LLIF Plus Posterior Decompression for Severe Lumbar Spinal Stenosis

2019 ◽  
Author(s):  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Posterior Decompression ◽  
Lumbar Spinal

scholarly journals Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study

2020 ◽  
Vol 29 (9) ◽  
pp. 2254-2261
Author(s):  
Erland Hermansen ◽  
Ivar Magne Austevoll ◽  
Christian Hellum ◽  
Kjersti Storheim ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Controlled Trial ◽  
Spinous Process ◽  
Surgical Techniques ◽  
Posterior Decompression ◽  
Clinical Trial Registration ◽  
Dural Sac ◽  
Radiological Results ◽  
Lumbar Spinal

Abstract Purpose To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. Clinical trial registration The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study

2006 ◽  
Vol 5 (5) ◽  
pp. 404-409 ◽  
Author(s):  
Ko Ikuta ◽  
Osamu Tono ◽  
Takayuki Tanaka ◽  
Junichi Arima ◽  
Soichiro Nakano ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Epidural Hematoma ◽  
Posterior Decompression ◽  
Dural Sac ◽  
Group 2 ◽  
Lumbar Spinal ◽  
Spinal Epidural ◽  
Group 1

Object The incidence of postoperative spinal epidural hematoma (SEH) is low, and to the best of the authors’ knowledge, no researchers have evaluated its actual incidence and clinical features. The purpose of this study was to investigate the clinical consequences of SEH after microendoscopic posterior decompression (MEPD) in patients with lumbar spinal stenosis. Methods Data obtained in 30 patients undergoing MEPD for lumbar spinal stenosis were reviewed. At 1 week after surgery, magnetic resonance (MR) imaging documented SEHs in 10 patients (33% [Group 1]) and no evidence of SEHs in 20 patients (67% [Group 2]). The authors compared MR imaging findings, postoperative morbidities, and clinical outcomes between the groups. Three Group 1 patients had symptomatic SEHs. All symptoms were mild without associated neurological deterioration and spontaneously subsided within 3 weeks of surgery. Magnetic resonance imaging demonstrated spontaneous regression of the SEH in all patients at 3 months after surgery. In Group 1 patients, however, the authors observed less expansion of the dural sac after 1 year despite sufficient widening of the osseous spinal canal. Low-back pain within 1 week of surgery was moderate in Group 1 and mild in Group 2. Improvements at the final follow up were greater in Group 2 patients. Conclusions The incidence of postoperative SEHs may be greater than reported. Postoperative SEHs caused poor expansion of the dural sac despite its spontaneous regression. In addition, postoperative SEHs caused a delay in the patient’s recovery and led to a poor clinical improvement. The prevention of postoperative SEHs might be required to prevent not only neurological deterioration but also a delay in the patient’s recovery.

Facet Preserving Technique by En Bloc Flavectomy in Microscopic Posterior Decompression Surgery for Lumbar Spinal Stenosis

2017 ◽  
Vol 30 (5) ◽  
pp. 197-203 ◽  
Author(s):  
Yasushi Fujiwara ◽  
Hideki Manabe ◽  
Tadayoshi Sumida ◽  
Bunichiro Izumi ◽  
Kazuyoshi Nakanishi ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Decompression Surgery ◽  
Posterior Decompression ◽  
En Bloc ◽  
Lumbar Spinal

scholarly journals Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

2020 ◽  
Author(s):  
Jun Li ◽  
Hao Li ◽  
Zhang Ning ◽  
Zhi-wei Wang ◽  
Teng-fei Zhao ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Central Canal ◽  
Posterior Decompression ◽  
Canal Diameter ◽  
Average Change ◽  
Lumbar Spinal ◽  
Lateral Interbody

Abstract Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lumbar lateral interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D. Methods: For radiographic analysis, we included 181 segments from 110 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas’ classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were compared using Student's t-test, with P- values < 0.05 considered to indicate statistically significant differences. Results: Among the 181 segments included for radiological evaluation, there were 23 grade A segments, 37 grade B segments, 103 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average change of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression. Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments was comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

scholarly journals Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

2020 ◽  
Author(s):  
Jun Li ◽  
Hao Li ◽  
Zhang Ning ◽  
Zhi-wei Wang ◽  
Teng-fei Zhao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Outcome ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Central Canal ◽  
Posterior Decompression ◽  
Canal Diameter ◽  
Lumbar Spinal ◽  
Lateral Interbody

Abstract Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lumbar lateral interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D.Methods: For radiographic analysis, we included 202 segments from 124 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas’ classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were confronted by using Student's t-test, obtaining a statistically significant difference for values inferior to 0.05.Results: Among the 202 segments included for radiological evaluation, there were 42 grade A segments, 41 grade B segments, 101 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average changes of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression.Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments were comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

Endoscopic posterior decompression under local anesthesia for degenerative lumbar spinal stenosis

2018 ◽  
Vol 29 (6) ◽  
pp. 661-666 ◽  
Author(s):  
Myung Soo Youn ◽  
Jong Ki Shin ◽  
Tae Sik Goh ◽  
Seung Min Son ◽  
Jung Sub Lee
Keyword(s):  
Spinal Stenosis ◽  
Local Anesthesia ◽  
Lumbar Spinal Stenosis ◽  
Short Form ◽  
Posterior Decompression ◽  
Mean Values ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Sf 36 ◽  
Lumbar Spinal

OBJECTIVEVarious minimally invasive techniques have been described for the decompression of lumbar spinal stenosis (LSS). However, few reports have described the results of endoscopic posterior decompression (EPD) with laminectomy performed under local anesthesia. This study aimed to evaluate the clinical and radiological outcomes of EPD performed under local anesthesia in patients with LSS and to compare the procedural outcomes in patients with and without preoperative spondylolisthesis.METHODSFifty patients (28 female and 22 male) who underwent EPD under local anesthesia were included in this study. Patients were assessed before surgery and were followed up with regular outpatient visits (at 1, 3, 6, 12, and 24 months postoperatively). Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and the 36-Item Short Form Survey (SF-36) outcome questionnaire. Radiological outcomes were assessed by measuring lumbar lordosis, disc-wedging angle, percentage of vertebral slippage, and disc height index on plain standing radiographs.RESULTSThe VAS, ODI, and SF-36 scores were significantly improved at 1 month after surgery compared to the baseline mean values, and the improved scores were maintained over the 2-year follow-up period. Radiological progression was found in 2 patients during the follow-up period. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical and radiological outcomes.CONCLUSIONSEPD performed under local anesthesia is effective for LSS treatment. Similar favorable outcomes can be obtained in patients with and without preoperative spondylolisthesis using this approach.

Sign in / Sign up

Export Citation Format

Share Document