Short-term Clinical Outcomes of Muscle-preserving Interlaminar Decompression (MILD) for the Lumbar Canal Stenosis

Abstract Objective: Because surgery in elderly patients should be minimally invasive, interspinous process distraction has been widely used in this group to treat lumbar canal stenosis. We developed a new interspinous process distraction spacer composed of hydroxyapatite ceramic. In this work, we demonstrate the usefulness of this novel device. Methods: Since 2003, we operated on 19 elderly patients with lumbar canal stenosis, including 14 men and five women. Their mean age was 70.1 years. We compared the intervertebral angle, posterior disc height, and interspinous process distance on midsagittal magnetic resonance images obtained before and after the surgery. We also assessed clinical outcomes by using the Visual Analog Scale and the Zurich Claudication Questionnaire. Results: The average operation time per level was 44.7 minutes. Postoperatively, there were significant changes in the angle (from 12.5 to 8.6 degrees, P < 0.0001), the posterior disc height (from 10.6 to 13.1 mm, P < 0.0001), and the interspinous process distance (from 9.7 to 14.1 mm, P < 0.0001). The clinical outcomes, which we assessed by using the Visual Analog Scale and the Zurich Claudication Questionnaire, were considered satisfactory. (Visual Analog Scale, from 6.88 to 3.00; Zurich Claudication Questionnaire, symptom severity domain from 2.94 to 1.92, physical function from 2.51 to 1.73.) Conclusion: Our ceramic spacer is useful in the treatment of elderly patients with lumbar canal stenosis. Treatment comprises an easy surgical procedure and produces no metal artifact on radiological evaluations, such as magnetic resonance imaging and computed tomographic scans.

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POSTEROLATERAL ARTHRODESIS AND INTERBODY ARTHRODESIS FOR LUMBAR CANAL STENOSIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192701191115 ◽

2019 ◽

Vol 27 (1) ◽

pp. 38-41

Author(s):

Oswaldo Roberto Nascimento ◽

Leonardo Yukio Jorge Asano ◽

André Nunes Machado ◽

André Evaristo Marcondes Cesar ◽

Luciano Miller Reis Rodrigues

Keyword(s):

Clinical Outcomes ◽

Interbody Fusion ◽

Functional Disability ◽

Treatment Options ◽

Posterolateral Fusion ◽

Level Of Evidence ◽

Lumbar Canal Stenosis ◽

Canal Stenosis ◽

Scale Scores ◽

Fusion Methods

ABSTRACT Objectives: To compare the clinical outcomes and quality of life of patients surgically treated for lumbar spinal stenosis with decompression and posterolateral fusion, and decompression with interbody fusion. Methods: The study included 88 patients with lumbar canal stenosis who underwent surgery treatment (decompression and interbody fusion in 36 patients and decompression and posterolateral fusion [PL] in 52 patients). The clinical outcomes were assessed using the Oswestry Disability Index (ODI), Roland-Morris (RM) functional disability scale, and visual analog scale (VAS) for pain. These questionnaires were administered preoperatively and 1 month, 6 months, 1 year, and 2 years postoperatively. Results: Eighty-eight patients had surgery 2 years prior. The ODI and RM scale scores showed significant differences in the posterolateral group. In the interbody group, the ODI score showed a significant change only from before to 1 and 2 years after surgery. The VAS score significantly changed only from before to after surgery in the posterolateral group, but in the interbody group, the change was also observed at 1 month and 1 year after surgery. Conclusions: The two techniques are effective surgical treatment options for lumbar canal stenosis as long as they are well indicated. Level of evidence III, Comparative prospective case-control study.

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