Does Additional Discectomy and the Degree of Dural Sac Compression Influence the Outcome of Decompressive Surgery for Lumbar Spinal Stenosis?

Abstract Purpose To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. Clinical trial registration The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

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55. Early deformity development following decompressive surgery for lumbar spinal stenosis

The Spine Journal ◽

10.1016/j.spinee.2020.05.158 ◽

2020 ◽

Vol 20 (9) ◽

pp. S26-S27

Author(s):

Arya Ahmady ◽

Zachary L. Gordon ◽

Louis Magdon ◽

Nicholas U. Ahn ◽

Christina W. Cheng ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompressive Surgery ◽

Lumbar Spinal

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Indications for fusion following decompression for lumbar spinal stenosis

Neurosurgical FOCUS ◽

10.3171/foc.1997.3.2.5 ◽

1997 ◽

Vol 3 (2) ◽

pp. E4 ◽

Cited By ~ 8

Author(s):

Mark W. Fox ◽

Burton M. Onofrio

Keyword(s):

Clinical Outcomes ◽

Elderly People ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompressive Surgery ◽

Common Condition ◽

Decompressive Laminectomy ◽

Degenerative Lumbar Spinal Stenosis ◽

Lumbar Spinal ◽

Better Than

Degenerative lumbar spinal stenosis is a common condition affecting middle-aged and elderly people. Significant controversy exists concerning the appropriate indications for fusion following decompressive surgery. The purpose of this report is to compare the clinical outcomes of patients who were and were not treated with fusion following decompressive laminectomy for spinal stenosis and to identify whether fusion was beneficial. The authors conclude that patients in whom concomitant fusion procedures were performed fared better than patients who were treated by means of decompression alone when evidence of radiological instability existed preoperatively.

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Comparative Study Between Uniportal Full-Endoscopic Interlaminar and Tubular Approach in the Treatment of Lumbar Spinal Stenosis: A Pilot Study

Global Spine Journal ◽

10.1177/2192568219878419 ◽

2020 ◽

Vol 10 (2_suppl) ◽

pp. 70S-78S

Author(s):

Angela Carrascosa-Granada ◽

Willian Velazquez ◽

Ralf Wagner ◽

Anwar Saab Mazzei ◽

Andrés Vargas-Jimenez ◽

...

Keyword(s):

Clinical Improvement ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Endoscopic Approach ◽

Endoscopic Technique ◽

Dural Sac ◽

Lumbar Spinal ◽

Endoscopic Group

Study Design: Multicenter, prospective, randomized, and double-blinded study. Objectives: To compare tubular and endoscopic interlaminar approach. Methods: Patients with lumbar spinal stenosis and neurogenic claudication of were randomized to tubular or endoscopic technique. Enrollment period was 12 months. Clinical follow up at 1, 3, 6 months after surgery with visual analogue scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiologic evaluation with magnetic resonance pre- and postsurgery. Results: Twenty patients were enrolled: 10 in tubular approach (12 levels) and 10 in endoscopic approach (11 levels). The percentage of enlargement of the spinal canal was higher in endoscopic approach (202%) compared with tubular approach (189%) but was not statistically significant ( P = .777). The enlargement of the dural sac was higher in endoscopic group (209%) compared with tubular group (203%) but no difference was found between the 2 groups ( P = .628). A modest significant correlation was found between the percentage of spinal canal decompression and enlargement of the dural sac ( r = 0.5, P = .023). Both groups reported a significant clinical improvement postsurgery. However, no significant association was found between the percentage of enlargement of the spinal canal or the dural sac and clinical improvement as determined by scales scores. Endoscopic group had lower intrasurgical bleeding ( P < .001) and lower disability at 6 months of follow-up than tubular group (p=0.037). Conclusions: In the treatment of lumbar spinal stenosis, endoscopic technique allows similar decompression of the spinal canal and the dural sac, lower intrasurgical bleeding, similar symptoms improvement, and lower disability at 6 months of follow-up, as compared with the tubular technique.

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The Risk of Getting Worse: Predictors of Deterioration After Decompressive Surgery for Lumbar Spinal Stenosis: A Multicenter Observational Study

World Neurosurgery ◽

10.1016/j.wneu.2015.05.055 ◽

2015 ◽

Vol 84 (4) ◽

pp. 1095-1102 ◽

Cited By ~ 31

Author(s):

Ulf S. Nerland ◽

Asgeir S. Jakola ◽

Charalampis Giannadakis ◽

Ole Solheim ◽

Clemens Weber ◽

...

Keyword(s):

Observational Study ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompressive Surgery ◽

Multicenter Observational Study ◽

Lumbar Spinal

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Degenerative central lumbar spinal stenosis: Is endoscopic decompression through bilateral transforaminal approach sufficient?

10.21203/rs.3.rs-25624/v2 ◽

2020 ◽

Author(s):

Bin Zhang ◽

Qingquan Kong ◽

Yuqing Yan ◽

Pin Feng

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Operation Time ◽

Decompression Surgery ◽

Cross Sectional ◽

Endoscopic Decompression ◽

Dural Sac ◽

Transforaminal Approach ◽

The Mean ◽

Lumbar Spinal

Abstract Background: At present, few percutaneous endoscopic transforaminal decompression surgery has been reported to solve central lumbar spinal stenosis (CLSS). Whether endoscopic decompression through lateral transforaminal approach decompression is sufficient for degenerative CLSS.Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through a bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.Results：All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dura tear and 3 cases of transient postoperative dysthesia. The cross sectional area of the dural sac was significantly enlargement at the last fellow up (74.28±13.08 mm2 vs.104.91±12.40 mm2, P=0.00).Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

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