Lumbar facet distraction and fixation in patients with lumbar spinal stenosis: Long-term clinical outcome and reoperation rates

OBJECT Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure, but minimally invasive laminectomy through tubular retractors is an alternative. The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of this procedure in patients who underwent LSS and to compare outcomes in patients with and without preoperative spondylolisthesis. METHODS Patients with LSS without spondylolisthesis and with stable Grade I spondylolisthesis who had undergone minimally invasive tubular laminectomy between 2004 and 2011 were included in this analysis. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, as well as Macnab's criteria. RESULTS Among 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. At a mean follow-up of 28.8 months, scoring revealed a median improvement of 16% on the ODI, 2.75 on the VAS back, and 3 on the VAS leg, compared with the preoperative baseline (p < 0.0001). The reoperation rate requiring fusion at the same level was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or reoperation rate. CONCLUSIONS Minimally invasive laminectomy is an effective procedure for the treatment of LSS. Reoperation rates for instability are lower than those reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be an alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis.

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A long-term (4- to 12-year) follow-up study of surgical treatment of lumbar spinal stenosis

European Spine Journal ◽

10.1007/s005860000161 ◽

2000 ◽

Vol 9 (6) ◽

pp. 563-570 ◽

Cited By ~ 43

Author(s):

M. Cornefjord ◽

G. Byröd ◽

H. Brisby ◽

B. Rydevik

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Follow Up Study ◽

Lumbar Spinal

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Minimally Invasive Laminectomy for Lumbar Spinal Stenosis in Patients with and without Preoperative Spondylolisthesis: Clinical Outcome and Reoperation Rate

Global Spine Journal ◽

10.1055/s-0034-1376717 ◽

2014 ◽

Vol 4 (1_suppl) ◽

pp. s-0034-1376717-s-0034-1376717

Author(s):

M. Alimi ◽

C. P. Hofstetter ◽

S. Y. Pyo ◽

D. Paulo ◽

R. Hartl

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Reoperation Rate ◽

Lumbar Spinal

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Improvement of Back and Leg Pain after Lumbar Spinal Decompression without Fusion

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1669473 ◽

2018 ◽

Vol 80 (02) ◽

pp. 081-087

Author(s):

Nicola Bongartz ◽

Christian Blume ◽

Hans Clusmann ◽

Christian Müller ◽

Matthias Geiger

Keyword(s):

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Leg Pain ◽

Short Term ◽

Clear Trend ◽

Long Term Follow Up ◽

Lumbar Spinal

Background To evaluate whether decompression in lumbar spinal stenosis without fusion leads to sufficient improvement of back pain and leg pain and whether re-decompression alone is sufficient for recurrent lumbar spinal stenosis for patients without signs of instability. Material and Methods A successive series of 102 patients with lumbar spinal stenosis (with and without previous lumbar surgery) were treated with decompression alone during a 3-year period. Data on pre- and postoperative back pain and leg pain (numerical rating scale [NRS] scale) were retrospectively collected from questionnaires with a return rate of 65% (n = 66). The complete cohort as well as patients with first-time surgery and re-decompression were analyzed separately. Patients were dichotomized to short-term follow-up (< 100 weeks) and long-term follow-up (> 100 weeks) postsurgery. Results Overall, both back pain (NRS 4.59 postoperative versus 7.89 preoperative; p < 0.0001) and leg pain (NRS 4.09 versus 6.75; p < 0.0001) improved postoperatively. The short-term follow-up subgroup (50%, n = 33) showed a significant reduction in back pain (NRS 4.0 versus 6.88; p < 0.0001) and leg pain (NRS 2.49 versus 6.91: p < 0.0001). Similar results could be observed for the long-term follow-up subgroup (50%, n = 33) with significantly less back pain (NRS 3.94 versus 7.0; p < 0.0001) and leg pain (visual analog scale 3.14 versus 5.39; p < 0.002) postoperatively. Patients with previous decompression surgery benefit significantly regarding back pain (NRS 4.82 versus 7.65; p < 0.0024), especially in the long-term follow-up subgroup (NRS 4.75 versus 7.67; p < 0.0148). There was also a clear trend in favor of leg pain in patients with previous surgery; however, it was not significant. Conclusions Decompression of lumbar spinal stenosis without fusion led to a significant and similar reduction of back pain and leg pain in a short-term and a long-term follow-up group. Patients without previous surgery benefited significantly better, whereas patients with previous decompression benefited regarding back pain, especially for long-term follow-up with a clear trend in favor of leg pain.

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