Risk Factors for Negative Global Treatment Outcomes in Lumbar Spinal Stenosis Surgery: A Mixed Effects Model Analysis of Data from an International Spine Registry

OBJECT In this study, the authors aimed to identify specific risk factors for postdecompression lumbar disc herniation (PDLDH) in patients who have not undergone discectomy and/or fusion. METHODS Between 2007 and 2012, 493 patients with lumbar spinal stenosis underwent bilateral partial laminectomy without discectomy and/or fusion in a single hospital. Eighteen patients (herniation group [H group]: 15 men, 3 women; mean age 65.1 years) developed acute sciatica as a result of PDLDH within 2 years after surgery. Ninety patients who did not develop postoperative acute sciatica were selected as a control group (C group: 75 men, 15 women; mean age 65.4 years). Patients in the C group were age and sex matched with those in the H group. The patients in the groups were also matched for decompression level, number of decompression levels, and surgery date. The radiographic variables measured included percentage of slippage, intervertebral angle, range of motion, lumbar lordosis, disc height, facet angle, extent of facet removal, facet degeneration, disc degeneration, and vertebral endplate degeneration. The threshold for PDLDH risk factors was evaluated using a continuous numerical variable and receiver operating characteristic curve analysis. The area under the curve was used to determine the diagnostic performance, and values greater than 0.75 were considered to represent good performance. RESULTS Multivariate analysis revealed that preoperative retrolisthesis during extension was the sole significant independent risk factor for PDLDH. The area under the curve for preoperative retrolisthesis during extension was 0.849; the cutoff value was estimated to be a retrolisthesis of 7.2% during extension. CONCLUSIONS The authors observed that bilateral partial laminectomy, performed along with the removal of the posterior support ligament, may not be suitable for lumbar spinal stenosis patients with preoperative retrolisthesis greater than 7.2% during extension.

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Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

10.21203/rs.3.rs-1017167/v1 ◽

2021 ◽

Author(s):

frédérick rault ◽

Anaïs R Briant ◽

Thomas Gaberel ◽

Hervé Kamga ◽

Evelyne Emery

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Heart Diseases ◽

The Elderly ◽

Lumbar Spine Surgery ◽

Increased Risk ◽

History Of ◽

Lumbar Spinal

Abstract Introduction:Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to find confounding factors.Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded.Results996 patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC.ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

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The influence of catastrophising on treatment outcomes after surgery for lumbar spinal stenosis

The Bone & Joint Journal ◽

10.1302/0301-620x.97b11.36016 ◽

2015 ◽

Vol 97-B (11) ◽

pp. 1546-1554 ◽

Cited By ~ 9

Author(s):

H. J. Kim ◽

J. W. Park ◽

B. S. Chang ◽

C. K. Lee ◽

J. S. Yeom

Keyword(s):

Treatment Outcomes ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Spinal

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Response to the letter to the Editor: “The necessity and risk factors of subsequent fusion after decompression alone for lumbar spinal stenosis with lumbar spondylolisthesis: 5 years follow-up in two different large populations”

The Spine Journal ◽

10.1016/j.spinee.2021.01.005 ◽

2021 ◽

Vol 21 (4) ◽

pp. 725

Author(s):

Hikari Urakawa ◽

Sheeraz A Qureshi

Keyword(s):

Risk Factors ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Letter To The Editor ◽

Large Populations ◽

Lumbar Spinal ◽

Lumbar Spondylolisthesis

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Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

European Spine Journal ◽

10.1007/s00586-011-2101-2 ◽

2011 ◽

Vol 21 (5) ◽

pp. 825-828 ◽

Cited By ~ 45

Author(s):

Fredrik Strömqvist ◽

◽

Bo Jönsson ◽

Björn Strömqvist

Keyword(s):

Risk Factors ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Incidence Risk ◽

Lumbar Spinal

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Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis

BioMed Research International ◽

10.1155/2020/2453503 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Janan Abbas ◽

Natan Peled ◽

Israel Hershkovitz ◽

Kamal Hamoud

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Control Group ◽

Degenerative Lumbar Spinal Stenosis ◽

Lower Lumbar Spine ◽

Lumbar Spinal ◽

Lower Lumbar ◽

Facet Tropism

The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.

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Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04940-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ning Fan ◽

Shuo Yuan ◽

Peng Du ◽

Qichao Wu ◽

Tianyi Wang ◽

...

Keyword(s):

Risk Factors ◽

Spinal Stenosis ◽

Disc Degeneration ◽

Lumbar Spinal Stenosis ◽

Epidural Hematoma ◽

Univariate Analysis ◽

Dural Tear ◽

Site Infection ◽

Posterior Neck ◽

Lumbar Spinal

Abstract Background With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors. Methods Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test. Results The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications. Conclusion Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.

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