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 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 “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 Injection Treatment and Back Pain Associated with Degenerative Lumbar Spinal Stenosis in Older Adults

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. E347-E355
Author(s):  
Virginia G. Briggs
Keyword(s):  
Older Adults ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lower Back Pain ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Pain Scores ◽  
Lower Back ◽  
Injection Treatment ◽  
Lumbar Spinal

Background: Lower back pain is one of the most common health-related complaints in the adult population. Thirty percent of Americans 65 years and older reported symptoms of lower back pain in 2004 (NCHS, 2006). Injection treatment is a commonly used non-surgical procedure to alleviate lower back pain in older adults. However, the effectiveness of injection treatment, particularly in older adults, has not been well documented. Objective: This study quantified the effectiveness of injection treatment on pain relief among adults 60 years and over who were diagnosed with degenerative lumbar spinal stenosis, a common cause of lower back pain in older adults. The variations of the effectiveness were examined by selected patient attributes. Study Design: Prospective, non-randomized, observational human study. Setting: Single institution spine clinic. Methods: Patients scheduled for lumbar injection treatment between January 1 and July 1, 2008 were prospectively selected from the study spine clinic. Selection criteria included patients age 60 and over, diagnosed with degenerative lumbar spinal stenosis and no previous lumbar injection within 6 months or lumbar surgery within 2 years. The pain sub-score of the SF-36 questionnaire was used to measure pain at baseline and at one and 3 months post injection. Variations in longitudinal changes in pain scores by patient characteristics were analyzed in both unadjusted (univariate) analyses using one-way analysis of variance (ANOVA), and adjusted (multiple regression) analyses using linear mixed effects models. Limitations: This study is limited by its sample size and observational design. Results: Of 62 patients receiving epidural steroid injections, the mean Pain score at baseline was 27.4 (SD =1 3.6), 41.7 (SD = 22.0) at one month and 35.8 (SD = 19.0) at 3 months. Mean Pain scores improved significantly from baseline to one month (14.1 points), and from baseline to 3 months (8.3 points). Post injection changes in pain scores varied by body mass index (BMI) and baseline emotional health. Based on a linear mixed effects model analysis, higher baseline emotional health, as measured by the SF-36 Mental Component Score (MCS≥50), was associated with greater reduction in pain over 3 months when compared to lower emotional health (MCS <50). In patients with higher emotional health, pain scores improved by 14.1 (P < .05: 95% CI 6.9, 21.3). Patients who were obese also showed significant improvement in pain scores over 3 months compared to non-obese patients. In obese patients, pain scores increased by 7.9 (P <.05; 95% CI:1.0, 14.8) points. Conclusion: Lower back pain in older adults with degenerative lumbar spinal stenosis might be clinically significantly alleviated after injection treatment. Pain relief varies by a patient’s personal and clinical characteristics. Healthier emotional status and obesity appears to be associated with more pain relief experienced over 3 months following injection. Key words: Degenerative lumbar spinal stenosis, low back pain, older adults, epidural steroid injection, MRI, SF-36, Pain sub-score.

scholarly journals Fusion or Not for Degenerative Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review

2018 ◽  
Vol 1 (21;1) ◽  
pp. 1-8
Author(s):  
Jie Hao
Keyword(s):  
Systematic Review ◽  
Spinal Fusion ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Fusion Surgery ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal

Background: Degenerative lumbar spinal stenosis (DLSS) is the main cause for chronic low back pain in the elderly. When refractory to conservative treatment, symptomatic patients commonly undergo surgery. However, whether or not fusion is a relatively better surgical option still remains unclear. Objective: The purpose of the present study was to systematically review the clinical outcomes of spinal decompression with or without spinal fusion for DLSS. Study Design: A systematic review of the therapeutic effect for DLSS with or without fusion. Methods: A literature search of 5 electronic databases was performed including PubMed, EMBASE, MEDLINE, Cochrane Library, and CENTRAL from inception to August 2016. Only randomized controlled trials (RCTs) assessing the comparison between decompression and fusion surgery for DLSS were included. Results: A total of 5 RCTs involving 438 patients met the inclusion criteria. Low-quality evidence of the meta-analysis was performed for the heterogeneity of the included studies. Pooled analysis showed no significant differences between decompression alone and fusion groups for the Oswestry Disability Index (ODI) scores at the baseline (P = 0.50) and 2 years follow-up (P = 0.71), and the satisfaction rate of operations was also similar for the groups (P = 0.53). However, operation time (P = 0.002), blood loss (P < 0.00001), and length of hospital stay (P = 0.007) were remarkably higher in the fusion group. Furthermore, there was no difference in the reoperation rate between these 2 groups at the latest follow-up (P = 0.49). Limitation: The methodological criteria and sample sizes were highly variable. The studies were heterogeneous. Conclusion: The present meta-analysis is the first to compare the efficacy of decompression alone and spinal fusion for the treatment of DLSS, including 5 RCTs. Our results demonstrate that additional fusion surgery seems unlikely to result in better outcomes for patients with DLSS, but it may increase additional risks and costs. High-quality homogeneous research is required to provide further evidence about surgical procedures for patients with DLSS. Key words: Decompression, fusion, lumbar spinal stenosis, meta-analysis

scholarly journals Management for lumbar spinal stenosis: Protocol for a network meta-analysis and systematic review

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902097521
Author(s):  
Fei-Long Wei ◽  
Ya Liu ◽  
Cheng-Pei Zhou ◽  
Si-Guo Sun ◽  
Kai-Long Zhu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Meta Analysis ◽  
Operation Time ◽  
Evaluation Framework ◽  
Adult Patients ◽  
Leg Pain ◽  
Cochrane Library ◽  
Lumbar Spinal

Introduction: Lumbar spinal stenosis (LSS) is caused by structural changes of the spine, which lead to several severe symptoms, including back pain, leg pain, numbness and tingling in the legs, as well as reduced physical function. However, there is little evidence suggesting whether a patient with LSS should be treated with surgery. If surgery is recommended, which type of surgery benefits the patient most? To answer these questions, we will conduct a network meta-analysis and a systematic review to compare surgical and nonsurgical interventions in terms of efficacy as well as safety in adult patients with LSS. Methods and analysis: We will search the PubMed, Cochrane library, and EMBASE databases for articles published prior to October 10, 2019. We will search for randomized controlled trials assessing surgical and nonsurgical interventions for adult patients with degenerative LSS without any language restrictions. The primary outcome measures will be pain and disability. The secondary outcomes will include adverse events (number of events or number of people with each type of adverse event), reoperations, complications, blood loss and operation time. We will obtain the full texts of the potentially relevant studies and independently assess them. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. A random-effects network meta-analysis will be performed to analyze all the evidence under the frequentist framework, and the ranking results will be presented. We will generate plots depicting the network geometry using Stata. The network meta-analysis will be performed according to the Bayesian framework. Ethics and dissemination Ethics approval is not required. The research will be published in a peer-reviewed journal.

What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review

2014 ◽  
Vol 23 (6) ◽  
pp. 1282-1301 ◽  
Author(s):  
Carlo Ammendolia ◽  
Kent Stuber ◽  
Christy Tomkins-Lane ◽  
Michael Schneider ◽  
Y. Raja Rampersaud ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Neurogenic Claudication ◽  
Walking Ability ◽  
Lumbar Spinal

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 &lt; .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 &lt; .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.

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