Long-Term Clinical Outcome and Reoperation Rate for Microsurgical Bilateral Decompression via Unilateral Approach of Lumbar Spinal Stenosis

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.

Download Full-text

LONG-TERM RESULTS OF MICROSURGICAL TREATMENT OF LUMBAR SPINAL STENOSIS BY UNILATERAL LAMINOTOMY FOR BILATERAL DECOMPRESSION

Neurosurgery ◽

10.1227/01.neu.0000245616.32226.58 ◽

2006 ◽

Vol 59 (6) ◽

pp. 1264-1270 ◽

Cited By ~ 78

Author(s):

Markus F. Oertel ◽

Yu-Mi Ryang ◽

Marcus C. Korinth ◽

Joachim M. Gilsbach ◽

Veit Rohde

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Clinical Results ◽

Reoperation Rate ◽

Long Term Results ◽

Spinal Instability ◽

Long Term Follow Up ◽

Lumbar Spinal

Abstract OBJECTIVE Laminectomy and bilateral laminotomy are the standard procedures for decompression of lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, the technique of unilateral laminotomy for bilateral decompression (ULBD) was developed. However, limited follow-up data exist to determine the efficiency and outcome of ULBD. Therefore, the authors present their 10-year experience with ULBD and postoperative long-term results. METHODS One hundred thirty-three consecutive patients (73 men and 60 women; mean age, 63 yr) meeting clinical and radiographic criteria for LSS who underwent first-time ULBD between 1994 and 1999 entered the study. The study parameters were set to ensure a follow-up period of at least 4 years. All patients were available for short-term follow-up re-evaluation within 3 months, and 102 (77%) of the 133 patients were available for long-term examination after a mean duration of 5.6 years. The scale of Finneson and Cooper was used for evaluation of the clinical results. RESULTS One hundred thirty patients (97.7%) improved immediately after surgery. Ninety-four (92.2%) of the 102 patients available for long-term follow-up examination remained improved, and 85.3% had an excellent-to-fair operative result. The incidence of complications was 9.8%. Resurgery for complication was necessary in three patients, for restenosis in seven patients, and for spinal instability in two patients, accounting for a reoperation rate of 11.8%. CONCLUSION ULBD allows achievement of good and long-lasting operative results in patients with LSS. Postoperative deterioration, recurrences, and spinal instability are infrequent. For the authors, ULBD is the preferred technique to treat symptomatic LSS.

Download Full-text

Lumbar facet distraction and fixation in patients with lumbar spinal stenosis: Long-term clinical outcome and reoperation rates

Journal of Craniovertebral Junction and Spine ◽

10.4103/jcvjs.jcvjs_128_20 ◽

2020 ◽

Vol 11 (4) ◽

pp. 262

Author(s):

Giovanni Grasso ◽

Atul Goel

Keyword(s):

Clinical Outcome ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Spinal ◽

Reoperation Rates ◽

Lumbar Facet

Download Full-text

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

Journal of Neurosurgery Spine ◽

10.3171/2014.11.spine13597 ◽

2015 ◽

Vol 22 (4) ◽

pp. 339-352 ◽

Cited By ~ 56

Author(s):

Marjan Alimi ◽

Christoph P. Hofstetter ◽

Se Young Pyo ◽

Danika Paulo ◽

Roger Härtl

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Case Series ◽

Reoperation Rate ◽

Effective Procedure ◽

Functional Improvement ◽

Lumbar Spinal ◽

Reoperation Rates

OBJECT Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure, but minimally invasive laminectomy through tubular retractors is an alternative. The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of this procedure in patients who underwent LSS and to compare outcomes in patients with and without preoperative spondylolisthesis. METHODS Patients with LSS without spondylolisthesis and with stable Grade I spondylolisthesis who had undergone minimally invasive tubular laminectomy between 2004 and 2011 were included in this analysis. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, as well as Macnab's criteria. RESULTS Among 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. At a mean follow-up of 28.8 months, scoring revealed a median improvement of 16% on the ODI, 2.75 on the VAS back, and 3 on the VAS leg, compared with the preoperative baseline (p < 0.0001). The reoperation rate requiring fusion at the same level was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or reoperation rate. CONCLUSIONS Minimally invasive laminectomy is an effective procedure for the treatment of LSS. Reoperation rates for instability are lower than those reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be an alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis.

Download Full-text

A long-term (4- to 12-year) follow-up study of surgical treatment of lumbar spinal stenosis

European Spine Journal ◽

10.1007/s005860000161 ◽

2000 ◽

Vol 9 (6) ◽

pp. 563-570 ◽

Cited By ~ 43

Author(s):

M. Cornefjord ◽

G. Byröd ◽

H. Brisby ◽

B. Rydevik

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Follow Up Study ◽

Lumbar Spinal

Download Full-text

Improvement of Back and Leg Pain after Lumbar Spinal Decompression without Fusion

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1669473 ◽

2018 ◽

Vol 80 (02) ◽

pp. 081-087

Author(s):

Nicola Bongartz ◽

Christian Blume ◽

Hans Clusmann ◽

Christian Müller ◽

Matthias Geiger

Keyword(s):

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Leg Pain ◽

Short Term ◽

Clear Trend ◽

Long Term Follow Up ◽

Lumbar Spinal

Background To evaluate whether decompression in lumbar spinal stenosis without fusion leads to sufficient improvement of back pain and leg pain and whether re-decompression alone is sufficient for recurrent lumbar spinal stenosis for patients without signs of instability. Material and Methods A successive series of 102 patients with lumbar spinal stenosis (with and without previous lumbar surgery) were treated with decompression alone during a 3-year period. Data on pre- and postoperative back pain and leg pain (numerical rating scale [NRS] scale) were retrospectively collected from questionnaires with a return rate of 65% (n = 66). The complete cohort as well as patients with first-time surgery and re-decompression were analyzed separately. Patients were dichotomized to short-term follow-up (< 100 weeks) and long-term follow-up (> 100 weeks) postsurgery. Results Overall, both back pain (NRS 4.59 postoperative versus 7.89 preoperative; p < 0.0001) and leg pain (NRS 4.09 versus 6.75; p < 0.0001) improved postoperatively. The short-term follow-up subgroup (50%, n = 33) showed a significant reduction in back pain (NRS 4.0 versus 6.88; p < 0.0001) and leg pain (NRS 2.49 versus 6.91: p < 0.0001). Similar results could be observed for the long-term follow-up subgroup (50%, n = 33) with significantly less back pain (NRS 3.94 versus 7.0; p < 0.0001) and leg pain (visual analog scale 3.14 versus 5.39; p < 0.002) postoperatively. Patients with previous decompression surgery benefit significantly regarding back pain (NRS 4.82 versus 7.65; p < 0.0024), especially in the long-term follow-up subgroup (NRS 4.75 versus 7.67; p < 0.0148). There was also a clear trend in favor of leg pain in patients with previous surgery; however, it was not significant. Conclusions Decompression of lumbar spinal stenosis without fusion led to a significant and similar reduction of back pain and leg pain in a short-term and a long-term follow-up group. Patients without previous surgery benefited significantly better, whereas patients with previous decompression benefited regarding back pain, especially for long-term follow-up with a clear trend in favor of leg pain.

Download Full-text