scholarly journals A Comparison of Bilateral Decompression via Unilateral Approach and Classic Laminectomy in Patients with Lumbar Spinal Stenosis in terms of postoperative back pain.

2021 ◽  
Vol 11 (1) ◽  
pp. 45-49
Author(s):  
Osama Ahmad Khan ◽  
Muhammad Pervez Khan ◽  
Muhammad Azam ◽  
Zainul Abideen ◽  
Shams Uddin
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Visual Analogue Score ◽  
Study Groups ◽  
P Value ◽  
Female Ratio ◽  
Unilateral Approach ◽  
Lumbar Spinal

Back ground: Lumbar spinal stenosis (LSS) is a common cause of morbidity in elderly patients due to degenerative changes ofspine. Different surgical procedures have been proposed including open lumbar laminectomy and other less invasivedecompressive procedures to minimize soft tissue damage and lessen the post-operative complication. So we conducted thisstudy to find more appropriate and less invasive procedure.Objective: To compare mean post-operative back pain score in patients with lumbar spinal stenosis undergoing bilateraldecompression via unilateral approach versus classic laminectomy.Material and Methods: This randomized control trial was carried out in department of neurosurgery, Saidu Teaching HospitalSharif Swat from April 2018 to October 2018.Atotal of 60 patients having confirmed degenerative lumbar spine stenosis with painscore of >5 on Visual Analogue Score (VAS) presenting in outpatient department were included in the study. Patients not willing forthe study and fulfilling the set exclusion criteria were excluded. Patients were divided in two groups randomly on basis of lotterymethod. Written informed consent was taken and VAS at presentation of all patients was recorded. In group Apatient underwentbilateral decompression via unilateral approach. In-group B patient underwent classic laminectomy. Pain evaluation in both groupsvia Visual Analogue Scoring was recorded before surgery and at 1month post-operative follow-up. Follow up was advised at a 2weeks interval and final outcome was measured at 1 month post operatively. Data collected was analyzed through SPSS 22.Results: In our study the mean age of the patients was 59.12±12.88 years, the male to female ratio was 0.9:1. Statistically highlysignificant difference was found between the study groups with pain at 1st month i.e. p-value=0.000.Conclusion: The bilateral decompression via unilateral approach had significantly reduced post-operative pain as compared toclassic laminectomy in patients with LSS.Key words: pain, classic laminectomy, bilateral decompression, unilateral approach, lumbar spinal Stenosis

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

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.

scholarly journals Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome

2020 ◽  
pp. 219256822094251
Author(s):  
Freyr Gauti Sigmundsson ◽  
Anders Möller ◽  
Fredrik Strömqvist
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Rating Scale ◽  
Leg Pain ◽  
Successful Outcome ◽  
Neurogenic Claudication ◽  
Lumbar Spinal ◽  
Outcome Of Surgery

Study Design: Prospective register cohort study. Objectives: The indication for surgery in patients with lumbar spinal stenosis (LSS) is considered to be leg pain and neurogenic claudication (NC). Nevertheless, a significant part of patients operated for LSS have mild leg pain levels defined as leg pain ≤minimally important clinical difference (MICD). Information is lacking on how to inform these patients about the probable outcome of surgery. The objective was to report the outcome of surgery for LSS in patients with a mild preoperative level of leg pain. Methods: A total of 2559 patients operated upon for LSS with preoperative leg pain ≤3 NRS (Numerical Rating Scale) were evaluated for outcome at the 1-year follow-up. NRS for back pain, the Oswestry Disability Index (ODI), and the EuroQol (EQ-5D) were used. Results: In the period 2007 to 2017, we identified 3239 patients (14%) who had mild leg pain (≤3 on the NRS). In this cohort, leg pain increased 0.40 (0.56-0.37) and back pain decreased 1.0 (0.95-1.2) at the 1-year follow up. ODI decreased 11.1 (10.2-11.4) and the EQ-5D increased 0.15 (0.17-0.14). A total of 31% reached successful outcome in terms of back pain, 43% in terms of ODI and 48% in terms of EQ-5D. 63% of the patients were satisfied with the outcome. Conclusion: A minority of patients with mild leg pain levels operated upon for LSS attain MICD for back pain, ODI, and EQ-5D. The results from this study can aid the surgeon in the shared decision-making process before surgery.

Interspinous process device versus conventional decompression for lumbar spinal stenosis: 5-year results of a randomized controlled trial

2021 ◽  
pp. 1-9
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Reoperation Rate ◽  
Decompressive Surgery ◽  
Long Term Results ◽  
Long Term Follow Up ◽  
Lumbar Spinal

OBJECTIVE Interspinous process distraction devices (IPDs) can be implanted to treat patients with intermittent neurogenic claudication (INC) due to lumbar spinal stenosis. Short-term results provided evidence that the outcomes of IPD implantation were comparable to those of decompressive surgery, although the reoperation rate was higher in patients who received an IPD. This study focuses on the long-term results. METHODS Patients with INC and spinal stenosis at 1 or 2 levels randomly underwent either decompression or IPD implantation. Patients were blinded to the allocated treatment. The primary outcome was the Zurich Claudication Questionnaire (ZCQ) score at 5-year follow-up. Repeated measurement analysis was applied to compare outcomes over time. RESULTS In total, 159 patients were included and randomly underwent treatment: 80 patients were randomly assigned to undergo IPD implantation, and 79 underwent spinal bony decompression. At 5 years, the success rates in terms of ZCQ score were similar (68% of patients who underwent IPD implantation had a successful recovery vs 56% of those who underwent bony decompression, p = 0.422). The reoperation rate at 2 years after surgery was substantial in the IPD group (29%), but no reoperations were performed thereafter. Long-term visual analog scale score for back pain was lower in the IPD group than the bony decompression group (p = 0.02). CONCLUSIONS IPD implantation is a more expensive alternative to decompressive surgery for INC but has comparable functional outcome during follow-up. The risk of reoperation due to absence of recovery is substantial in the first 2 years after IPD implantation, but if surgery is successful this positive effect remains throughout long-term follow-up. The IPD group had less back pain during long-term follow-up, but the clinical relevance of this finding is debatable.

scholarly journals Effect of self-quarantine due to COVID-19 on low back and leg symptoms in patients with lumbar spinal stenosis

2021 ◽  
Author(s):  
Kazunori Hayashi ◽  
Toru Tanaka ◽  
Tsuneyuki Ebara ◽  
Akira Sakawa ◽  
Hidekazu Tanaka ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Short Form ◽  
Low Back ◽  
Significant Difference ◽  
Lumbar Spinal ◽  
Pain Improvement

Abstract The effect of self-quarantine and avoiding non-essential outings due to COVID-19 on the symptoms of patients with lumbar spinal stenosis (LSS) remains unknown. In this prospective study, patients with LSS who self-quarantined from baseline (SQ group; 80 patients) were matched to controls who did not self-quarantine (non-SQ group: 60 patients), based on age, gender, medication, activities of daily living (ADL), and low back symptoms. The change in low back symptoms, ADL, and health-related quality of life (HRQoL) between baseline and follow-up (after self-quarantine periods) were compared between the groups. Compared to baseline, the NRS score for low back pain at follow-up in SQ group significantly improved, but not in non-SQ group. No significant difference was found regarding changes in leg pain or numbness. Low back pain improvement did not lead to ADL improvement. The Short Form 12 evaluation revealed the role/social component score in SQ group to be lower than that in non-SQ group at follow-up; no difference was found for the physical or mental components. This study revealed self-quarantine with conservative treatment accompanied short-term low back pain improvement in patients with LSS. It might help to understand the situation in the spine department during the COVID-19 pandemic.

scholarly journals Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jingbo Xue ◽  
Haoxiang Chen ◽  
Bin Zhu ◽  
Xuelin Li ◽  
Zhihua Ouyang ◽  
...  
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Leg Pain ◽  
Short Term ◽  
Time Points ◽  
Interlaminar Approach ◽  
Postoperative Time ◽  
Lumbar Spinal

Abstract Background Recently, a percutaneous spinal endoscopy unilateral posterior interlaminar approach to perform bilateral decompression has been proposed for use in treatment of lumbar spinal stenosis, As a development and supplement to traditional surgery, its advantages regarding therapeutic effects and prognosis, such as minor soft tissue damage, little intraoperative blood loss, and a quick return to daily life. However, there are few analyses of this surgery with a follow-up of more than 1 year,we conducted this study in order to quantitatively investigate radiographic and clinical efficacies of this surgery for central lumbar spinal stenosis. Materials and methods Forty-six patients with central lumbar spinal stenosis were enrolled from January 2017 to July 2018. The visual analog scale (VAS) for back pain and leg pain, Oswestry disability index (ODI), modified MacNab criteria were used to evaluate clinical efficiency at preoperative and postoperative time points. The intervertebral height index (IHI), cross-sectional area of the spinal canal (CSAC), calibrated disc signal (CDS) and spinal stability were examined to assess radiographic decompression efficiency via magnetic resonance imaging and X-ray at preoperative and postoperative time points. Results The VAS score for lower back pain and leg pain improved from 7.50 ± 0.78 to 1.70 ± 0.66 and from 7.30 ± 0.79 to 1.74 ± 0.68, respectively, and the ODI improved from 72.35 ± 8.15 to 16.15 ± 4.51. In terms of modified MacNab criteria, 91.3% of the patients achieved good or excellent outcomes. Furthermore, significant changes after surgery were observed for the percentage of CSAC, increasing from 125.3 ± 53.9 to 201.4 ± 78 mm2; however, no significant differences were observed for the remaining measurement indicators. Conclusions The clinical and radiographic efficacies of this surgery for central lumbar spinal stenosis were good in short-term follow-up, and this surgery did not cause meaningful changes in IHI, CDS, and spine stability in short-term follow-up. The effect of long-term follow-up needs further investigation.

scholarly journals Improvement of Lower Back Pain in Lumbar Spinal Stenosis After Decompression Surgery and Factors That Predict Residual Lower Back Pain

2020 ◽  
pp. 219256822090561
Author(s):  
Takahiro Kitagawa ◽  
Yoji Ogura ◽  
Yoshiomi Kobayashi ◽  
Yoshiyuki Takahashi ◽  
Yoshiro Yonezawa ◽  
...  
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lower Back Pain ◽  
Decompression Surgery ◽  
Thoracolumbar Kyphosis ◽  
Lower Back ◽  
Group I ◽  
Lumbar Spinal

Study Design: Retrospective observational study. Objectives: There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP. Methods: We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R. Results: LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P < .001; JOABPEQ LBP score, 41.3 vs 79.6, P < .001; RMDQ, 10.3 vs 3.6, P < .001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R. Conclusions: Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.

Endoscope-assisted spinal decompression surgery for lumbar spinal stenosis

2013 ◽  
Vol 19 (6) ◽  
pp. 664-671 ◽  
Author(s):  
Akihito Minamide ◽  
Munehito Yoshida ◽  
Hiroshi Yamada ◽  
Yukihiro Nakagawa ◽  
Masaki Kawai ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Decompression Surgery ◽  
Sf 36 ◽  
Lumbar Spinal

Object The authors undertook this study to document the clinical outcomes of microendoscopic laminotomy, a minimally invasive decompressive surgical technique using spinal endoscopy for lumbar decompression, in patients with lumbar spinal stenosis (LSS). Methods A total of 366 patients were enrolled in the study and underwent microendoscopic laminotomy between 2007 and 2010. Indications for surgery were single- or double-level LSS, persistent neurological symptoms, and failure of conservative treatment. Microendoscopy provided wide visualization through oblique lenses and allowed bilateral decompression via a unilateral approach, through partial resection of the base of the spinous process, thereby preserving the supraspinous and interspinous ligaments and contralateral musculature. Clinical symptoms and signs of low-back pain were evaluated prior to and following surgical intervention by applying the Japanese Orthopaedic Association (JOA) scoring system, Roland-Morris Disability Questionnaire (RMDQ), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and 36-Item Short Form Health Survey (SF-36). These items were evaluated preoperatively and 2 years postoperatively. Results Effective circumferential decompression was achieved in all patients. The 2-year follow-up evaluation was completed for 310 patients (148 men and 162 women; mean age 68.7 years). The average recovery rate based on the JOA score was 61.3%. The overall results were excellent in 34.9% of the patients, good in 34.9%, fair in 21.7%, and poor in 8.5%. The mean RMDQ score significantly improved from 11.3 to 4.8 (p < 0.001). In all categories of both JOABPEQ and SF-36, scores at 2 years' follow-up were significantly higher than those obtained before surgery (p < 0.001). Twelve surgery-related complications were identified: dural tear (6 cases [1.9%]), wrong-level operation (1 [0.3%]), transient neuralgia (4 [1.3%]), and infection (1 [0.3%]). All patients recovered, and there were no serious postoperative complications. Conclusions Microendoscopic laminotomy is a safe and very effective minimally invasive surgical technique for the treatment of degenerative LSS.

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