In Reply to the Letter to the Editor Regarding “Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up”

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.

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Long-Term Outcomes of Surgical and Nonsurgical Management of Lumbar Spinal Stenosis: 8 to 10 Year Results from the Maine Lumbar Spine Study

Spine ◽

10.1097/01.brs.0000158953.57966.c0 ◽

2005 ◽

Vol 30 (8) ◽

pp. 936-943 ◽

Cited By ~ 375

Author(s):

Steven J. Atlas ◽

Robert B. Keller ◽

Yen A. Wu ◽

Richard A. Deyo ◽

Daniel E. Singer

Keyword(s):

Lumbar Spine ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Long Term Outcomes ◽

Nonsurgical Management ◽

Lumbar Spinal

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Mid-term changes in spinopelvic sagittal alignment in lumbar spinal stenosis with coexisting degenerative spondylolisthesis or scoliosis after minimally invasive lumbar decompression surgery: minimum 5-year follow-up

The Spine Journal ◽

10.1016/j.spinee.2021.11.012 ◽

2021 ◽

Author(s):

Hamidullah Salimi ◽

Hiromitsu Toyoda ◽

Hidetomi Terai ◽

Kentaro Yamada ◽

Masatoshi Hoshino ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Sagittal Alignment ◽

Degenerative Spondylolisthesis ◽

Decompression Surgery ◽

Lumbar Decompression ◽

Lumbar Spinal ◽

Lumbar Decompression Surgery

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Coflex Interspinous Process Dynamic Stabilization for Lumbar Spinal Stenosis: Long-term Follow-up

10.21203/rs.3.rs-22773/v1 ◽

2020 ◽

Author(s):

Mingrui Du ◽

Fei-Long Wei ◽

Kai-Long Zhu ◽

Cheng-Pei Zhou ◽

Ji-Xian Qian

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Dynamic Stabilization ◽

Adjacent Segment ◽

Imaging Data ◽

Process Dynamic ◽

The Difference ◽

Lumbar Spinal

Abstract [Objective]To evaluate the long-term efficacy of Coflex interspinous process dynamic stabilization device in the treatment of lumbar spinal stenosis.[Methods]The clinical and imaging data of 73 patients undergoing Coflex interspinous process dynamic stabilization surgery from July 2008 to June 2012 were retrospectively analyzed. Clinical data include: visual analogue scale of pain (VAS), Owestry disability index(ODI) and Japanese Orthopedic Association Scores(JOA) of preoperation, 6 months after surgery, and last follow-up; complications; reoperation rates and incidence of adjacent segment degeneration(ASD). Imaging data including: lumbar range of motion(ROM), intervertebral space height(ISH) and intervertebral foramen height (IFH) of operative and adjacent segment at preoperative, 6 months after operation and the last follow-up.[Results]56 patients were followed up. The follow-up time was 107.6 ± 13.3 months, the operation time was 10.0 ± 3.1 minutes, the intraoperative blood loss was 153.9 ± 80.6 ml, and the hospitalization time was 10.2 ± 3.2 days. The VAS, ODI and JOA scores improved significantly after surgery. At 6 months after surgery and the last follow-up, ROM was significantly lower than that before surgery with statistical significance (P < 0.001). ROM was slightly increased at the last follow-up compared with that 6 months after operation, but the difference was not statistically significant (P > 0.05). The ROM of adjacent segments increased at 6 months and at the last follow-up compared with that before surgery, but the difference was not statistically significant (P > 0.05). At 6 months after surgery, ISH and IFH of implanted segment was significantly higher than that before surgery, and the difference was statistically significant (P < 0.05). At the last follow-up, there was a decrease in ISH and IFH, with no statistical difference compared with that before the operation. During the follow-up period, a total of 11 patients (19.6%) experienced complications and 6 patients (10.7%) underwent secondary surgery.[Conclusion]Coflex interspinous process dynamic stabilization is effective in the treatment of lumbar spinal stenosis in the long term. The surgical segment retains a small range of motion. The incidence of complications and reoperation is low. However, the ISH and IFH of implanted segment can only be maintained for a short period of time.

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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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