scholarly journals Minimally Invasive Lumbar Spinal Decompression in Elderly Patients with Magnetic Resonance Imaging Morphological Analysis

2018 ◽  
Vol 12 (2) ◽  
pp. 285-293 ◽  
Author(s):  
Seungman Ha ◽  
Youngho Hong ◽  
Seungcheol Lee
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Clinical Symptoms ◽  
Morphological Features ◽  
Radiological Parameters ◽  
Significant Difference ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Case-control study.</p></sec><sec><title>Purpose</title><p>In this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with lumbar spinal stenosis (LSS) who were treated by minimally invasive surgery (MIS) unilateral laminectomy for bilateral decompression (ULBD) using a tubular retractor.</p></sec><sec><title>Overview of Literature</title><p>Numerous methods using imaging have been attempted to describe the severity of spinal stenosis. But the relationship between clinical symptoms and radiological features remains debatable.</p></sec><sec><title>Objective</title><p>In this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with LSS who were treated by MIS-ULBD.</p></sec><sec><title>Methods</title><p>We methodically assessed 85 consecutive patients aged &gt;65 years who were treated for LSS. The patients were retrospectively analyzed in two age groups: 66–75 years (group 1) and &gt;75 years (group 2). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria. Outcome parameters were compared between the groups at the 1-year follow-up. Core radiologic parameters for central and lateral stenosis were analyzed and clinical findings of the groups were compared.</p></sec><sec><title>Results</title><p>At the 1-year follow-up, patients in both groups 1 and 2 demonstrated significant improvement in their VAS and ODI scores. All clinical outcomes, except postoperative ODI, were not significantly difference between the groups. In addition, no significant difference was noted in the preoperative radiological parameters between the groups. There was no statistically significant correlation between radiological parameters and clinical symptoms or their outcomes. Moreover, no differences were noted in perioperative adverse events and in the need for repeat surgery at follow-ups between the groups.</p></sec><sec><title>Conclusions</title><p>MIS-ULBD by tubular approach is a safe and effective treatment option for elderly patients with LSS. Clinical outcomes in patients with LSS and aged &gt;75 years were comparable with those in patients with LSS and aged 66–75 years. Moreover, we did not find any correlation between radiological parameters and clinical outcomes in either of the two patient groups.</p></sec>

The effect of minimally invasive lumbar decompression surgery on sagittal spinopelvic alignment in patients with lumbar spinal stenosis: a 5-year follow-up study

2021 ◽  
pp. 1-8
Author(s):  
Hamidullah Salimi ◽  
Hiromitsu Toyoda ◽  
Kentaro Yamada ◽  
Hidetomi Terai ◽  
Masatoshi Hoshino ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Decompression Surgery ◽  
Vas Score ◽  
Spinopelvic Alignment ◽  
Sagittal Malalignment ◽  
Lumbar Spinal

OBJECTIVE Several studies have examined the relationship between sagittal spinopelvic alignment and clinical outcomes after spinal surgery. However, the long-term reciprocal changes in sagittal spinopelvic alignment in patients with lumbar spinal stenosis after decompression surgery remain unclear. The aim of this study was to investigate radiographic changes in sagittal spinopelvic alignment and clinical outcomes at the 2-year and 5-year follow-ups after minimally invasive lumbar decompression surgery. METHODS The authors retrospectively studied the medical records of 110 patients who underwent bilateral decompression via a unilateral approach for lumbar spinal stenosis. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain (LBP), leg pain, leg numbness, and spinopelvic parameters were evaluated before surgery and at the 2-year and 5-year follow-ups. Sagittal malalignment was defined as a sagittal vertical axis (SVA) ≥ 50 mm. RESULTS Compared with baseline, lumbar lordosis significantly increased after decompression surgery at the 2-year (30.2° vs 38.5°, respectively; p < 0.001) and 5-year (30.2° vs 35.7°, respectively; p < 0.001) follow-ups. SVA significantly decreased at the 2-year follow-up compared with baseline (36.1 mm vs 51.5 mm, respectively; p < 0.001). However, there was no difference in SVA at the 5-year follow-up compared with baseline (50.6 mm vs 51.5 mm, respectively; p = 0.812). At the 5-year follow-up, 82.5% of patients with preoperative normal alignment maintained normal alignment, whereas 42.6% of patients with preoperative malalignment developed normal alignment. Preoperative sagittal malalignment was associated with the VAS score for LBP at baseline and 2-year and 5-year follow-ups and the JOA score at the 5-year follow-up. Postoperative sagittal malalignment was associated with the VAS score for LBP at the 2-year and 5-year follow-ups and the VAS score for leg pain at the 5-year follow-up. There was a trend toward deterioration in clinical outcomes in patients with persistent postural malalignment compared with other patients. CONCLUSIONS After minimally invasive surgery, spinal sagittal malalignment can convert to normal alignment at both short-term and long-term follow-ups. Sagittal malalignment has a negative impact on the VAS score for LBP and a weakly negative impact on the JOA score after decompression surgery.

scholarly journals Comparison of Clinical Outcomes Following Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis With Degenerative Spondylolisthesis

2021 ◽  
Vol 7 ◽  
Author(s):  
Wenbin Hua ◽  
Bingjin Wang ◽  
Wencan Ke ◽  
Qian Xiang ◽  
Xinghuo Wu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Complication Rate ◽  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lumbar Spinal

Introduction: Both lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have been used to treat one-level lumbar spinal stenosis (LSS) with degenerative spondylolisthesis, while the differences of the clinical outcomes are still uncertain.Methods: Among 60 consecutive patients included, 24 surgeries were performed by LE-ULBD and 36 surgeries were performed by MI-TLIF. Patient demographics, operation characteristics and complications were recorded. Sagittal parameters, including slip percentage (SP) and slip angle (SA) were compared. The visual analog scale (VAS) score, the Oswestry Disability Index (ODI) score, and Macnab criteria were used to evaluate the clinical outcomes. Follow-up examinations were conducted at 3, 6, 12, and 24 months postoperatively.Results: The estimated blood loss, time to ambulation and length of hospitalization of the LE-ULBD group were shorter than the MI-TLIF group. Preoperative and final follow-up SP of the LE-ULBD group was of no significant difference, while final follow-up SP of the MI-TLIF group was significantly improved compared with preoperative SP. The postoperative mean VAS and ODI scores decreased significantly in both LE-ULBD group and MI-TLIF group. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 95.8 and 97.2%, respectively, in both LE-ULBD group and MI-TLIF group. Intraoperative complication rate of the LE-ULBD and the MI-TLIF group were 4.2 and 0%, respectively. One case of intraoperative epineurium injury was observed in the LE-ULBD group. Postoperative complication rate of the LE-ULBD and the MI-TLIF group were 0 and 5.6%, respectively. One case with transient urinary retention and one case with pleural effusion were observed in the MI-TLIF group.Conclusion: Both LE-ULBD and MI-TLIF are safe and effective to treat one-level LSS with degenerative spondylolisthesis.

Clinical outcomes after microendoscopic laminotomy for lumbar spinal stenosis: a 5-year follow-up study

2014 ◽  
Vol 24 (2) ◽  
pp. 396-403 ◽  
Author(s):  
Akihito Minamide ◽  
Munehito Yoshida ◽  
Hiroshi Yamada ◽  
Yukihiro Nakagawa ◽  
Hiroshi Hashizume ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Follow Up Study ◽  
Lumbar Spinal

scholarly journals S-line as Predictor of Clinical Outcome for Patients Undergone Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

2021 ◽  
Author(s):  
Yilin Lu ◽  
Jian Zhu ◽  
Xi Luo ◽  
Kaiqiang Sun ◽  
Jingchuan Sun ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Lumbar Spinal

Abstract Background: Some have speculated that LSTV has an impact on lumbar curve. A retrospective study was conducted to evaluate S-line as predictor of clinical outcome for patients undergone transforaminal lumbar interbody fusion for lumbar spinal stenosis.Methods: 126 patients undergoing transforaminal lumbar interbody fusion were enrolled. S-line stands for the connecting line between the highest points of the iliac crests on both sides. The patients were divided into two groups according to the position of S-line, S-line (-) group included patients whose S-line were between L4 and L5, and S-line (+) group included patients whose S-line is above or below this range, which were divided into two subgroups. Their pre-operative imaging data about sagittal alignment were collected, including lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT). Clinical outcomes were measured using Japanese Orthopaedic Association (JOA) scores, the Oswestry disability index (ODI), visual analog scale (VAS) before the surgery and postoperatively. The correlation of S-line and clinical outcomes, as well as sagittal alignment and clinical outcomes, were analyzed.Results: LL, SS, PI, PT and PI minus(-) LL of S-line (-) group were (45.39°±12.68°), (30.27°±10.55°), (43.32°±12.22°), (13.05°±6.52°), (-2.07°±8.20°), respectively, and those parameters of S-line (+) group were (40.29±14.92), (35.70°±14.09°), (52.59°±17.07°), (16.89°±8.24°), (12.30°±9.98°), respectively. Significant difference were seen in the above parameters between S-line (-) and S-line (+) group. For S-line (-) and S-line (+) group, post-operative JOA score were (22.39±2.12), (20.26±2.46), post-operative VAS were (2.07±0.88), (3.14±1.47), the post-operative ODI were (8.36±3.28), (11.82±3.32), the improvement rate is (0.61±0.13), (0.55±0.15), Significant differences of those parameters are seen between S-line (-) group and S-line (+) group.Conclusion: S-line is a reliable predictor of clinical outcome for patients undergone transforaminal lumbar interbody fusion for lumbar spinal stenosis.

scholarly journals Comparison between dynamic stabilization and instrumented fusion in the treatment of spinal stenosis with degenerative lumbar scoliosis

2019 ◽  
Author(s):  
Lei Luo ◽  
Lang Fang ◽  
Qiang Zhou ◽  
Chen Zhao ◽  
Pei Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Perioperative Complications ◽  
Dynamic Stabilization ◽  
Degenerative Lumbar Scoliosis ◽  
Instrumented Fusion ◽  
Lumbar Scoliosis ◽  
Significant Difference ◽  
Posterior Instrumented Fusion

Abstract Background Posterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis with degenerative lumbar scoliosis (DLS). However, long fusion can affect daily activities due to lumbar stiffness. Several clinical studies have shown that Dynesys dynamic stabilization in addition to laminectomy could lead to significant improvements in clinical outcomes. This study aimed to compare the outcomes of Dynesys dynamic stabilization with posterior instrumented fusion for the management of spinal stenosis with DLS. Methods Between August 2010 and Deccember 2015, a total of 46 patients with spinal stenosis and degenerative lumbar scoliosis were enrolled in this study. 26 patients (Dynesys group) had fenestration decompression, selective intervertebral fusion and Dynesys stabilizationin. 20 patients (fusion group) underwent posterior instrumented fusion. Clinical outcomes, radiographic data, and perioperative complications were compared between the two groups. The average duration of follow-up for the Dynesys group and fusion group was 38 and 33 months respectively. Results The mean number of fixed segments were 3.3±0.8 in Dynesys group and 4.3±0.8 in fusion group. Lower average values of operative duration and blood loss were observed in the dynamic group than in the fusion group. VAS for back and leg pain improved in both groups of patients. There were significant difference in ODI and LSDI (lumbar stiffness disability index) between Dynesys group and fusion group at the last follow-up. The scoliosis Cobb's angle and lumbar lordosis significantly improved in both groups after surgery, and no significant difference were observed between the groups at the last follow-up (P＞0.05). Dynesys stabilization resulted in significantly higher preservation of motion at the implanted segments. Conclusions This study demonstrated that both Dynesys dynamic stabilization and instrumented fusion can improve clinical outcomes of patients with degenerative lumbar scoliosis. Compared to instrumented fusion, Dynesys stabilizationin have advantages on blood loss, operation time, perioperative complications. In addition, Dynesys stabilization partially preserves the ROM of the stabilized segments that may reduce the limitation on daily activities caused by lumbar stiffness. Dynesys stabilizationin can also correct scoliosis, prevent progression of the curve, and maintain lumbar lordosis in mild to moderate lumbar scoliosis without sagittal imbalance.

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