Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis

2005 ◽  
Vol 2 (5) ◽  
pp. 624-633 ◽  
Author(s):  
Ko Ikuta ◽  
Junichi Arima ◽  
Takayuki Tanaka ◽  
Masayoshi Oga ◽  
Soichiro Nakano ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Posterior Decompression ◽  
Technical Problems ◽  
Content Type ◽  
The Mean ◽  
Lumbar Spinal ◽  
Fine Print

Object. The authors applied the technique of microendoscopic discectomy to posterior decompression procedures for lumbar spinal stenosis. The purpose of this study was to determine the feasibility of using an endoscopic technique to treat lumbar spinal stenosis and to evaluate the clinical and radiographic results of microendoscopic posterior decompression (MEPD). Methods. Microendoscopic posterior decompression, which involves a unilateral endoscopic approach for bilateral decompression, was performed in 47 patients. Clinical and radiographic/neuroimaging results were evaluated during the follow-up period (minimum duration 1 year). The clinical results were compared with those of the conventional laminotomy. Radiographic instability and the degree of surgical invasion of the facet joints were evaluated. In a control a group of 29 patients open laminotomy was performed. The clinical outcome was evaluated in 44 patients. The mean follow-up duration was 22 months. The mean rate of improvement was 72% based on the Japanese Orthopaedic Association score, and good results were obtained in 38 patients. Although the rate of morbidity decreased in the MEPD group, the incidence of complication was slightly higher. Effective decompression was demonstrated in the majority of the patients by using magnetic resonance imaging. Radiographic instability appeared in one patient postoperatively, and based on computerized tomography scanning, a tendency toward invasion of the facet joint on the approach side was noted. Conclusions. Microendoscopic posterior decompression is a minimally invasive procedure and is as useful as other conventional procedures in treating lumbar spinal stenosis; however, a few technical problems remain to be solved.

Results of degenerative spondylolisthesis treated with posterior decompression alone via a new surgical approach

2001 ◽  
Vol 95 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Tomoaki Kinoshita ◽  
Isao Ohki ◽  
Kenneth R. Roth ◽  
Kageharu Amano ◽  
Hideshige Moriya
Keyword(s):  
Japanese Orthopaedic Association ◽  
Degenerative Spondylolisthesis ◽  
Spinal Instability ◽  
Content Type ◽  
Significant Difference ◽  
Potential Alternative ◽  
The Mean ◽  
New Surgical Technique ◽  
Fine Print

Object. The purpose of this study was to assess radiologically demonstrated results and clinical outcomes in patients with degenerative spondylolisthesis who underwent posterior decompressive surgery via a new (unilateral) approach. This approach allows surgeons to perform central and bilateral decompression while only stripping the muscles unilaterally, thus preserving the posterior osteoligamentous complexes. Methods. The authors evaluated 51 consecutive patients in whom surgery was performed between 1987 and 1996. The mean follow-up period was 4.7 years. There was no statistically significant difference between the pre- and postoperative measurements in percentage of vertebral slippage. Postoperative dynamic angulation statistically decreased compared with its preoperative value (p < 0.05). Improvement of an average of 67% was shown on the Japanese Orthopaedic Association scale, and in 78% of these patients, good to excellent results were demonstrated. Secondary fusion was required in only three patients (5.9%). Conclusions. This new surgical technique offers a potential alternative for the treatment of degenerative spondylolisthesis in a minimally invasive manner, avoiding the risk of causing or aggravating postoperative spinal instability.

Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age

1999 ◽  
Vol 91 (2) ◽  
pp. 181-185 ◽  
Author(s):  
Todd W. Vitaz ◽  
George H. Raque ◽  
Christopher B. Shields ◽  
Steven D. Glassman
Keyword(s):  
Surgical Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Intraoperative Complication ◽  
Content Type ◽  
Fusion Procedure ◽  
Lumbar Decompression ◽  
Preoperative Selection ◽  
Lumbar Spinal ◽  
Fine Print

Object. The purpose of this study was to evaluate the safety and efficacy of the surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. Methods. The authors reviewed the records of 65 patients with lumbar spinal stenosis who were at least 75 years of age at the time of surgery, which was performed between November 1990 and May 1996. The 65 patients (43 women, 22 men; average age 78 years) underwent a total of 71 operations (one patient underwent three, and four patients underwent two). Fifteen patients (21%) underwent isolated lumbar decompression, and 56 patients (79%) underwent decompression in conjunction with posterior spinal fusion. There was an average of 1.7 levels decompressed per isolated lumbar decompression and 2.6 levels per decompression and fusion procedure. Seven patients (10%) experienced one or more serious postoperative complication, which included wound infection, septicemia, small bowel obstruction, stroke, myocardial infarction, gastrointestinal bleeding, and pulmonary embolus. In addition there was one intraoperative complication (hypotension [1%]) that required modification of the planned surgical procedure. No deaths were documented in the perioperative period. Conclusions. With appropriate preoperative selection and evaluation, careful intraoperative monitoring, and attentive perioperative care, the surgical treatment of elderly patients with lumbar spinal stenosis can effect significant improvement with acceptable levels of morbidity and mortality.

Familial lumbar spinal stenosis with acute disc herniations

1979 ◽  
Vol 51 (2) ◽  
pp. 234-236 ◽  
Author(s):  
George Varughese ◽  
Gilbert R. C. Quartey
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Case Histories ◽  
Content Type ◽  
Spinal Lesions ◽  
Hereditary Factors ◽  
Disc Herniations ◽  
Lumbar Spinal ◽  
Fine Print

✓ The case histories are reported of four brothers with lumbosciatic syndrome due to acute disc herniations, and associated spinal stenosis. Hereditary factors, although not hitherto reported, may be implicated for these spinal lesions, as the parents had also undergone spinal operations previously.

Spinal stenosis due to ossified lumbar lesions

2005 ◽  
Vol 3 (4) ◽  
pp. 262-270 ◽  
Author(s):  
Yoshiharu Kawaguchi ◽  
Takeshi Oya ◽  
Yumiko Abe ◽  
Masahiko Kanamori ◽  
Hirokazu Ishihara ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Surgical Results ◽  
Content Type ◽  
Spinal Lesions ◽  
Whole Spine ◽  
Fine Print

Object. Spinal stenosis due to lumbar ossified lesions is a rare pathological entity. The authors retrospectively evaluated the clinical features and surgical results associated with cases involving lumbar ossified lesion—induced stenosis. Methods. Data obtained in 20 surgically treated patients with lumbar hyperostotic spinal stenosis were included. To evaluate the background of the disease, body mass index and general complications were assessed. Whole-spine radiological examination was conducted. The presence of ossification of the posterior longitudinal ligament or ossification of the ligamentum flavum was evaluated. Surgical results were classified according to the Japanese Orthopaedic Association (JOA) scale. In the patients in whom neurological deterioration was observed during follow up, the causes of deterioration were reviewed. Seven patients (35%) were obese and six patients (30%) suffered diabetes mellitus. Twelve patients harbored coexisting cervical and/or thoracic ossified lesions. The overall mean JOA score improved from 10.2 to a peak of 22.5; at last follow-up examination the mean JOA score was 20.9. In female and older patients with a long history of preoperative symptoms, a low preoperative JOA score, and other spinal lesions, recovery tended to be poorer. Recovery was poor in one patient, and neurological deterioration due to coexisting ossified spinal lesions occurred in another patient during the follow-up period. Conclusions. Because coexisting ossified lesions were frequently seen, whole-spine analysis is recommended. Early diagnosis and appropriate treatment are important to achieve a better surgical outcome.

Lumbar spinal stenosis: postoperative results in terms of preoperative posture-related pain

1990 ◽  
Vol 72 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Jeremy C. Ganz
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Selection Criteria ◽  
Decompressive Surgery ◽  
Leg Pain ◽  
Postoperative Result ◽  
Content Type ◽  
Lumbar Spinal ◽  
Exacerbation Of Symptoms ◽  
Fine Print

✓ Thirty-three consecutive patients with lumbar spinal stenosis were treated with decompressive surgery aimed at relieving pain. The selection criteria for surgery included marked symptoms and lumbar spinal stenosis demonstrated by myelography. Preoperatively, only 15 patients had claudication; however, 23 experienced relief or exacerbation of symptoms related to changes in posture. A good postoperative result was obtained in 82% of the entire series, but in only 50% of patients whose symptoms were not affected by posture. Of those whose symptoms did have a postural component, a good result was obtained in 96%. The relief of back pain by decompressive surgery was significantly less successful than the relief of leg pain. It is therefore suggested that surgery be restricted to as few levels as possible.

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.

Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome

1995 ◽  
Vol 83 (1) ◽  
pp. 27-30 ◽  
Author(s):  
H. Gordon Deen ◽  
Richard S. Zimmerman ◽  
Mark K. Lyons ◽  
Malcolm C. McPhee ◽  
Joseph L. Verheijde ◽  
...  
Keyword(s):  
Functional Status ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Exercise Tolerance ◽  
Walking Speed ◽  
Neurogenic Claudication ◽  
Content Type ◽  
The Mean ◽  
Lumbar Spinal ◽  
Mean Time

✓ A prospective study of patients with neurogenic claudication and lumbar spinal stenosis was undertaken to determine whether measurement of exercise tolerance on the treadmill would be useful in defining baseline functional status and response to surgical treatment. Twenty patients with an average age of 73 years, all of whom had intractable neurogenic claudication and radiographically confirmed severe lumbar spinal stenosis, were studied. Lumbar decompressive laminectomy was performed in all patients. Preoperatively and 2 months postoperatively, quantitative assessment of ambulation was conducted on a treadmill at 0° ramp incline at two different speeds: 1.2 mph and the patient's preferred walking speed. The following information was recorded: time to first symptoms, time to severe symptoms, and nature of symptoms (leg pain, back pain, or generalized fatigue). The examination was stopped after 15 minutes or at the onset of severe symptoms. In the preoperative 1.2-mph trial, the mean time to first symptoms was 2.68 minutes (median 1.31) and the mean time to severe symptoms was 5.47 minutes (median 3.42). In the postoperative trial at the same speed, 13 patients (65%) were able to walk symptom free for 15 minutes. The mean time to first symptoms was 11.12 minutes (median 15) and the mean time to severe symptoms was 11.81 minutes (median 15). Similar findings were recorded in the preferred walking—speed trials. There were no complications from the treadmill testing procedure. These findings indicate that exercise stress testing on a treadmill is a safe, easily administered, and quantifiable means of assessing baseline functional status and outcome following laminectomy in patients with symptomatic lumbar spinal stenosis.

scholarly journals Unfolding the outcomes of surgical treatment of lumbar spinal stenosis—a prospective 5- and 10-year follow-up study

2020 ◽  
Vol 29 (9) ◽  
pp. 2231-2242
Author(s):  
I. Tuomainen ◽  
T Aalto ◽  
J. Pesonen ◽  
M. Rade ◽  
M. Pakarinen ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Surgical Outcomes ◽  
Walking Distance ◽  
Walking Ability ◽  
Pain Disability ◽  
Study Results ◽  
The Mean ◽  
Lumbar Spinal

Abstract Purpose In this prospective study, we aim to determine surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery. Methods The study population consisted of 96 LSS patients who underwent decompressive surgery, 72 of whom participated in the 10-year follow-up. The patients completed a questionnaire preoperatively and 3 months, 5 years, and 10 years postoperatively. Outcome measures were satisfaction with the surgical outcomes, the Oswestry Disability Index (ODI), the visual analog scale (VAS), the numeric rating scale (NRS-11), and walking ability quantified in meters. Postoperative improvements at 5 and 10 years were analyzed using linear mixed models. Furthermore, comparisons between postoperative time points were made for clinical courses of pain, disability, and walking ability. Results At the 10-year follow-up, 68% of the patients were satisfied with the surgical outcomes. All the measured outcomes showed statistically significant improvement from baseline to the 5- and 10-year follow-up. The mean VAS score was 9.8 mm higher at the 5-year follow-up and 7.8 mm at the 10-year follow-up compared to the 3-month follow-up point. Similarly, the mean ODI was 4.8% higher at the 10-year follow-up compared to the 3-month follow-up point. Conclusion This study reports the clinical course of pain, disability, and walking distance after LSS surgery with the 10-year follow-up. Based on our study results, patients with LSS could expect to have positive effects of their back surgery up to 10 years. However, minor worsening in pain and disability may occur and one-fourth of the patients may need a reoperation during the 10-year follow-up period.

scholarly journals Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis: Preliminary Report of Seven Cases with 12-Month Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jincai Yang ◽  
Chang Liu ◽  
Yong Hai ◽  
Peng Yin ◽  
Lijin Zhou ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Operation Time ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
The Mean ◽  
Bone Trabeculae ◽  
Lumbar Spinal

Purpose. The objective of this study was to investigate the preliminary effectiveness of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of lumbar spinal stenosis (LSS). Methods. From September 2016 to June 2017, a series of seven patients consisting of six females and one male with an average age of 55.25 years (range 43–77 years) who were diagnosed with LSS were involved in this study. All patients were treated by PE-TLIF. During perioperative and follow-up period, demographic data, operation time, intraoperative blood loss, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria were evaluated and perioperative complications were documented. Results. All patients were followed up for more than 12 months, with an average follow-up time of 15 (range 12-21) months. The mean VAS of back pain was 7.43 (range 6-8) preoperatively and 0.86 (range 0-2) at the final follow-up. The mean VAS of leg pain was 6.14 (range 4-9) preoperatively and 0.71 (range 0-1) at the final follow-up. The mean ODI was 53.57% (range 38%-63%) preoperatively and 15.57% (range 5%-26%) at the final follow-up. In three-month follow-up, continuous bone trabeculae bridging between intervertebral bodies was seen in 3 cases, and the remaining 4 cases could identify continuous bone trabeculae bridging at 6-month follow-up, reaching the standard of spinal intervertebral fusion. At the final follow-up, 4 patients were rated as excellent (4/7) and 3 patients were rated as good (3/7) according to the modified MacNab criteria. Conclusions. Our study suggested that percutaneous endoscopic transforaminal lumbar interbody fusion could acquire satisfactory treatment effects for the patients with lumbar spinal stenosis, even for the patient who could not afford general anesthesia.

MIDTERM OUTCOME AFTER MICROENDOSCOPIC DECOMPRESSIVE LAMINOTOMY FOR LUMBAR SPINAL STENOSIS

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 100-110 ◽  
Author(s):  
Manuel Castro-Menéndez ◽  
Jose A. Bravo-Ricoy ◽  
Roberto Casal-Moro ◽  
Moisés Hernández-Blanco ◽  
Francisco J. Jorge-Barreiro
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Oswestry Disability Index Score ◽  
Pain Visual Analog Scale ◽  
The Mean ◽  
Lumbar Spinal

ABSTRACT OBJECTIVE To evaluate the efficacy of radicular decompression in lumbar spinal stenosis using a microendoscopic technique. METHODS This was a longitudinal prospective study of 50 patients with a diagnosis of lumbar spinal stenosis who were treated by microendoscopic decompression using an 18-mm METRx tubular retractor according to the METRx technique (Medtronic Sofamor Danek, Memphis, TN). Twenty of the patients had an additional disc prolapse, and a microendoscopic discectomy was associated with decompressive laminectomy. The results were evaluated using the visual analog scale pain score, Oswestry Disability Index score, patient satisfaction questionnaire, and modified Macnab classification. RESULTS The average age of the patients was 56 years; 29 (58%) were men and 21 (42%) were women. The most commonly affected level was L4–L5 (64%). The mean surgical intervention time was 94.3 (± 14.3) minutes. Mean postoperative hospital stay was 3.16 (± 2.3) days. The follow-up time after surgery was 4 years (48 ± 6.6 months; range, 24–72 months). We obtained good or excellent results in 72% of patients, achieving good subjective satisfaction in 68% of the patients. The mean decrease in the Oswestry Disability Index score was 30.23 (± 24.29), the mean decrease in the leg pain visual analog scale score was 6.02 (± 2.57), and the mean decrease in the lumbar pain visual analog scale score was 0.84 (± 2.06). Adjusted mean differences were in all cases statistically significant (P &lt;0.05). CONCLUSION Data indicate that, in our experience, on midterm follow-up, microendoscopic laminectomy decompression is an effective technique for the treatment of lumbar spinal stenosis.

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