Which is the most effective treatment for lumbar spinal stenosis: Decompression, fusion, or interspinous process device? A Bayesian network meta-analysis

Zhang, Yijian; Lu, Dongdong; Ji, Wei; He, Fan; Chen, Angela Carley; Yang, Huilin; Zhu, Xuesong

doi:10.1016/j.jot.2020.07.003

Cited by 12 publications

(9 citation statements)

References 40 publications

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“…A recent meta-analysis showed that the optimal choice for interventional treatments for lumbar spinal stenosis included non-fusion methods (such as decompression and an interspinous process device). In addition, it noted that the use of an interspinous process device had both a low incidence of complications and a high rate of reoperation [ 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Lumbar Stenosis Spinal Surgery-Associated Cerebrospinal Fluid Leak Without Headache: An Autobiographical Case Report

Cohen¹,

Dorros²

2022

Cureus

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Lumbar spinal stenosis, a narrowing of the spinal canal around the spinal neurovascular structures, is a common etiology for lower back and leg pain in older people. Sciatica, a frequent symptom of lumbar spinal stenosis, typically presents with sharp and/or aching pain that originates in the buttock, extends to the thigh, and radiates into the foot and toes; in addition, it can be accompanied by weakness of the associated lower extremity. In individuals with sciatica-related persistent symptoms or functional limitations or both, spinal decompression surgery may be necessary. A cerebrospinal fluid leak is a potential complication of lumbar spinal stenosis surgery; it is frequently--yet not always--accompanied by a postural headache. The cerebrospinal fluid leak can result from an intraoperative tear or postoperatively. Albeit a more common adverse event after body contouring surgery, seroma--a postoperative serous fluid collection that is usually detectable as a palpable or visible fluid wave on clinical examination--has also been observed as a complication following lumbar spinal stenosis surgery. A man who experienced an intra-operative accidental dural tear during lumbar spinal stenosis surgery is described. A large cerebrospinal fluid leak that involved both the laminectomy bed and the subcutaneous tissue of his back subsequently developed; the leak eventually presented as duro-cutaneous fistulas without headache. His doctors misinterpreted the cerebrospinal fluid leak as a seroma; this may have occurred since not only did the color of the persistent and continuously dripping fluid varied from being clear to slightly tinged pink, but also the patient never had a headache or any other symptoms associated with a cerebrospinal fluid leak. When his lower back was appropriately evaluated with magnetic resonance imaging, the diagnosis of a large cerebrospinal fluid leak was established. In conclusion, lumbar spinal stenosis back surgery can be associated with postoperative complications, including cerebrospinal fluid leak and--less frequently--seroma. However, following lumbar spinal stenosis surgery, the absence of a headache does not exclude the possibility of a cerebrospinal fluid leak. Also, the presence of fluid leaking from the surgical site after lumbar spinal stenosis back surgery should not only prompt the clinician to entertain the possibility of a surgery-associated cerebrospinal fluid leak but also to obtain additional diagnostic studies--such as magnetic resonance imaging--to establish the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Lumbar Stenosis Spinal Surgery-Associated Cerebrospinal Fluid Leak Without Headache: An Autobiographical Case Report

Cohen¹,

Dorros²

2022

Cureus

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“…Decompression and fusion is the main treatment option for lumbar degenerative disease. 1 The traditional pedicle screw (PS) fixation has been used in clinical practice for several years with excellent correction, spinal stability, and fusion results. PS fixation is the method of choice for surgical implantation in spine‐related diseases.…”

Section: Introductionmentioning

confidence: 99%

“…With the development of society and increase in the aging population, the number of patients with lumbar degenerative disease has been increasing annually. Decompression and fusion is the main treatment option for lumbar degenerative disease 1 . The traditional pedicle screw (PS) fixation has been used in clinical practice for several years with excellent correction, spinal stability, and fusion results.…”

Section: Introductionmentioning

confidence: 99%

The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study

Lin

Zheng

2023

Orthopaedic Surgery

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Objective Although cortical bone trajectory (CBT) screw fixation has been used for several years, the number of studies on its fusion effects is limited. Furthermore, several studies report conflicting outcomes. We aimed to compare the fusion rates and clinical efficacy of CBT screw fixation and pedicle screw (PS) fixation for L4‐L5 interbody fusion. Methods This study was a retrospective cohort control study. Patients with lumbar degenerative disease who underwent L4‐L5 oblique lumbar interbody fusion (OLIF) or posterior decompression using CBT screws between February 2016 and February 2019 were included. Patients in whom PS was used were matched for age, sex, height, weight, and BMI. Record the operation time, blood loss. All enrolled patients underwent lumbar CT imaging at one‐year follow‐up to evaluate the fusion rate. At the two‐year follow‐up the visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association scores (JOA) were used to identify symptom improvement. Independent t ‐test was used for the comparison, and score data were analyzed using the χ 2 and exact probability tests. Results A total of 144 patients with were included. All patients were followed‐up postoperatively for 25–36 months (average 32.42 ± 10.55 months). Twenty‐eight patients underwent OLIF and CBT screw fixation, 36 underwent OLIF and PS fixation, 32 underwent posterior decompression and CBT screw fixation, and 48 underwent posterior decompression and PS fixation. The fusion rates following CBT screw and PS fixations in OLIF were 92.86% (26/28) and 91.67% (33/36), respectively ( P = 1). The fusion rates following CBT screw and PS fixations in posterior decompression were 93.75% (30/32) and 93.75% (45/48), respectively ( P > 0.05). Regardless of OLIF or posterior decompression, there were no significant differences in the VAS, ODI, and JOA scores between patients treated with CBT and PS ( P > 0.05). Conclusion CBT screw fixation can achieve a satisfactory interbody fusion rate with a clinical efficacy similar to that of PS in patients with lumbar degenerative disease, regardless of whether OLIF or posterior decompression was performed.

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“… 4 Compared to decompression and fusion, IPD surgery has better pain relief and higher improvements in disability with a lower incidence of complications. 5 …”

Section: Introductionmentioning

confidence: 99%

Interspinous Process Devices Do Not Reduce Intervertebral Foramina and Discs Heights on Adjacent Segments

Krakowiak¹,

Rulewska²,

Rudaś³

et al. 2022

JPR

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Aim Interspinous process device (IPD) placement is an attractive treatment option for lumbar spinal and foraminal stenosis. The goal of the treatment is to release the stress on facets joints as well as decompress the nerve roots by enlarging the intervertebral foramina and narrowed canal recesses. Purpose To evaluate possible structural changes in the lumbar spine after implantation of an IPD on operated and adjacent segments. Patients and Methods Twenty-two patients were enrolled in the study. Preoperative MRI scans of the lumbar spine evaluated recess and foraminal stenosis prior to the application of an IPD. CT exams were performed and morphometric measurements were made to assess the size of intervertebral foramina after implantation on the operated and adjacent segments. Results Statistically significant enlargements in diameter and surface area of the intervertebral foramen were seen at the operating level. On the right and left sides, foraminal enlargement after the procedure was 1 mm in diameter. The average enlargement of the foramina surface area at the level of implantation was 10 mm 2 . The median interspinous distance was significantly enlarged by 3.5 mm. No significant changes in adjacent segments were observed. Clinical improvement was confirmed by the Oswestry Disability Index (ODI) and visual analog scale (VAS). Preoperative disability was reduced (mean ODI from 70.5 (12.25) to 49.5 (23.75)), as well as back pain (mean VAS from 8.0 (1.7) to 4.4 (2.6)) and pain in lower limbs (mean VAS from 7.4 (1.9) to 3.8 (2.9)). Conclusion Decompression surgery using an IPD is effective in the treatment of lumbar foraminal and canal stenosis. It provides relief of symptoms in short-term observation through enlargement of intervertebral foramina and decompression of neural roots. It reduces overload of facet joints of the operated segment and does not decrease the size of the intervertebral foramina and disc heights of adjacent segments.

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Which is the most effective treatment for lumbar spinal stenosis: Decompression, fusion, or interspinous process device? A Bayesian network meta-analysis

Cited by 12 publications

References 40 publications

Lumbar Stenosis Spinal Surgery-Associated Cerebrospinal Fluid Leak Without Headache: An Autobiographical Case Report

Lumbar Stenosis Spinal Surgery-Associated Cerebrospinal Fluid Leak Without Headache: An Autobiographical Case Report

The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study

Interspinous Process Devices Do Not Reduce Intervertebral Foramina and Discs Heights on Adjacent Segments

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