 ± 8.8 years; mean ± SD follow-up 18.8 ± 6.0 months). Demographic data and perioperative complication rates were similar. The percentages of patients who achieved the minimal clinically important differences for patient-reported outcomes or satisfaction rate at 1 year were similar. CONCLUSIONS Among patients with central canal stenosis who underwent revision, the short-term outcomes of the patients who underwent decompression were comparable to those of the patients who underwent decompression and fusion. Decompression surgery may be effective for patients without instability or radiculopathy.

Early Readmission and Reoperation After Percutaneous Transforaminal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis: Incidence and Risk Factors

“…However, this process usually takes months to years. 36 Early reoperation is mainly attributed to surgical complications or untreated pre-existing degeneration, which may explain why the disc degeneration grade was not associated with early reoperation in this study.…”

Demographic predictors of treatments and surgical complications of lumbar degenerative diseases

“…However, these studies have low sample sizes <100. [ 36 - 38 ] One hypothesis for this increased in mortality with fusion is that patients requiring these surgeries were unhealthier overall, and thus had increased mortality when compared to decompression patients. Indications for fusion include traumatic causes, infection, tumor, and spinal disease causing instability, which may not be present in patients undergoing only decompression.…”

Recompression after percutaneous transforaminal endoscopic decompression for degenerative lumbar spinal stenosis: risk factors and outcomes of two different reoperation procedures

“…The risk factors for rLDH include obesity, age, disc height index, Modic changes, sagittal range of motion, and adjacent segment degeneration (11)(12)(13). However, the all-cause recompression of the spinal canal or nerve root after surgical treatment of DLSS, which accounts for 52.1%-100% of reoperation cases (14), has not been fully investigated. Haimoto (15) reported that a decrease in disc height or progression of disc wedging was a risk factor for recompression after microscopic decompression; however, the sample size was relatively small (7 in the recompression group).…”

“…Therefore, the treatment of recompression is more complicated. Although many studies have considered spinal fusion the optimal revision choice (19)(20)(21)(22), some clinicians support minimally invasive and non-fusion concepts to reduce surgical trauma (14,23), especially for those without lumbar instability. However, whether PTED can achieve better efficacy than traditional spinal fusion has not been determined.…”

“…Regarding rLDH, both PELD and traditional open surgery can achieve satisfactory outcomes ( 9 , 16 – 18 ). However, the causes of nerve root compression are more complex in patients with DLSS than those with only LDH, including herniated disc, residual ligament flavum, thickening of the facet joints, and scarring ( 14 ). Therefore, the treatment of recompression is more complicated.…”