Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system

Sylvain Palmer; Robert Turner; Rosemary Palmer

doi:10.3171/foc.2002.13.1.5

Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.2.0213 ◽

2002 ◽

Vol 97 (2) ◽

pp. 213-217 ◽

Cited By ~ 35

Author(s):

Sylvain Palmer ◽

Robert Turner ◽

Rosemary Palmer

Keyword(s):

Mr Imaging ◽

Blood Loss ◽

Spinal Stenosis ◽

Outpatient Basis ◽

Tubular Retractor ◽

Content Type ◽

Unilateral Approach ◽

Flexion Extension ◽

The Mean ◽

Fine Print

Object. The authors studied a consecutive series of patients with spinal stenosis in whom surgery was performed by a single surgeon who used a microscopic tubular retractor system (METRx-MD); patients underwent prospective evaluation involving radiography and magnetic resonance (MR) imaging. The objective was to assess the feasibility and surgery-related efficacy of performing unilateral-approach bilateral decompression and utilization of METRx-MD instrumentation in patients with spinal stenosis. Methods. Seventeen consecutive patients with spinal stenosis underwent bilateral decompression; surgery was performed via a unilateral approach using METRx-MD instrumentation. The procedures were performed on an outpatient basis after induction of general anesthesia. Preoperative and 3-month follow-up plain radiographs with flexion—extension views were obtained. Preoperative and postoperative MR imaging was also performed. All studies were assessed by a single radiologist blinded to the clinical results. Twenty-two levels were surgically decompressed. The mean operative time was 90 minutes and the mean blood loss was 28 ml per level. Preoperatively stenosis was severe at 13 levels, moderate/severe at eight, and moderate at one. Postoperatively stenosis was absent at 13 levels, mild at seven, mild/moderate at one, and moderate at one. Preoperatively degenerative spondylolisthesis was documented in eight patients, with flexion—extension radiography revealing motion in three cases. On early (3-month) postoperative x-ray films there was no evidence of progression in any case. Grade I spondylolisthesis developed postoperatively in one patient, who remained asymptomatic. Conclusions. Minimally invasive bilateral decompression and instrumentation-assisted fusion can be successfully performed via a unilateral approach in patients with acquired spinal stenosis; the procedure can be undertaken on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity rates.

Download Full-text

Management of intended durotomy in minimally invasive intradural spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2014.3.spine13719 ◽

2014 ◽

Vol 21 (2) ◽

pp. 279-285 ◽

Cited By ~ 14

Author(s):

Lee A. Tan ◽

Ippei Takagi ◽

David Straus ◽

John E. O'Toole

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Length Of Hospital Stay ◽

Bed Rest ◽

Tubular Retractor ◽

Specific Patient ◽

Dural Closure ◽

Estimated Blood Loss ◽

The Mean ◽

Operative Notes

Object Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. Methods A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. Results Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. Conclusions Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

Download Full-text

Endoscopic decompression for the treatment of lumbar spinal stenosis: an updated systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2021.8.spine21890 ◽

2021 ◽

pp. 1-9

Author(s):

Roberto J. Perez-Roman ◽

Wendy Gaztanaga ◽

Victor M. Lu ◽

Michael Y. Wang

Keyword(s):

Systematic Review ◽

Back Pain ◽

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Meta Analysis ◽

Lumbar Stenosis ◽

Lumbar Spinal ◽

Endoscopic Methods

OBJECTIVE Lumbar stenosis treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between endoscopic (uni- and biportal) and microscopic techniques for the treatment of lumbar stenosis. METHODS Following PRISMA guidelines, a systematic search was performed using the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid Embase, and PubMed databases from their dates of inception to December 14, 2020. All identified articles were then systematically screened against the following inclusion criteria: 1) studies comparing endoscopic (either uniportal or biportal) with minimally invasive approaches, 2) patient age ≥ 18 years, and 3) diagnosis of lumbar spinal stenosis. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata. RESULTS From a total of 470 studies, 14 underwent full-text assessment. Of these 14 studies, 13 comparative studies were included for quantitative analysis, totaling 1406 procedures satisfying all criteria for selection. Regarding postoperative back pain, 9 studies showed that endoscopic methods resulted in significantly lower pain scores compared with MIS (mean difference [MD] −1.0, 95% CI −1.6 to −0.4, p < 0.01). The length of stay data were reported by 7 studies, with endoscopic methods associated with a significantly shorter length of stay versus the MIS technique (MD −2.1 days, 95% CI −2.7 to −1.4, p < 0.01). There was no significant difference with respect to leg visual analog scale scores, Oswestry Disability Index scores, blood loss, surgical time, and complications, and there were not any significant quality or bias concerns. CONCLUSIONS Both endoscopic and MIS techniques are safe and effective methods for treating patients with symptomatic lumbar stenosis. Patients who undergo endoscopic surgery seem to report less postoperative low-back pain and significantly reduced hospital stay with a trend toward less perioperative blood loss. Future large prospective randomized trials are needed to confirm the findings in this study.

Download Full-text

Long-Term Clinical Outcome and Reoperation Rate for Microsurgical Bilateral Decompression via Unilateral Approach of Lumbar Spinal Stenosis

World Neurosurgery ◽

10.1016/j.wneu.2019.01.105 ◽

2019 ◽

Vol 125 ◽

pp. e465-e472

Author(s):

İsmail Yüce ◽

Okan Kahyaoğlu ◽

Halit Arda Çavuşoğlu ◽

Halit Çavuşoğlu ◽

Yunus Aydın

Keyword(s):

Clinical Outcome ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Reoperation Rate ◽

Unilateral Approach ◽

Lumbar Spinal

Download Full-text

Treatment of lumbar spinal stenosis with a total posterior arthroplasty prosthesis: implant description, surgical technique, and a prospective report on 29 patients

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.1.14 ◽

2007 ◽

Vol 22 (1) ◽

pp. 1-11 ◽

Cited By ~ 32

Author(s):

Paul McAfee ◽

Larry T. Khoo ◽

Luiz Pimenta ◽

Andy Capuccino ◽

Domagoj Coric ◽

...

Keyword(s):

Spinal Stenosis ◽

Short Form ◽

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment ◽

Surgical Morbidity ◽

Flexion Extension ◽

Surgical Data ◽

The Mean ◽

Facet Arthropathy

Object Total disc replacement is an alternative to lumbar fusion, but patients with spinal stenosis, spondylolisthesis, and facet arthropathy are often excluded from this procedure because increased adjacent-segment motion can exacerbate dorsal spondylotic changes. In such cases of degenerative spondylolisthesis with stenosis, decompression and fusion remain the gold standard of treatment. To avoid attendant loss of motion at the treated segment, the TOPS system is a novel total posterior arthroplasty prosthesis that allows for an alternative dynamic, multiaxial, three-column stabilization and motion preservation. The purpose of this study is to report preliminary surgical data and clinical outcomes in patients treated with the TOPS lumbar total posterior arthroplasty system. Methods Twenty-nine patients were enrolled in a nonrandomized, multicenter, prospective pilot study outside the US. All patients had spinal stenosis and/or spondylolisthesis at L4–5 due to facet arthropathy. Radiographs and scores on outcome measures including the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI), Short Form-36, and Zurich Claudication Questionnaire were prospectively recorded before surgery and at 6-week, 3-month, 6-month, and 1-year intervals after surgery. Prior to instrumentation, a bilateral total facetectomy and laminectomy at L4–5 or L3–4 was performed via a standard midline posterior approach. After decompression, the TOPS screws were inserted into four pedicles to achieve maximal purchase with triangulating bicortical trajectories. An appropriately sized TOPS arthroplasty implant was then applied. The mean surgical time was 3.1 hours, and patients' clinical status improved significantly following treatment with the TOPS device. The mean ODI score decreased compared with baseline by 41% at 1 year, and the 100-mm VAS score declined by 76 mm over the same time period. Radiographic analysis showed that lumbar motion was maintained, disc height was preserved, and no evidence of screw loosening was found. No device malfunctions or migrations and no device-related adverse events were reported during the study. Conclusions The TOPS total posterior arthroplasty system represents a novel, dynamic, posterior arthroplasty device that provides multiaxial stability in flexion, extension, rotation, and lateral bending after total facetectomy and neural decompression. The surgical data indicate that it can be safely applied via a traditional approach with low surgical morbidity and excellent 1-year functional and radiographic outcomes in patients with degenerative spondylolisthesis accompanied by stenosis and back pain.

Download Full-text

Clinical Outcomes of Posterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Three-Level Degenerative Lumbar Spinal Stenosis

BioMed Research International ◽

10.1155/2016/9540298 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Guoxin Fan ◽

Xinbo Wu ◽

Shunzhi Yu ◽

Qi Sun ◽

Xiaofei Guan ◽

...

Keyword(s):

Blood Loss ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Degenerative Lumbar Spinal Stenosis ◽

Sf 36 ◽

Lumbar Spinal

The aim of this study was to directly compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in three-level lumbar spinal stenosis. This retrospective study involved a total of 60 patients with three-level degenerative lumbar spinal stenosis who underwent MIS-TLIF or PLIF from January 2010 to February 2012. Back and leg visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) scale were used to assess the pain, disability, and health status before surgery and postoperatively. In addition, the operating time, estimated blood loss, and hospital stay were also recorded. There were no significant differences in back VAS, leg VAS, ODI, SF-36, fusion condition, and complications at 12-month follow-up between the two groups (P>0.05). However, significantly less blood loss and shorter hospital stay were observed in MIS-TLIF group (P<0.05). Moreover, patients undergoing MIS-TLIF had significantly lower back VAS than those in PLIF group at 6-month follow-up (P<0.05). Compared with PLIF, MIS-TLIF might be a prior option because of noninferior efficacy as well as merits of less blood loss and quicker recovery in treating three-level lumbar spinal stenosis.

Download Full-text

Functional outcome of Lumber Spinal Stenosis in Laminectomy, Laminotomy and Unilateral approach

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i2.44883 ◽

2020 ◽

Vol 9 (2) ◽

pp. 105-110

Author(s):

Md Moshiur Rahman ◽

SIM Khairun Nabi Khan ◽

Robert Ahmed Khan ◽

Md Rokibul Islam ◽

Umme Kulsum Sharmin Zaman ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Spinal Stenosis ◽

Revision Surgery ◽

Surgical Outcome ◽

Leg Pain ◽

Patients Âgés ◽

Unilateral Approach ◽

Satisfactory Outcome

Objective: The objective of the study was to compare the surgical outcome between Bilateral Laminotomy, Laminectomy and Unilateral approach in Lumber Spinal Stenosis. Methods: One hundred forty four (144) patients were going to underwent three prospective surgery such as Bilateral Laminotomy (48 patients), Laminectomy (48 patient) and Unilateral approach (48 patients). This study conducted between 2009 to 2014 at private medical hospitals in Dhaka. All the patients ages are e” 40. All the patients were observed prospectively. Clinical outcomes for back and leg pain were analyses using Oswestry Disability Index (ODI) questionnaires and Swiss score. Results: Satisfactory decompression was accomplished in all patients. The complications were less in patients who had experienced Unilateral Laminotomy rather than Bilateral Laminotomy and Laminectomy. Mean age of patients were 52.16+/ - 6.87 years with the range of 40-68 years. Among them 101 patients are male (70.11%) and 43 patients are female (29.99%). The rates of improvements are 79.17% in Laminectomy, 85.1% in Bilateral Laminotomy and 91.9% in Unilateral Laminotomy. From here unilateral Laminotomy have quite better results than others. Minimum follow up period was 2 years. Conclusion: Unilateral Laminotomy has a satisfactory outcome in Lumber Spinal Stenosis surgery in comparison to rest of two approaches. Postoperative complications were minimum in respect to blood loss, hospital stay and revision surgery. Bang. J Neurosurgery 2020; 9(2): 105-110

Download Full-text

Paraspinal Muscle Denervation, Paradoxically Good Lumbar Endurance, and an Abnormal Flexion–Extension Cycle in Lumbar Spinal Stenosis

Spine ◽

10.1097/01.brs.0000048495.81763.8c ◽

2003 ◽

Vol 28 (4) ◽

pp. 324-331 ◽

Cited By ~ 8

Author(s):

Ville Leinonen ◽

Sara Määttä ◽

Simo Taimela ◽

Arto Herno ◽

Markku Kankaanpää ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Paraspinal Muscle ◽

Muscle Denervation ◽

Flexion Extension ◽

Lumbar Spinal

Download Full-text

Treatment of lumbar spinal stenosis with a total posterior arthroplasty prosthesis: implant description, surgical technique, and a prospective report on 29 patients

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.1.13 ◽

2007 ◽

Vol 22 (1) ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Paul McAfee ◽

Larry T. Khoo ◽

Luiz Pimenta ◽

Andy Capuccino ◽

Domagoj Coric ◽

...

Keyword(s):

Spinal Stenosis ◽

Short Form ◽

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment ◽

Surgical Morbidity ◽

Flexion Extension ◽

Surgical Data ◽

The Mean ◽

Facet Arthropathy

Object Total disc replacement is an alternative to lumbar fusion, but patients with spinal stenosis, spondylolisthesis, and facet arthropathy are often excluded from this procedure because increased adjacent-segment motion can exacerbate dorsal spondylotic changes. In such cases of degenerative spondylolisthesis with stenosis, decompression and fusion remain the gold standard of treatment. To avoid attendant loss of motion at the treated segment, the TOPS system is a novel total posterior arthroplasty prosthesis that allows for an alternative dynamic, multiaxial, three-column stabilization and motion preservation. The purpose of this study is to report preliminary surgical data and clinical outcomes in patients treated with the TOPS lumbar total posterior arthroplasty system. Methods Twenty-nine patients were enrolled in a nonrandomized, multicenter, prospective pilot study outside the US. All patients had spinal stenosis and/or spondylolisthesis at L4–5 due to facet arthropathy. Radiographs and scores on outcome measures including the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI), Short Form-36, and Zurich Claudication Questionnaire were prospectively recorded before surgery and at 6-week, 3-month, 6-month, and 1-year intervals after surgery. Prior to instrumentation, a bilateral total facetectomy and laminectomy at L4–5 or L3–4 was performed via a standard midline posterior approach. After decompression, the TOPS screws were inserted into four pedicles to achieve maximal purchase with triangulating bicortical trajectories. An appropriately sized TOPS arthroplasty implant was then applied. The mean surgical time was 3.1 hours, and patients' clinical status improved significantly following treatment with the TOPS device. The mean ODI score decreased compared with baseline by 41% at 1 year, and the 100-mm VAS score declined by 76 mm over the same time period. Radiographic analysis showed that lumbar motion was maintained, disc height was preserved, and no evidence of screw loosening was found. No device malfunctions or migrations and no device-related adverse events were reported during the study. Conclusions The TOPS total posterior arthroplasty system represents a novel, dynamic, posterior arthroplasty device that provides multiaxial stability in flexion, extension, rotation, and lateral bending after total facetectomy and neural decompression. The surgical data indicate that it can be safely applied via a traditional approach with low surgical morbidity and excellent 1-year functional and radiographic outcomes in patients with degenerative spondylolisthesis accompanied by stenosis and back pain.

Download Full-text

Long-Term Outcome of Microendoscopic Diskectomy for Lumbar Disk Herniation. A Clinical Study of Consecutive 112 Cases with More than 5-Year Follow-Up

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1598657 ◽

2017 ◽

Vol 78 (05) ◽

pp. 446-452 ◽

Cited By ~ 2

Author(s):

Noriyuki Iesato ◽

Yoshinori Terashima ◽

Katsumasa Tanimoto ◽

Tsuneo Takebayashi ◽

Toshihiko Yamashita ◽

...

Keyword(s):

Blood Loss ◽

Recurrence Rate ◽

Operative Time ◽

Clinical Results ◽

Improvement Rate ◽

Long Term Outcome ◽

Sf 36 ◽

The Mean

Background Clinical results and recurrence rate after microendoscopic diskectomy (MED) with long-term follow-up is still unclear, in spite of its relatively long history. Materials and Methods A total of 112 who underwent MED participated in this study. Operative time, blood loss, serum C-reactive protein (CRP), creatine kinase (CK), and visual analog scale (VAS) were evaluated as indexes of surgical invasiveness. The 36-Item Short Form Survey Instrument (SF-36), Japanese Orthopaedic Association (JOA) score, patient satisfaction, and recurrence were also evaluated with a follow-up of at least 5 years. Results The mean operative time was 86.7 minutes, and the mean blood loss was 35.7 mL. The mean CRP on postoperative day 3 and CK on the first postoperative day was 0.72 mg/dL and 224.6 IU/L, respectively, and VAS to assess surgical site pain on the first postoperative day was 24.9 mm on average. The improvement rate in the JOA score was 68.7%. The physical component summary of SF-36 in norm-based scoring was improved from 23.4 to 48.6. Overall, 90.8% of patients evaluated their response to the surgery as extremely satisfied or satisfied. The recurrence rate was 10.5%, and reoperation was performed in 7.9% of patients. Conclusions MED is a technique that offers both reduced invasiveness and good long-term clinical results.

Download Full-text