Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis

Object Lumbar spinal stenosis (LSS) may lead to disabling neurogenic symptoms and has traditionally been treated using open laminectomy. A new technique for correcting LSS involves lengthening the lumbar pedicles through bilateral percutaneous pedicle osteotomies. In this paper, the authors' goal was to evaluate the changes in spinal canal dimensions and kinematic behavior after pedicle-lengthening osteotomies. Methods The kinematic behavior of 8 cadaveric lumbar segments was evaluated intact and after bilateral pedicle-lengthening osteotomies at the L-4, L-5, and L-4 and L-5 levels. Testing was conducted with and without a compressive preload using a custom kinematic apparatus that allowed for 3D tracking of each vertebra during flexion-extension, right-left bending, and right-left rotation. A validated finite element (FE) spine model was used to measure the changes in the cross-sectional area of the spinal canal and neural foramen after 2-, 3-, and 4.5-mm simulated pedicle-lengthening osteotomy procedures. Results The overall and segmental kinematics were not significantly altered after the pedicle-lengthening osteotomy procedure at the L-4 and/or L-5 pedicles. The kinematic signatures of the intact and lengthened states were similar for all motion pairs. The FE spine model yielded kinematics predictions within or close to the 95% confidence interval for the cadaveric data. The FE spine demonstrated substantial, pedicle length–dependent enlargement of the cross-sectional areas of the spinal canal and neural foramen after simulated pedicle lengthening. Conclusions Bilateral pedicle-lengthening osteotomies produced substantial increases in the cross-sectional areas of the spinal canal and neural foramen without significantly altering normal spinal kinematics. This technique deserves further study as a less invasive treatment option for LSS.

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Percutaneous Pedicle-Lengthening Osteotomy in Minimal Invasive Spinal Surgery to Treat Degenerative Lumbar Spinal Stenosis: A Single-Center Preliminary Experience

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1641148 ◽

2018 ◽

Vol 79 (05) ◽

pp. 365-371

Author(s):

Luigi Basile ◽

Carlo Gulì ◽

Aurelia Banco ◽

Giovanna Giordano ◽

Antonella Giugno ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Invasive Procedure ◽

High Risk Population ◽

Minimally Invasive Procedure ◽

Clinical Series ◽

Lengthening Osteotomy ◽

Lumbar Spinal

Background Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal due to spinal degeneration, and its main clinical symptom is neurogenic claudication. Surgical treatment is pursued for patients who do not improve with conservative care. Patients with symptomatic LSS who also have significant medical comorbidities, although clearly in need of intervention, are unattractive candidates for traditional open lumbar decompressive procedures. Thus it is important to explore minimally invasive surgical techniques to treat select patients with LSS. Methods This retrospective case series evaluated the clinical and radiographic outcomes of a new minimally invasive procedure to treat LSS: pedicle-lengthening osteotomy using the ALTUM system ((Innovative Surgical Designs, Inc., Bloomington, Indiana, United States). Peri- and postoperative demographic and radiographic data were collected from a clinical series of seven patients with moderate LSS who were > 60 years of age. Clinical outcome was evaluated using visual analog scale (VAS) scores and the spinal canal area on computed tomography scans. Results Twelve months after the procedure, scoring revealed a median improvement of 3.7 on the VAS for the back and 6.3 on the VAS for the leg, compared with the preoperative baseline (p < 0.05). The postoperative central area of the lumbar canal was significantly increased, by 0.39 cm2; the right and left neural foramina were enlarged by 0.29 cm2 and 0.47 cm2, respectively (p < 0.05). Conclusions In this preliminary study, the ALTUM system showed a good clinical and radiologic outcome 1 year after surgery. In an older or high-risk population, a short minimally invasive procedure may be beneficial for treating LSS.

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Twelve-month results of a clinical pilot study utilizing pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2012.11.spine12402 ◽

2013 ◽

Vol 18 (4) ◽

pp. 347-355 ◽

Cited By ~ 9

Author(s):

Sergey Mlyavykh ◽

Steven C. Ludwig ◽

Jean-Pierre Mobasser ◽

Christopher K. Kepler ◽

D. Greg Anderson

Keyword(s):

Pilot Study ◽

Adverse Events ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Lengthening Osteotomy ◽

The Mean ◽

Lumbar Spinal ◽

Disease Specific ◽

Time Point

Object Lumbar spinal stenosis (LSS) is a common condition that leads to significant disability, particularly in the elderly. Current therapeutic modalities for LSS have certain drawbacks when applied to this patient population. The object of this study was to define the 12-month postoperative outcomes and complications of pedicle-lengthening osteotomies for symptomatic LSS. Methods A prospective, single-treatment clinical pilot study was conducted. A cohort of 19 patients (mean age 60.9 years) with symptomatic LSS was treated by pedicle-lengthening osteotomy procedures at 1 or 2 levels. All patients had symptoms of neurogenic claudication or radiculopathy secondary to LSS and had not improved after a minimum 6-month course of nonoperative treatment. Eleven patients had a Meyerding Grade I degenerative spondylolisthesis in addition to LSS. Clinical outcomes were measured using the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), 12-Item Short-Form Health Survey (SF-12), and a visual analog scale (VAS). Procedural variables, neurological outcomes, adverse events, and radiological imaging (plain radiographs and CT scans) were collected at the 1.5-, 3-, 6-, 9-, and 12-month time points. Results The pedicle-lengthening osteotomies were performed through percutaneous approaches with minimal blood loss in all cases. There were no operative complications. Four adverse events occurred during the follow-up period. Clinically, significant improvement was observed in the mean values of each of the outcome scales (comparing preoperative and 12-month values): ODI scores improved from 52.3 to 28.1 (p < 0.0001); the ZCQ physical function domain improved from 2.7 to 1.8 (p = 0.0021); the SF-12 physical component scale improved from 27.0 to 37.9 (p = 0.0024); and the VAS score for leg pain while standing improved from 7.2 to 2.7 (p < 0.0001). Imaging studies, reviewed by an independent radiologist, showed no evidence of device subsidence, migration, breakage, or heterotopic ossification. Thin-slice CT documented healing of the osteotomy site in all patients at the 6-month time point and an increase in the mean cross-sectional area of the spinal canal of 115%. Conclusions Treatment of patients with symptomatic LSS with a pedicle-lengthening osteotomy procedure provided substantial enlargement of the area of the spinal canal and favorable clinical results for both disease-specific and non–disease-specific outcome measures at the 12-month time point. Future studies are needed to compare this technique to alternative therapies for lumbar stenosis.

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Pedicle-Lengthening Osteotomy for the Treatment of Lumbar Spinal Stenosis: the Surgical Technique (Pilot Clinical Study)

Sovremennye tehnologii v medicine ◽

10.17691/stm2018.10.3.7 ◽

2018 ◽

Vol 10 (3) ◽

pp. 58

Author(s):

S.G. Mlyavykh ◽

A.E. Bokov ◽

K.S. Yashin ◽

D.G. Anderson

Keyword(s):

Clinical Study ◽

Surgical Technique ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Pilot Clinical Study ◽

Lengthening Osteotomy ◽

Lumbar Spinal

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Spinal canal diameter in degenerative lumbar spinal stenosis

Journal of Anatomical Society of India ◽

10.1016/j.jasi.2018.07.005 ◽

2018 ◽

Vol 67 ◽

pp. S25-S28 ◽

Cited By ~ 1

Author(s):

R. Sethi ◽

V. Singh

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Degenerative Lumbar Spinal Stenosis ◽

Canal Diameter ◽

Lumbar Spinal

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Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study

BioMed Research International ◽

10.1155/2017/3742182 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Yang Yang ◽

Liangming Zhang ◽

Jianwen Dong ◽

Zihao Chen ◽

Peigen Xie ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Degenerative Lumbar Spinal Stenosis ◽

Lateral Lumbar Interbody Fusion ◽

Radiological Parameters ◽

One Year ◽

Lumbar Spinal

Aim. To investigate the feasibility and effectiveness of intraoperative myelography in determining adequacy of indirect spinal canal decompression during transpsoas lateral lumbar interbody fusion (LLIF). Methods. Seven patients diagnosed with degenerative lumbar spinal stenosis (DLSS) were prospectively included to this study. All patients underwent LLIF and subsequently received intraoperative myelography to determine the effect of indirect spinal canal decompression, which was visualized in both anterior-posterior and lateral images. Those patients with insufficient indirect canal decompression were further resolved by microendoscopic canal decompression (MECD). Radiological parameters, including stenosis ratio and dural sac area of operated levels, were measured and compared before and after operation. Besides, all patients were followed up for at least one year using visual analogue scale (VAS) for back and leg, Japanese Orthopaedic Association score (JOA), and Oswestry disability index (ODI). Results. Seven patients with 8 operated levels underwent LLIF safely and demonstrated significant symptom relief postoperatively. Five operated levels showed adequate indirect canal decompression intraoperatively, while the remaining three levels did not achieve the adequacy, and their residual stenosis was resolved following MECD. Radiological parameters were improved statistically when compared with preoperation (P<0.05). Furthermore, neurological symptoms of all patients were also improved significantly (P<0.05), shown by improved VAS (back and leg), JOA, and ODI at both two-week and one-year follow-up. Conclusions. Intraoperative myelography during LLIF is able to assess adequacy of indirect canal decompression for DLSS, thus promising favorable clinical outcomes.

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The Narrow Lumbar Spinal Canal or Lumbar Spinal Stenosis

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-197601000-00040 ◽

1976 ◽

Vol 1976 (114) ◽

pp. 319???325

Author(s):

L. MERCER McKINLEY ◽

GERALD L. DAVIS

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Lumbar Spinal Canal ◽

Lumbar Spinal

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Comparative Study Between Uniportal Full-Endoscopic Interlaminar and Tubular Approach in the Treatment of Lumbar Spinal Stenosis: A Pilot Study

Global Spine Journal ◽

10.1177/2192568219878419 ◽

2020 ◽

Vol 10 (2_suppl) ◽

pp. 70S-78S

Author(s):

Angela Carrascosa-Granada ◽

Willian Velazquez ◽

Ralf Wagner ◽

Anwar Saab Mazzei ◽

Andrés Vargas-Jimenez ◽

...

Keyword(s):

Clinical Improvement ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Endoscopic Approach ◽

Endoscopic Technique ◽

Dural Sac ◽

Lumbar Spinal ◽

Endoscopic Group

Study Design: Multicenter, prospective, randomized, and double-blinded study. Objectives: To compare tubular and endoscopic interlaminar approach. Methods: Patients with lumbar spinal stenosis and neurogenic claudication of were randomized to tubular or endoscopic technique. Enrollment period was 12 months. Clinical follow up at 1, 3, 6 months after surgery with visual analogue scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiologic evaluation with magnetic resonance pre- and postsurgery. Results: Twenty patients were enrolled: 10 in tubular approach (12 levels) and 10 in endoscopic approach (11 levels). The percentage of enlargement of the spinal canal was higher in endoscopic approach (202%) compared with tubular approach (189%) but was not statistically significant ( P = .777). The enlargement of the dural sac was higher in endoscopic group (209%) compared with tubular group (203%) but no difference was found between the 2 groups ( P = .628). A modest significant correlation was found between the percentage of spinal canal decompression and enlargement of the dural sac ( r = 0.5, P = .023). Both groups reported a significant clinical improvement postsurgery. However, no significant association was found between the percentage of enlargement of the spinal canal or the dural sac and clinical improvement as determined by scales scores. Endoscopic group had lower intrasurgical bleeding ( P < .001) and lower disability at 6 months of follow-up than tubular group (p=0.037). Conclusions: In the treatment of lumbar spinal stenosis, endoscopic technique allows similar decompression of the spinal canal and the dural sac, lower intrasurgical bleeding, similar symptoms improvement, and lower disability at 6 months of follow-up, as compared with the tubular technique.

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Five-year results of a clinical pilot study utilizing a pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2017.11.spine16664 ◽

2018 ◽

Vol 29 (3) ◽

pp. 241-249 ◽

Cited By ~ 1

Author(s):

Sergey Mlyavykh ◽

Steven C. Ludwig ◽

Christopher K. Kepler ◽

D. Greg Anderson

Keyword(s):

Pilot Study ◽

Adverse Events ◽

Spinal Stenosis ◽

Spinal Canal ◽

Ct Scans ◽

Time Points ◽

Lengthening Osteotomy ◽

Lumbar Spinal ◽

Disease Specific

OBJECTIVELumbar spinal stenosis (LSS) is a common condition that leads to significant disability, particularly in the elderly. Current therapeutic options have certain drawbacks. This study evaluates the 5-year clinical and radiographic results of a minimally invasive pedicle-lengthening osteotomy (PLO) for symptomatic LSS.METHODSA prospective, single-arm, clinical pilot study was conducted involving 20 patients (mean age 61.7 years) with symptomatic LSS treated by a PLO procedure at 1 or 2 lumbar levels. All patients had symptoms of neurogenic claudication or radiculopathy secondary to LSS, and had not improved after a minimum 6-month course of nonoperative treatment. Eleven patients had a Meyerding grade I degenerative spondylolisthesis in addition to LSS. Clinical outcomes were measured using the Oswestry Disability Index, Zürich Claudication Questionnaire, 12-Item Short Form Health Survey, and a visual analog scale for back and leg pain. Procedural variables, neurological outcomes, adverse events, and radiological imaging (plain radiographs and CT scans) were collected at the 1.5-, 3-, 6-, 9-, 12-, 24-, and 60-month time points.RESULTSThe PLOs were performed through percutaneous incisions, with minimal blood loss in all cases. There were no operative complications. Four adverse events occurred during the follow-up period. Statistically significant improvement was observed in each of the outcome instruments and maintained over the 5-year follow-up period. Imaging studies, reviewed by an independent radiologist, showed no evidence of device subsidence, migration, breakage, or heterotopic ossification. Thin-slice CT scans documented healing of the osteotomy site in all patients at the 6-month time point and an increase of 115% in the mean cross-sectional area of the spinal canal.CONCLUSIONSTreatment of patients with symptomatic LSS with a PLO procedure provided substantial enlargement of the area of the spinal canal and favorable clinical results for both disease-specific and non–disease-specific outcome measures at all follow-up time points out to 5 years. Future research is needed to compare this technique to alternative therapies for LSS.

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