Concomitant back pain as a predictor of outcome after single level lumbar micro-decompressive surgery – A study of 995 patients

OBJECTIVE: The objective of the study was to compare between the conventional discectomy and the interbody fusion with bilateral pedicular screw fixation in the management of single level lumbar disk herniation. METHODS: This is a prospective study done on 50 patients (25 in each group) at Cairo University Hospitals in the period between October 2018 and June 2019 fulfilling the inclusion criteria. Diagnosis was made clinically with history (low back pain and sciatica),examination (motor power assessment, straight leg raising test), and radiological findings (MRI, CT and X-ray lumbar spine). The pain status (VAS) was pre and postoperatively evaluated and followed up every 3 months for 1 year. RESULTS: The study included 50 patients (25 in each group) (mean age 40.4 years old) with slight female predominance. The most common clinical findings presented at diagnosis were low back pain followed by lower limb pain in the form of claudication and sciatica. L5-S1 disk prolapse was the most common level affected in both groups followed by L4-5 level. Regarding the clinical outcome, there was statistical significance in the VAS of low back pain at 9 months and 1-year follow-up favoring the fusion group with mean VAS 0.40 and 1.32 (p < 0.05). CONCLUSION: Clinical outcome was excellent in both groups. However, the reduction in low back pain after surgery was greater in the fusion group (p < 0.05). The rate of recurrent disk herniation at the surgical level in the nonfusion group was higher, but intraoperative blood loss, operation time, length of hospital stay, and total cost of procedure were all less in the patients undergoing discectomy alone. Although there is still controversy regarding the pros and cons of fusion in association with disk excision without instability, fusion results were highly favorable.

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Interspinous process device versus conventional decompression for lumbar spinal stenosis: 5-year results of a randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/2021.8.spine21419 ◽

2021 ◽

pp. 1-9

Keyword(s):

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Reoperation Rate ◽

Decompressive Surgery ◽

Long Term Results ◽

Long Term Follow Up ◽

Lumbar Spinal

OBJECTIVE Interspinous process distraction devices (IPDs) can be implanted to treat patients with intermittent neurogenic claudication (INC) due to lumbar spinal stenosis. Short-term results provided evidence that the outcomes of IPD implantation were comparable to those of decompressive surgery, although the reoperation rate was higher in patients who received an IPD. This study focuses on the long-term results. METHODS Patients with INC and spinal stenosis at 1 or 2 levels randomly underwent either decompression or IPD implantation. Patients were blinded to the allocated treatment. The primary outcome was the Zurich Claudication Questionnaire (ZCQ) score at 5-year follow-up. Repeated measurement analysis was applied to compare outcomes over time. RESULTS In total, 159 patients were included and randomly underwent treatment: 80 patients were randomly assigned to undergo IPD implantation, and 79 underwent spinal bony decompression. At 5 years, the success rates in terms of ZCQ score were similar (68% of patients who underwent IPD implantation had a successful recovery vs 56% of those who underwent bony decompression, p = 0.422). The reoperation rate at 2 years after surgery was substantial in the IPD group (29%), but no reoperations were performed thereafter. Long-term visual analog scale score for back pain was lower in the IPD group than the bony decompression group (p = 0.02). CONCLUSIONS IPD implantation is a more expensive alternative to decompressive surgery for INC but has comparable functional outcome during follow-up. The risk of reoperation due to absence of recovery is substantial in the first 2 years after IPD implantation, but if surgery is successful this positive effect remains throughout long-term follow-up. The IPD group had less back pain during long-term follow-up, but the clinical relevance of this finding is debatable.

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Multidirectional Flexibility of the Spine Following Posterior Decompressive Surgery After Single-Level Cervical Disc Arthroplasty

Spine ◽

10.1097/brs.0b013e3181f06ca8 ◽

2010 ◽

Vol 35 (25) ◽

pp. E1465-E1471 ◽

Cited By ~ 4

Author(s):

Jun Kikkawa ◽

Bryan W. Cunningham ◽

Osamu Shirado ◽

Nianbin Hu ◽

Paul C. McAfee ◽

...

Keyword(s):

Decompressive Surgery ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Single Level

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Comparison of Single-Level Open and Minimally Invasive Transforaminal Lumbar Interbody Fusions Presenting a Learning Curve

BioMed Research International ◽

10.1155/2020/3798537 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Viktor Zs. Kovari ◽

Akos Kuti ◽

Krisztina Konya ◽

Istvan Szel ◽

Anna K. Szekely ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Blood Transfusion ◽

Blood Loss ◽

Minimally Invasive ◽

Learning Curve ◽

Operative Time ◽

Leg Pain ◽

Low Back ◽

Single Level

Background. Comparison of single-level open and minimally invasive transforaminal lumbar interbody fusions (O-TLIF and MI-TLIF) of a single surgeon and presentation of his MI-TLIF learning curve in a retrospective observational cohort study. Methods. 27 MI-TLIF and 31 O-TLIF patients, performed between 03/01/2013 and 03/31/2018, were compared regarding the operative time, blood loss, blood transfusion frequency, postoperative length of stay (LOS), and adverse events. An overall comparison of pre- and postoperative Oswestry Disability Index (ODI) results and Visual Analog Score (VAS) results of low back and leg pain was performed in the case of the two techniques. For a learning curve presentation, the MI-TLIF cases were compared and the optimal operative time was determined. Results. The gender ratio and age did not differ in the groups. Operative time showed no difference (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P≤0.001) in the MI-TLIF group (288.9 ± 339.8 mL) than in the O-TLIF group (682.3 ± 465.4 mL) while the incidence of blood transfusion was similar (P=0.64). The MI-TLIF group had shorter LOS (2.7 ± 1.1 days vs. 5 ± 2.7, P≤0.001). The frequencies of the surgical site infections (SSI), durotomy, new motor, and sensory deficit were not significantly different (P=0.17, 0.5, 0.29, 0.92). All the ODI, the VAS low back pain, and the VAS leg pain scores improved in both groups significantly (P≤0.001, P≤0.001, and P≤0.001 in the MI-TLIF group and P≤0.001, P≤0.001, and P≤0.001 in the O-TLIF group). The comparison of the pre- and postoperative results of the ODI and VAS questionnaires of the two techniques showed no significant difference regarding the improvement of these scores (MI-TLIF versus O-TLIF pre- and postoperative ODI difference p=0.64, VAS low back pain P=0.47, and VAS leg pain P=0.21). Assessing the MI-TLIF learning curve, operative time was shortened by 63 minutes (P=0.04). After the 14th MI-TLIF case, the surgical duration became relatively constant. Comparing the 14th and previous MI-TLIF cases to the later cases, LOS showed reduction by 1.03 days (P=0.01), while the other parameters did not show significant changes. Conclusions. Similar operative time and postoperative quality of life improvement can be achieved by MI-TLIF procedure as with O-TLIF, and additionally LOS and blood loss can be reduced. When comparing parameters, MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. The learning curve of MI-TLIF can be steep, although it depends on the circumstances.

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Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

10.21203/rs.3.rs-18785/v1 ◽

2020 ◽

Author(s):

Jia Li ◽

Di Zhang ◽

Yong Shen ◽

Xiangbei Qi

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Degenerative Disease ◽

Leg Pain ◽

Low Back ◽

Lumbar Degenerative Disease ◽

Single Level ◽

Vas Scores ◽

Oblique Lateral Interbody Fusion

Abstract Background: The objective of the retrospective study was to investigated the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion(OLIF).Methods: In this retrospective study, 120 patients who undergoing single-level OLIF to treat lumbar degenerative disease were recruited. Preoperative and postoperative radiographic parameters, including segmental lordosis(SL), lumbar lordosis(LL), disk height(DH), pelvic incidence(PI), pelvic tilt (PT), sacral slope(SS), thoracic kyphosis(TK), C7-sagittal vertical axis (SVA). Visual analog scale(VAS) for back and leg pain, and Oswestry Disability Index(ODI), were used to evaluate symptoms and quantify disability. All patients achieved at least two-year follow-up.Results: A total of 120 Patients who complained low back pain were apportioned to LBP group (n=38; VAS scores for back pain≥3) or Non-LBP group (n=82;VAS scores for back pain＜3). There was no difference in age(P=0.082), gender(P=0.425), body mass index(P=0.138), degenerative spondylolisthesis or lumbar spinal stenosis(P=0.529) surgical level(P=0.651), blood Loss (P=0.889) and operative time(P=0.731) between the groups. In both groups, the ODI and VAS scores for back pain and leg pain were significantly improved at the final follow-up compared to the preoperative scores (P=0.003). Furthermore, except for the LBP (P=0.000), there were no significant differences in these scores between the two groups at the final follow-up (P > 0.05). According to the radiographic parameters, in Non-LBP group, the LL, SL, DH, TK and SS had all significantly improved; PT and C7-SVA significantly decreased at the final follow-up compared to the preoperative values. The DH in both groups had significantly improved, no significant difference was found(P=0.325). In the final follow-up, LL, PI-LL, PT and C7-SVA in Non-LBP group had more improvements compared to the LBP group (P＜0.05) . Multivariate analysis showed that PT, PI-LL and C7-SVA were identified as significant risk factors for LBP after OLIF.Conclusion: The clinical outcomes of OLIF for single-level lumbar degenerative disease were satisfactory. Our findings showed that PT, PI-LL mismatch and C7-SVA had the greatest impact on the incidence of LBP. Therefore, patients with appropriate decreased PT, improved C7-SVA and PI-LL match experienced less low back pain.

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Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery

Neurosurgical FOCUS ◽

10.3171/2019.2.focus197 ◽

2019 ◽

Vol 46 (5) ◽

pp. E9 ◽

Cited By ~ 17

Author(s):

Dong Hwa Heo ◽

Dong Chan Lee ◽

Choon Keun Park

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Endoscopic Surgery ◽

Operation Time ◽

Endoscopic Approach ◽

Decompressive Surgery ◽

Leg Pain ◽

Vas Score ◽

Canal Stenosis ◽

Endoscopic Group

OBJECTIVERecently, minimally invasive unilateral laminotomy with bilateral decompression (ULBD) has been performed for lumbar stenosis using endoscopic approaches. The object of this retrospective study was to compare the clinical and radiological outcomes of three types of minimally invasive decompressive surgery: microsurgery, percutaneous uniportal endoscopic surgery, and percutaneous biportal endoscopic surgery.METHODSIn the period from March 2016 to December 2017, minimally invasive ULBD was performed using microscopy, a uniportal endoscopic approach, or a biportal endoscopic approach to treat lumbar canal stenosis. Patients were classified into three groups based on the surgery they had undergone. The angle of medial facetectomy area and postoperative dural expansion were measured using MR images. The visual analog scale (VAS) score for leg and back pain, Oswestry Disability Index (ODI), operation time, and complications were assessed. Clinical and radiological parameters were compared among the three groups.RESULTSThere were 33 patients in the microscopy group, 37 in the biportal endoscopy group, and 27 in the uniportal endoscopy group. Preoperatively stenotic dural areas were significantly expanded in each of the three groups after surgery (p < 0.05). Mean dural expansion in the uniportal endoscopy group was significantly lower than that in the microscopy or biportal endoscopy group (p < 0.05). The mean angle of the facetectomy in the biportal endoscopic group was significantly lower than that in the microscopic group or uniportal endoscopic group (p < 0.05). On the 1st day after surgery, the VAS score for back pain was significantly higher in the microscopic group than in the uniportal or biportal endoscopic group (p < 0.05). However, there were no significant differences in the VAS score for back pain, VAS score for leg pain, or ODI at the final follow-up among the three groups (p > 0.05).CONCLUSIONSAlthough radiological results were different among the three groups of patients, postoperative clinical outcomes were significantly improved after each type of surgery. The percutaneous biportal or uniportal endoscopic approach offers the advantage of reduced immediate postoperative pain. A percutaneous uniportal or biportal endoscopic lumbar approach may be effective for the treatment of lumbar central stenosis and an alternative to conventional microsurgical decompression.

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Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy

Journal of Neurosurgery Spine ◽

10.3171/2010.10.spine10190 ◽

2011 ◽

Vol 14 (2) ◽

pp. 261-267 ◽

Cited By ~ 87

Author(s):

Kaisorn L. Chaichana ◽

Debraj Mukherjee ◽

Owoicho Adogwa ◽

Joseph S. Cheng ◽

Matthew J. McGirt

Keyword(s):

Quality Of Life ◽

Back Pain ◽

Oswestry Disability Index ◽

Lumbar Discectomy ◽

Leg Pain ◽

Somatic Anxiety ◽

Single Level ◽

Sf 36

Object Lumbar discectomy is the most common surgical procedure performed in the US for patients experiencing back and leg pain from herniated lumbar discs. However, not all patients will benefit from lumbar discectomy. Patients with certain psychological predispositions may be especially vulnerable to poor clinical outcomes. The goal of this study was therefore to determine the role that preoperative depression and somatic anxiety have on long-term back and leg pain, disability, and quality of life (QOL) for patients undergoing single-level lumbar discectomy. Methods In 67 adults undergoing discectomy for a single-level herniated lumbar disc, the authors determined quantitative measurements of leg and back pain (visual analog scale [VAS]), quality of life (36-Item Short Form Health Survey [SF-36]), and disease-specific disability (Oswestry Disability Index) preoperatively and at 6 weeks, 3, 6, and 12 months after surgery. The degree of preoperative depression and somatization was assessed using the Zung Self-Rating Depression Scale and a modified somatic perception questionnaire (MSPQ). Multivariate regression analyses were performed to assess associations between Zung Scale and MSPQ scores with achievement of a minimum clinical important difference (MCID) in each outcome measure by 12 months postoperatively. Results All patients completed 12 months of follow-up. Overall, a significant improvement in VAS leg pain, VAS back pain, Oswestry Disability Index, and SF-36 Physical Component Summary scores was observed by 6 weeks after surgery. Improvements in all outcomes were maintained throughout the 12-month follow-up period. Increasing preoperative depression (measured using the Zung Scale) was associated with a decreased likelihood of achieving an MCID in disability (p = 0.006) and QOL (p = 0.04) but was not associated with VAS leg pain (p = 0.96) or back pain (p = 0.85) by 12 months. Increasing preoperative somatic anxiety (measured using the MSPQ) was associated with decreased likelihood of achieving an MCID in disability (p = 0.002) and QOL (p = 0.03) but was not associated with leg pain (p = 0.64) or back pain (p = 0.77) by 12 months. Conclusions The Zung Scale and MSPQ are valuable tools for stratifying risk in patients who may not experience clinically relevant improvement in disability and QOL after discectomy. Efforts to address these confounding and underlying contributors of depression and heightened somatic anxiety may improve overall outcomes after lumbar discectomy.

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