Transforaminal Endoscopic Decompression for Lumbar Spinal Stenosis: A Novel Surgical Technique and Clinical Outcomes

2018 ◽  
Vol 114 ◽  
pp. e873-e882 ◽  
Author(s):  
Sang-Ha Shin ◽  
Jun-Seok Bae ◽  
Sang-Ho Lee ◽  
Han-Joong Keum ◽  
Ho-Jin Kim ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Endoscopic Decompression ◽  
Lumbar Spinal

scholarly journals The relationship between preoperative predictive factors for clinical outcome in patients operated for lumbar spinal stenosis by decompressive laminectomy

2020 ◽  
Vol 11 ◽  
pp. 27 ◽  
Author(s):  
Dobran Mauro ◽  
Davide Nasi ◽  
Riccardo Paracino ◽  
Mara Capece ◽  
Erika Carrassi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Predictive Factors ◽  
Antidepressant Drugs ◽  
Decompressive Laminectomy ◽  
Pain Anxiety ◽  
Pain Medications ◽  
Improved Outcomes ◽  
Lumbar Spinal

Background: Our hypothesis was that by identifying certain preoperative predictive factors, we could favorably impact clinical outcomes in patients undergoing decompressive surgery for lumbar spinal stenosis (LSS). Methods: In this retrospective study, there were 65 patients (2016–2018) with symptomatic LSS who underwent decompressive laminectomy without fusion. Their clinical outcomes were assessed utilizing the Oswestry Disability Index (ODI). Multiple preoperative variables were studied to determine which ones would help predict improved outcomes: gender, age, body mass index (BMI), general/neurological examination, smoking, and drug therapies (anxiolytics and/or antidepressants). Results: All patients demonstrated statistically significant improvement on the ODI. Multivariate analysis revealed that those with higher preoperative BMI had significantly lower ODI on 1-year follow-up examinations, reflecting poorer outcomes. Postoperatively, 44 patients (67%) exhibited lower utilization of anxiolytic medications, 52 patients (80%) showed reduced use of antidepressant drugs, and pain medications utilization was reduced in 33 patients (50%). Conclusion: Decompressive laminectomy without fusion effectively managed LSS. It reduced patients’ use of pain, anxiety, and antidepressant medications. In addition, we found that increased preoperative BMIs contributed to poorer postoperative outcomes (e.g., ODI values).

scholarly journals Indications for fusion following decompression for lumbar spinal stenosis

1997 ◽  
Vol 3 (2) ◽  
pp. E4 ◽  
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.

scholarly journals Revision decompression with fusion as a treatment for same level restenosis after laminotomy for lumbar spinal stenosis

2020 ◽  
Vol 27 (1) ◽  
pp. 3-9
Author(s):  
Zhuohao Chow Liang ◽  
Wing Ngai Yim ◽  
Chung Ting Martin Wong ◽  
Hung On Cheng ◽  
Ka Kin Cheung
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Revision Surgery ◽  
Japanese Orthopaedic Association ◽  
Japanese Orthopaedic Association Score ◽  
Leg Pain ◽  
Complication Rates ◽  
Salvage Procedure ◽  
Lumbar Spinal

Background/Purpose: Laminotomy is an established procedure to relieve symptoms of lumbar spinal stenosis. However, there is a group of patients with symptomatic recurrence. Re-decompression and fusion could be an effective salvage procedure but the results are seldom found in the literature. In this study, we focused on investigating the clinical outcomes and complication rates of revision decompression with fusion in this patient group. Methods: A retrospective study including patients who had undergone revision decompression with fusion for recurrent symptoms due to same level restenosis after primary laminotomy for lumbar spinal stenosis was performed. Patients with recurrent symptoms due to prolapsed intervertebral disc, trauma, infection, and neoplasm were excluded. Demographics, clinical outcomes, and complications were retrieved. Results: Twenty-eight patients with a total number of 42 levels of revision decompression and fusion were included. With a mean follow-up time of 27 months after revision surgery, there were statistically significant improvement of 63, 49, and 13% in Japanese Orthopaedic Association score, visual analog scale for leg pain, and Roland-Morris disability questionnaire score, respectively. There were 6(21%), 2(7%), 0(0%), and 2(7%) cases of dural tear, infection requiring reoperation, new neurological deficit, and other complications, respectively, in these revision cases. Conclusion: Bearing potential complications in mind, re-decompression with fusion is a viable option with reasonable clinical outcomes for patients with recurrent symptoms after laminotomy for lumbar spinal stenosis. As a treatment option for symptomatic lumbar spinal stenosis, primary laminotomy could have the potential benefit of lower complication rates in revision surgery.

scholarly journals Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

2019 ◽  
Vol 46 (5) ◽  
pp. E10 ◽  
Author(s):  
Siri Sahib Khalsa ◽  
Hyeun Sung Kim ◽  
Ravindra Singh ◽  
Osama Nezar Kashlan
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Facet Joint ◽  
Volumetric Analysis ◽  
Facet Joints ◽  
Bone Removal ◽  
Endoscopic Decompression ◽  
Radiographic Outcomes ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal

OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

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