scholarly journals Percutaneous Interspinous Spacer vs Decompression in Patients with Neurogenic Claudication: An Alternative in Selected Patients?

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 621-629 ◽  
Author(s):  
Bernhard Meyer ◽  
Adad Baranto ◽  
Frederic Schils ◽  
Frederic Collignon ◽  
Bjorn Zoega ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Controlled Trial ◽  
Reoperation Rate ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Neurogenic Intermittent Claudication ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Index Level ◽  
Lumbar Spinal

Abstract BACKGROUND Standalone interspinous process devices (IPDs) to treat degenerative lumbar spinal stenosis with neurogenic intermittent claudication (NIC) have shown ambiguous results in the literature. OBJECTIVE To show that a minimally invasive percutaneous IPD is safe and noninferior to standalone decompressive surgery (SDS) for patients with degenerative lumbar spinal stenosis with NIC. METHODS A multicenter, international, randomized, controlled trial (RCT) was con- ducted. One hundred sixty-three patients, enrolled at 19 sites, were randomized 1:1 to treatment with IPD or SDS and were followed for 24 mo. RESULTS There was significant improvement in Zurich Claudication Questionnaire physical function, as mean percentage change from baseline, for both the IPD and the SDS groups at 12 mo (primary endpoint) and 24 mo (−32.3 ± 32.1, −37.5 ± 22.8; and −37.9 ± 21.7%, −35.2 ± 22.8, both P < .001). IPD treatment was not significantly noninferior (margin: 10%) to SDS treatment at 12 mo (P = .172) but was significantly noninferior at 24 mo (P = .005). Symptom severity, patient satisfaction, visual analog scale leg pain, and SF-36 improved in both groups over time. IPD showed lower mean surgical time and mean blood loss (24 ± 11 min and 6 ± 11 mL) compared to SDS (70 ± 39 min and 189 ± 148 mL, both P < .001). Reoperations at index level occurred in 18.2% of the patients in the IPD group and in 9.3% in the SDS group. CONCLUSION Confirming 3 recent RCTs, we could show that IPD as well as open decompression achieve similar results in relieving symptoms of NIC in highly selected patients. However, despite some advantages in secondary outcomes, a higher reoperation rate for IPD is confirmed.

scholarly journals Outcome of Surgical Treatment of Degenerative Lumbar Spinal Stenosis.

2016 ◽  
Vol 14 (1) ◽  
pp. 25-28
Author(s):  
Bishnu Babu Thapa ◽  
Sushil Rana Magar ◽  
Pankaj Chand ◽  
Bachhu Ram KC
Keyword(s):  
Conservative Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Leg Pain ◽  
Walking Distance ◽  
Neurogenic Claudication ◽  
Long Term Outcome ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Vas Score ◽  
Lumbar Spinal

Introduction: Spinal stenosis mostly occur in lumbar spine and causes back pain, leg pain & neurogenic claudication. Although conservative treatment is mainstay, decompression with or without fusion (with or without instrumentation) can be considered in non-responsive cases. However, long term outcome of the surgery is controversial. The aim of our study was to analyze the outcome of surgery in lumbar spinal stenosis in terms of post-operative pain and claudication distance.Methods: A prospective analysis of patients who underwent decompression or decompression with fusion (with or without instrumentation), after failure of 3-6 months conservative treatment, for lumbar spinal stenosis were conducted. Only those who were operated and followed up for at least two years were included.Their preop and postop VAS score and walking distance compared.Results: Of 22 cases enrolled in this study, VAS score was improved in 21 patients and walking distance increased. Only one patient complained of increase in pain score at 24 months.Conclusion: Operative management is a good option for selected patients, 21 out of 22 have improved VAS and claudication distance in our study

scholarly journals Effective of Fusion in the Treatment of Lumbar Spinal Stenosis：A Systematic Review Andmeta-Analysis

2021 ◽  
Author(s):  
Yang Yang ◽  
Shi-tian Tang ◽  
Qian Chen ◽  
fang chen
Keyword(s):  
Systematic Review ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Major Complication ◽  
Primary Objective ◽  
Leg Pain ◽  
Walking Ability ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Pain Scores ◽  
Lumbar Spinal

Abstract Objective: The debate on efficacy of fusion added to decompression for lumbar spinal stenosis (LSS) is ongoing. The primary objective of this systematic review is to compare the outcome after decompression with and without fusion in patients with lumbar spinal stenosis .Methods: A literature search was performed in the Web of Science, EMBASE, Pubmed,and Cochrane Libraryfrom January 1990 to May 2021.The information of screened studies included clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed.Data analysis was conducted using the Review Manager 5.0 software.Results: 17 studies were included in the analysis involving 2947 patients in total. In the majority of studies, including seven RCTs and ten observational studies. The pooled data revealed that fusion was associated with signifificantly higher rates of back pain scores when compared with decompression alone in RCT subgroup(SMD=-0.42, 95% CI (–0.60, -0.23), Z=4.31 P<0.0001).However, fusion signifificantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar leg Pain scores , EQ-5D, walking ability，ODI，major complication,clinical satisfactions and reoperation rate.Conclusions: Our studies showed that the additional fusion in the management of LSS yielded no clinical improvements over decompression alone within a 1-year follow-up period. We suggested that the least invasive and least costly procedure, being decompression alone, is preferred in patients with degenerative lumbar spinal stenosis. The appropriate surgical protocol for LSS should be discussed further.

scholarly journals Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome

2020 ◽  
pp. 219256822094251
Author(s):  
Freyr Gauti Sigmundsson ◽  
Anders Möller ◽  
Fredrik Strömqvist
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Rating Scale ◽  
Leg Pain ◽  
Successful Outcome ◽  
Neurogenic Claudication ◽  
Lumbar Spinal ◽  
Outcome Of Surgery

Study Design: Prospective register cohort study. Objectives: The indication for surgery in patients with lumbar spinal stenosis (LSS) is considered to be leg pain and neurogenic claudication (NC). Nevertheless, a significant part of patients operated for LSS have mild leg pain levels defined as leg pain ≤minimally important clinical difference (MICD). Information is lacking on how to inform these patients about the probable outcome of surgery. The objective was to report the outcome of surgery for LSS in patients with a mild preoperative level of leg pain. Methods: A total of 2559 patients operated upon for LSS with preoperative leg pain ≤3 NRS (Numerical Rating Scale) were evaluated for outcome at the 1-year follow-up. NRS for back pain, the Oswestry Disability Index (ODI), and the EuroQol (EQ-5D) were used. Results: In the period 2007 to 2017, we identified 3239 patients (14%) who had mild leg pain (≤3 on the NRS). In this cohort, leg pain increased 0.40 (0.56-0.37) and back pain decreased 1.0 (0.95-1.2) at the 1-year follow up. ODI decreased 11.1 (10.2-11.4) and the EQ-5D increased 0.15 (0.17-0.14). A total of 31% reached successful outcome in terms of back pain, 43% in terms of ODI and 48% in terms of EQ-5D. 63% of the patients were satisfied with the outcome. Conclusion: A minority of patients with mild leg pain levels operated upon for LSS attain MICD for back pain, ODI, and EQ-5D. The results from this study can aid the surgeon in the shared decision-making process before surgery.

scholarly journals “Slalom”: Microsurgical Cross-Over Decompression for Multilevel Degenerative Lumbar Stenosis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
H. Michael Mayer ◽  
Franziska Heider
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Facet Joint ◽  
Leg Pain ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Canal Stenosis ◽  
Microsurgical Decompression ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

Objective.Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches.Indications. Two-segmental and multisegmental degenerative central and lateral lumbar spinal stenosis.Contraindications. None.Surgical Technique.Minimally invasive, muscle, and facet joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side.Results.From December 2010 until December 2015 we operated on 202 patients with 2 or multisegmental stenosis (115 f; 87 m; average age 69.3 yrs, range 51–91 yrs). All patients were suffering from symptoms typical of a degenerative lumbar spinal stenosis. All patients complained about back pain; however the leg symptoms were dominant in all cases. Per decompressed segment, the average OR time was 36 min and the blood loss 45.7 cc. Patients were mobilized 6 hrs postop and hospitalization averaged 5.9 days. A total of 116/202 patients did not need submuscular drainage. 27/202 patients suffered from a complication (13.4%). Dural tears occurred in 3.5%, an epidural hematoma in 5.5%, a deep wound infection in 1.98%, and a temporary radiculopathy postop in 1.5%. Postop follow-up ranged from 12 to 24 months. There was a significant improvement of EQ 5 D, Oswestry Disability Index (ODI), VAS for Back and Leg Pain, and preoperative standing times and walking distances.

scholarly journals Percutaneous Epidural Adhesiolysis Using Inflatable Balloon Catheter and Balloon-less Catheter in Central Lumbar Spinal Stenosis with Neurogenic Claudication: A Randomized Controlled Trial

2018 ◽  
Vol 1 (21;1) ◽  
pp. 593-605
Author(s):  
Seong-Soo Choi
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Controlled Trial ◽  
Balloon Catheter ◽  
Controlled Study ◽  
Neurogenic Claudication ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Lumbar Spinal

Background: When conventional interventional procedures fail, percutaneous epidural adhesiolysis (PEA), which has moderate evidence for successful treatment of lumbar spinal stenosis (LSS), has been recommended over surgical treatments. In a previous study, we demonstrated the efficacy of a newly developed inflatable balloon catheter for overcoming the access limitations of pre-existing catheters for patients with severe stenosis or adhesions. Objectives: This study compared the treatment response of combined PEA with balloon decompression and PEA only in patients with central LSS over 6 months of follow-up. Study Design: This study used a randomized, single-blinded, active-controlled trial design. Setting: This study took place in a single-center, academic, outpatient interventional pain management clinic. Methods: This randomized controlled study included 60 patients with refractory central LSS who suffered from chronic lower back pain and/or lumbar radicular pain. Patients failed to maintain improvement for > 1 month with epidural steroid injection or PEA using a balloon-less catheter. Patients were randomly assigned to one of 2 interventions: balloon-less (n = 30) and inflatable balloon catheter (n = 30). The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), Global Perceived Effect of Satisfaction (GPES), and Medication Quantification Scale III were each measured at 1, 3, and 6 months after PEA. Results: There was a significant difference between groups in NRS-11 reduction ≥ 50% (or 4 points), ODI reduction ≥ 30% (or 10 points), GPES ≥ 6 and ≥ 4 points at 6 months, and NRS11 reduction ≥ 50% (or 4 points) at 3 months after PEA (P < .03). The proportion of successful responders was higher in the balloon group than in the balloon-less group throughout the total follow-up period. Furthermore, there was a statistically significant difference between groups at 6 months after PEA (P = .035). Limitations: The results may vary according to the definition of successful response. Follow-up loss in the present study seemed to be high. Conclusion: PEA using the inflatable balloon catheter leads to significant pain reduction and functional improvement compared to PEA using the balloon-less catheter in patients with central LSS. The study protocol was approved by our institutional review board (2012-0235), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002093). Key words: Balloon decompression, central, chronic pain, epidural adhesiolysis, lumbar, percutaneous, radiculopathy, spinal stenosis

scholarly journals Outcomes of decompression without fusion in patients with lumbar spinal stenosis and substantial back pain

2021 ◽  
pp. 1-4
Author(s):  
Rachid Bech-Azeddine ◽  
Søren Fruensgaard ◽  
Mikkel Andersen ◽  
Leah Y. Carreon
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Structural Instability ◽  
Radicular Pain ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Vas Score ◽  
The Mean ◽  
Lumbar Spinal

OBJECTIVEThe predominant symptom of lumbar spinal stenosis (LSS) is neurogenic claudication or radicular pain. Some surgeons believe that the presence of substantial back pain is an indication for fusion, and that decompression alone may lead to worsening of back pain from destabilization associated with facet resection. The purpose of this study was to determine if patients with LSS and clinically significant back pain could obtain substantial improvements in back pain after a decompression alone without fusion.METHODSThe DaneSpine database was used to identify 2737 patients with LSS without segmental instability and a baseline back pain visual analog scale (VAS) score ≥ 50 who underwent a decompression procedure alone without fusion. Standard demographic and surgical variables and patient outcomes, including back and leg pain VAS score (0–100), Oswestry Disability Index (ODI), and EQ-5D at baseline and at 12 months postoperatively, were collected.RESULTSA total of 1891 patients (69%) had 12-month follow-up data available for analysis; the mean age was 66.4 years, 860 (46%) were male, the mean BMI was 27.8 kg/m2, and 508 (27%) were current smokers. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for back pain (72.1 to 42.1), leg pain (71.2 to 41.3), EQ-5D (0.35 to 0.61), and ODI (44.1 to 27.8).CONCLUSIONSPatients with LSS, clinically substantial back pain, and no structural instability obtain improvement in back pain after decompression-only surgery and do not need a concomitant fusion.

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