Radiologic Efficacy and Patient Satisfaction after Minimally Invasive Unilateral Laminotomy and Bilateral Decompression in Patients with Lumbar Spinal Stenosis: A Retrospective Analysis

2020 ◽  
Vol 81 (06) ◽  
pp. 475-483
Author(s):  
Seung-Kook Kim ◽  
Sungmo Ryu ◽  
Eun-Sang Kim ◽  
Sun-Ho Lee ◽  
Su-Chan Lee
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Minimally Invasive ◽  
Retrospective Analysis ◽  
Spinal Stenosis ◽  
Surgical Procedure ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal

Abstract Background and Study Aims Lumbar spinal stenosis (LSS) is the most common spinal disease in older adults. Although surgical modalities are recommended in patients who are unresponsive to conservative treatment, the most appropriate minimally invasive surgical procedure for patients with LSS remains controversial. Moreover, few previous studies have focused on patient-centered outcomes with radiologic correlation. In the present study, we aimed to investigate radiologic efficacy and patient satisfaction following bilateral decompression via unilateral laminotomy. Materials and Methods We performed a retrospective analysis of radiologic efficacy and patient satisfaction in a series of surgical patients treated at our institution. We classified patients into two groups based on the primary pathology (i.e., central or lateral recess stenosis). Medical records were analyzed retrospectively for radiologic outcomes and clinical parameters including pain and changes in quality of life. Data related to outcomes were collected at 2 weeks, 3 months, and 12 months after surgery in the outpatient clinic. Results Among the 122 patients enrolled in this study, 51 had central spinal stenosis; 71 had lateral recess stenosis. Radiologically, we observed significant improvements in the anteroposterior diameter and cross-sectional area of the dural sac (central stenosis) and the lateral width of the central canal and depth of the lateral recess (lateral recess stenosis). Two weeks and 12 months after the surgical procedure, we observed significant improvements in the extent of symptoms, patient satisfaction, and quality of life (including physical function). Conclusion Our findings suggest that bilateral decompression via a unilateral approach shows improved radiologic outcomes, varying based on the type of stenosis. Furthermore, patient satisfaction significantly improved regardless of the type of disease.

scholarly journals Revision surgery following minimally invasive decompression for lumbar spinal stenosis with and without stable degenerative spondylolisthesis: a 5- to 15-year reoperation survival analysis

2021 ◽  
pp. 1-7
Author(s):  
Nizar Moayeri ◽  
Y. Raja Rampersaud
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
The Mean ◽  
Lumbar Spinal ◽  
Reoperation Rates ◽  
Minimally Invasive Decompression

OBJECTIVE Minimally invasive decompression (MID) is an effective procedure for lumbar spinal stenosis (LSS). Long-term follow-up data on reoperation rates are lacking. The objective of this retrospective cohort study was to evaluate reoperation rates in patients with LSS who underwent MID, stratified for degenerative lumbar spondylolisthesis (DLS), with a follow-up between 5 and 15 years. METHODS All consecutive patients with LSS who underwent MID between 2002 and 2011 were included. All patients had neurogenic claudication from central and/or lateral recess stenosis, without or with up to 25% of slippage (grade I spondylolisthesis), and no obvious dynamic instability on imaging (increase in spondylolisthesis by ≥ 5 mm demonstrated on supine-to-standing or flexion-extension imaging). Reoperation rates defined as any operation on the same or adjacent level were assessed. Revision decompression alone was considered if the aforementioned clinical and radiographic criteria were met; otherwise, patients underwent a minimally invasive posterior fusion. RESULTS A total of 246 patients (mean age 66 years) were included. Preoperative spondylolisthesis was present in 56.9%. The mean follow-up period was 8.2 years (range 5.0−14.9 years). The reoperation rates in patients with and without spondylolisthesis were 15.7% and 15.1%, respectively; fusion was required in 7.1% and 7.5%, with no significant difference (redecompression only, p = 0.954; fusion, p = 0.546). For decompression only, the mean times to reoperation were 3.9 years (95% CI 1.8−6.0 years) for patients with DLS and 2.8 years (95% CI 1.3−4.2 years) for patients without DLS; for fusion, the mean times to reoperation were 3.1 years (95% CI 1.0−5.3 years) and 3.1 years (95% CI 1.1−5.1 years), respectively. CONCLUSIONS In highly selected patients with stable DLS and leg-dominant pain from central or lateral recess stenosis, the long-term reoperation rate is similar between DLS and non-DLS patients undergoing MIS decompression.

IMPACT OF MINIMALLY INVASIVE DECOMPRESSION SURGERY ON THE QUALITY OF LIFE OF PATIENTS WITH LUMBAR SPINAL STENOSIS – A 2 YEAR FOLLOW-UP STUDY

2017 ◽  
Vol 15 (3) ◽  
pp. 0-0
Author(s):  
Michał Kłosiński ◽  
Ewa Kucharska ◽  
Brandon Henry ◽  
Anna Jarzębska ◽  
Bendik Skinningsrud ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Decompression Surgery ◽  
Lumbar Region ◽  
Sf 36 ◽  
Lumbar Spinal ◽  
Minimally Invasive Decompression

Background: Lumbar spinal stenosis (LSS) may result in a progressive narrowing of the spinal canal leading to compression of the nerve roots. The advantages of minimally invasive surgical approaches to the lumbar spine have been rigorously evaluated, however, the long-term impact on the health-related quality-of-life (HRQoL) of patients with LSS that have undergone minimally invasive decompression surgery is uncertain. To this end, the aim of our study was to evaluate the impact of this procedure on the HRQoL of patients with LSS. Methods: Enrolled patients were recruited to this prospective study at two orthopedic centers in Krakow, Poland. Patients eligible for inclusion were above 18 years of age, had been qualified for spine surgery of the lumbar region due to either discopathy or non-traumatic spinal stenosis, had uni- or bilateral neurogenic claudication, and verified spinal stenosis. During the interview, each patient completed the Polish version of the SSSQ (P-SSSQ), SF-36, and a demographic data questionnaire. Apart from the preoperative assessment the patients were again approached to fill in the questionnaires 6, 12, 18, and 24 months postoperatively. Results: One hundred and seventy-one consecutive patients with a mean age of 59 years were included in the study. This study found that LSS decompression statistically significantly increases HRQoL in a 2-year observation. There was a significant difference between the preoperative and postoperative SF-36 and P-SSSQ scores. The largest increase in HRQoL is between the preoperative period and 6 months post-op (p<0.0001). Starting from around 18 months post-op, further changes in HRQoL are minimal. Late complications (persistent pain, the need for revision surgery) may decrease HRQoL at around 24 months post-op. Conclusions: Minimally invasive decompression surgery for elderly patients with LSS significantly improves their HRQoL

scholarly journals Prediction of walking ability following posterior decompression for lumbar spinal stenosis

2021 ◽  
Author(s):  
Suzanne McIlroy ◽  
Feroz Jadhakhan ◽  
David Bell ◽  
Alison Rushton
Keyword(s):  
Quality Of Life ◽  
Higher Education ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Walking Distance ◽  
Walking Ability ◽  
Poor Outcome ◽  
Lumbar Spinal ◽  
Reduced Risk

Abstract Purpose Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. Methods An observational cohort study was conducted using data from the British Spine Registry (2017–2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. Results 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. Conclusion Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.

Health-related quality of life and comorbidities associated with lumbar spinal stenosis

2012 ◽  
Vol 12 (3) ◽  
pp. 189-195 ◽  
Author(s):  
Michele C. Battié ◽  
C. Allyson Jones ◽  
Donald P. Schopflocher ◽  
Richard W. Hu
Keyword(s):  
Quality Of Life ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Lumbar Spinal

Efficacy of percutaneous transforaminal endoscopic discectomy unilateral and bilateral approach for bilateral decompression in treatment of degenerative lumbar spinal stenosis and their effects on quality of life

2021 ◽  
Vol 7 (6) ◽  
pp. 6540-6554
Author(s):  
Xuanhuang Chen ◽  
Xiaoqiang Gao ◽  
Haibin Lin ◽  
Hanhua Cai ◽  
Feng Zheng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Stenosis ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Bilateral Approach ◽  
Group A ◽  
Group B ◽  
Lumbar Spinal

This study aimed to explore the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) unilateral and bilateral approach for bilateral decompression in the treatment of degenerative lumbar spinal stenosis (DLSS) and their effects on quality of life. Altogether 119 patients with DLSS admitted to our hospital from May 2012 to February 2014 were enrolled in this study. Patients in Group A (62 cases) were treated with PTED bilateral approach for bilateral decompression, while those in Group B (57 cases) were treated with PTED unilateral approach for bilateral decompression. The therapeutic effect and incidence of complications in the two groups were observed. Visual Analogue Scale (VAS) was used to assess the pain degree of the lower limbs. Oswestry Disability Index (ODI) was used to assess the improvement of neurological function. 36-ltem Short Form Health Survey (SF-36) developed by the Institute of Medicine was used to assess the quality of life. There were no significant differences between Group A and Group B in operative time, intraoperative blood loss, hospitalization time, the effective rate of treatment, and the incidence of complications (P>0.05). The recovery time of lumbar function in Group A was significantly shorter than that in Group B (P<0.01). VAS and ODI scores at 1, 3, and 6 months after operation in Group A were significantly lower than those in Group B (P<0.05). The scores of general health (GH), bodily pain (BP), social function (SF), vitality (VT), and mental health (MH) at 6 months after operation in Group A were significantly higher than those in Group B (P<0.05). In conclusion, PTED bilateral approach for bilateral decompression was effective in the treatment of patients with DLSS. It can promote the recovery of their lumbar function and neurological function, and improve their quality of life.

EVALUATION OF THE RESULTS OF USING THE ACCELERATED RECOVERY PROGRAM AFTER PERFORMING TWO-LEVEL LUMBAR SPINAL FUSION IN PATIENTS OF AN OLDER AGE GROUP

2021 ◽  
pp. 964-971
Author(s):  
В. А. Бывальцев ◽  
В. Ю. Голобородько ◽  
А. А. Калинин ◽  
Э. Е. Сатардинова ◽  
Ю. Я. Пестряков ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Spinal Fusion ◽  
Older Age ◽  
Age Group ◽  
Lumbar Spinal Fusion ◽  
Sf 36 ◽  
Lumbar Spinal ◽  
Recovery Program

Целью исследования явилась оценка результатов использования программы ускоренного восстановления после выполнения двухуровневого поясничного спондилодеза у пациентов старшей возрастной группы. Ретроспективно изучены результаты хирургического лечения 29 пациентов старше 65 лет с полисегментарными дегенеративными заболеваниями поясничного отдела, которым выполняли минимально-инвазивную двухуровневую ригидную стабилизацию с применением концепции «программа ускоренного восстановления» (ПУВ). Исследовали технические особенности оперативных вмешательств, специфичность послеоперационного периода, количество неблагоприятных исходов анестезиологического пособия и периоперационных хирургических осложнений, частоту повторных госпитализаций в течение 90 дней. Для оценки эффективности ПУВ использовали клинические параметры: уровень болевого синдрома в области операции по визуально-аналоговой шкале (ВАШ) в течение госпитализации, качество жизни пациентов по анкете SF-36 и удовлетворенность пациента результатом лечения по шкале Macnab. В результате установлено, что внедренная ПУВ после выполнения двухуровневого поясничного спондилодеза у пациентов старшей возрастной группы обеспечивает минимальное количество неблагоприятных последствий анестезиологического пособия и периоперационных хирургических осложнений, значительное восстановление уровня качества жизни и высокую удовлетворенность пациентов проведенным лечением. The aim of the study was to evaluate the results of using the accelerated recovery program after performing two-level lumbar spinal fusion in patients of an older age group. The results of surgical treatment of 29 patients older than 65 years with multisegmental degenerative diseases of the lumbar region, who performed minimally invasive two-level rigid stabilization using the concept of «accelerated recovery program» (PAR), were retrospectively studied. We studied the technical features of surgical interventions, the specificity of the postoperative period, the number of adverse outcomes of anesthetic benefits and perioperative surgical complications, the frequency of repeated hospitalizations for 90 days. Clinical parameters were used to evaluate the effectiveness of PAR: the level of pain in the area of operation according to the visual analogue scale (VAS) during hospitalization, the quality of life of patients on the SF-36 questionnaire, and patient satisfaction with the result of treatment using the Macnab scale. As a result, it was established that the introduced PAR after performing two-level lumbar spinal fusion in patients of an older age group provides the minimum number of adverse consequences of anesthesiological aid and perioperative surgical complications, a significant restoration of the quality of life and high patient satisfaction with the treatment.

scholarly journals Long-term Clinical Outcomes and Quality of Life in Elderly Patients Treated with Interspinous Devices for Lumbar Spinal Stenosis

2017 ◽  
Vol 79 (02) ◽  
pp. 139-144 ◽  
Author(s):  
Massimo Miscusi ◽  
Stefano Forcato ◽  
Alessandro Ramieri ◽  
Filippo Polli ◽  
Antonino Raco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Spinal Stenosis ◽  
Local Anesthesia ◽  
Lumbar Spinal Stenosis ◽  
Short Form ◽  
Meaningful Improvement ◽  
Lumbar Spinal

Background and Objective Lumbar spinal stenosis (LSS) is a common degenerative condition that occurs in the spine with increasing age. Clinically, LSS causes a progressive reduction in walking autonomy, resulting in a poor quality of life and impaired functional capacity. The aim of this study was to evaluate the clinical outcome and quality of life of elderly patients presenting with LSS and associated comorbidities after a 5-year follow-up who were treated with an interspinous process device (IPD). Material and Methods Sixty patients > 75 years of age presenting with symptomatic degenerative LSS were included. All were treated with an IPD under local anesthesia. American Society of Anesthesiology score, Zurich Claudication Questionnaire, and Short Form 36 were evaluated pre- and postoperatively and at the follow-up visit each year for 5 years. Results The mean surgery time while under local anesthesia was 20 minutes. Forty-eight patients were followed for 5 years. Significant clinical improvements in all outcome scores (p < 0.05) both postoperatively or at follow-up were found. Conclusions IPD seems to be an effective and safe treatment for LSS in elderly patients with general comorbidities. In our study, all followed up patients had a meaningful improvement of their quality of life even at 5 years after surgery.

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