scholarly journals Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Chul-Woo Lee ◽  
Kang-Jun Yoon ◽  
Sang-Soo Ha
Keyword(s):  
Back Pain ◽  
Hospital Stay ◽  
Surgical Outcome ◽  
Operation Time ◽  
Clinical Success Rate ◽  
Decompression Surgery ◽  
Lateral Recess ◽  
Lumbar Decompression ◽  
Lateral Recess Stenosis ◽  
Canal Diameter

Purpose. The purpose of our study is to compare the results of spinal decompression using the full-endoscopic interlaminar technique, tubular retractor, and a conventional microsurgical laminotomy technique and evaluate the advantages and clinical feasibility of minimally invasive spinal (MIS) lumbar decompression technique in the lumbar canal and lateral recess stenosis. Methods. The authors retrospectively reviewed clinical and radiological data from 270 patients who received microsurgical (group E: 72 patients), tubular (group T: 34 patients), or full-endoscopic decompression surgery (group E: 164 patients) for their lumbar canal and lateral recess stenosis from June 2016 to August 2017. Clinical (VAS, ODI, and Mcnab criteria), radiologic (spinal canal diameter, segmental dynamic angle, and disc height), and surgical outcome parameters (CPK level, Operative time, blood loss, and hospital stay) were evaluated pre- and postoperatively and compared among the three groups by means of statistical analysis. Failed cases and complications were reviewed in all groups. Results. The mean follow-up period was 6.38 months. The Overall clinical success rate was 89.4%. All groups showed favorable clinical outcome. The clinical and radiologic results were similar in all groups. Regarding surgical outcome, group E showed longer operation time than group M and T (group E: 84.17 minutes/level, group M: 52.22 minutes/level, and group T: 66.12 minutes/level) (p<0.05). However, groups E and T showed minimal surgical invasiveness compared with group M. Groups E and T showed less immediate postoperative back pain (VAS) (group E: 3.13, group M: 4.28, group T: 3.54) (p<0.05), less increase of serum CPK enzyme (group E: 66.38 IU/L, group M: 120 IU/L, and group T: 137.5 IU/L) (p<0.05), and shorter hospital stay (group E: 2.12 days, group M: 4.85 days, and group T: 2.83 days) (p<0.05). The rates of complications and revisions were not significantly different among the three groups. Conclusions. MIS decompression technique is clinically feasible and safe to treat the lumbar canal and lateral recess stenosis, and it has many surgical advantages such as less muscle trauma, minimal postoperative back pain, and fast recovery of the patient compared to traditional open microscopic technique.

scholarly journals Clinical Outcomes of TESSYS and TESSYS-ISEE Approach on Treatment of Lateral Recess Stenosis: A Comparison Study

2020 ◽  
Author(s):  
Boyu Wu ◽  
Chengjie Xiong ◽  
Biwang Huang ◽  
Dongdong Zhao ◽  
Zhipeng Yao ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Pain Score ◽  
Clinical Outcomes ◽  
Operation Time ◽  
The Elderly ◽  
Leg Pain ◽  
Lateral Recess ◽  
Lumbar Decompression ◽  
Lateral Recess Stenosis ◽  
Short Period

Abstract Background: Lateral recess stenosis (LRS) is a common degenerative disease in the elderly. Since the rise of comorbidity is associated with the increasing age, the percutaneous endoscopic lumbar decompression is advocated. The objective of this study was to compare the clinical outcomes of percutaneous endoscopic lumbar decompression in LRS via TESSYS or TESSYS-ISEE approach. Methods: A total of 45 and 42 consecutive patients with limp or radiculopathy symptoms underwent percutaneous endoscopic lumbar decompression using transforaminal endoscopic spine system (TESSYS) and TESSYS-ISEE, respectively. The radiation exposure and operation time, time to return to work, and complications were compared between two groups. Their clinical outcomes were evaluated with visual analogue scale (VAS) leg pain score, VAS back pain score, Oswestry Disability Index (ODI) and Modified MacNab’s criteria. Results: The average values of radiation exposure and operative time in TESSYS group were significantly higher than those in TESSYS-ISEE group (P<0.05). The postoperative VAS and ODI scores in both groups were significantly improved compared with before the operation (P<0.05). In addition, the VAS score of the leg and ODI score in the TESSYS-ISEE group were significantly lower than those in TESSYS group at 1 week follow-up (P<0.05). The good-to-excellent rates of the TESSYS and TESSYS-ISEE group were 88.89 and 90.48%, respectively, whereas the complication occurrence rates were 6.67 and 4.76% in TESSYS and TESSYS-ISEE groups, respectively. Conclusions: TESSYS-ISEE can be applied to treat LRS safely and effectively with short radiation exposure and operation time. This approach was comparable to the TESSYS approach with improved VAS leg pain and ODI score in short period after operation. However, potential complications and risks still needs to be considered.

scholarly journals Transforaminal Percutaneous Endoscopic Lumbar Decompression by Using Rigid Bendable Burr for Lumbar Lateral Recess Stenosis: Technique and Clinical Outcome

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Shuo Tang ◽  
Song Jin ◽  
Xiang Liao ◽  
Kun Huang ◽  
Jiaquan Luo ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Outcomes ◽  
Visual Analog Scale ◽  
Surgical Procedure ◽  
Leg Pain ◽  
Analog Scale ◽  
Lateral Recess ◽  
Lumbar Decompression ◽  
Lateral Recess Stenosis ◽  
The Mean

Background. Open laminectomy has been regarded as the standard surgical procedure for lumbar lateral recess stenosis during the last decades. Although percutaneous endoscopic lumbar decompression has led to successful results comparable with open decompression, its application in LSS with is still challenging and technically demanding. Here, we report the surgical procedure and preliminary clinical outcomes of transforaminal percutaneous endoscopic lumbar decompression (PELD) by using flexible burr for lumbar lateral recess stenosis. Method. A retrospective study was performed for the patients with lumbar lateral recess stenosis receiving PELD by using flexible burr. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. Before the operation, the transforaminal epidural lidocaine injections were carried out to make the diagnosis more precise and accurate. Radiologic findings were investigated, and visual analog scale (VAS) for back and leg pain, Oswestry Disability Index, and modified Macnab criteria were analyzed at the different time of preoperation, postoperation, 3 months, 6 months, and 12 months. Results. The follow-up period was 12 months. The mean VAS scores for back and leg pain immediately improved from 7.9 ± 1.2 to 2.8± 1.3, 2.4 ± 1.0, and 2.3 ± 1.0, respectively. The mean visual analog scale scores (VAS) for back pain and leg pain were significantly improved after PELD. The preoperative ODI dropped from 69.1 ± 7.3 to 25.9 ± 8.7, 25.0± 6.9, and 24.7 ± 6.4, respectively. The final outcome was excellent in 39.6%, good in 47.9%, fair in 8.3%, and poor in 4.17%. 87.5% of excellent-to-good ratio was achieved on the basis of Macnab criteria at postoperative 12 months. The complications were limited to transient postoperative dysesthesia (one case), temporary pain aggravation (six cases), and neck pain during the operation (one case). Conclusion. This observation suggests that the clinical outcomes of PELD for lateral recess stenosis were excellent or showed good results. This minimally invasive technique would be helpful in choosing a surgical method for lateral recess stenosis.

scholarly journals Acute Exacerbation of Symptoms After Lumbar Decompression Surgery: An Analysis Readmissions and Reoperations in 81 365 Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andre Samuel ◽  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Neurological Deficits ◽  
Leg Pain ◽  
Decompression Surgery ◽  
Rare Occurrence ◽  
Spinal Decompression ◽  
Lumbar Decompression ◽  
National Cohort ◽  
Exacerbation Of Symptoms

Abstract INTRODUCTION While lumbar spine decompression is a common surgical procedure, acute readmission or reoperation for exacerbation of symptoms is a rare occurrence that has not been extensively studied. METHODS A retrospective review was conducted of a national cohort of patients who underwent lumbar spine decompression surgery between 2013 and 2016. Readmission within 30 d postoperatively, due to exacerbation of back pain, leg pain, or neurological deficits were identified. Reoperations within 30 d for revision spinal decompression or fusion were also measured. Multivariate logistic regression was utilized to determine preoperative patient and surgical factors associated with 30-d readmissions or reoperations. RESULTS In all 40% patients underwent a laminectomy or bilateral decompression and 62% underwent a foraminotomy or unilateral decompression. A total of 3188 patients (3.9%) were readmitted within 30-d postoperatively due to exacerbation of back pain, leg pain, or neurological deficits. A total of 1967 patients (2.4%) underwent reoperation for revision spinal decompression or fusion within 30-d postoperatively. Revision decompression (OR: 2.0, P = .01), additional levels of foraminotomy/unilateral decompression levels (OR: 1.3, 1.5, and 2.5 for 1, 2, and 3+ levels, P = .05), microscopic laminectomy (OR: 1.5, P = .04), and female sex (odds ratios [OR]: 1.2, P = .01) were associated with increased likelihood for readmission. Revision decompression surgery (OR: 2.0) and additional foraminotomy/unilateral decompression levels (OR: 1.9, 1.8, and 2.3 for 1, 2, and 3 + levels, P = .05) were associated with an increased likelihood of reoperation. CONCLUSION While acute readmission or reoperation for symptom exacerbation after lumbar decompression is a rare occurrence, incidence of exacerbation increases with revision decompression surgery and multilevel foraminotomies/unilateral decompression.

scholarly journals Clinical implications of lumbar developmental spinal stenosis on back pain, radicular leg pain, and disability

2021 ◽  
Vol 103-B (1) ◽  
pp. 131-140
Author(s):  
Marcus Kin Long Lai ◽  
Prudence Wing Hang Cheung ◽  
Dino Samartzis ◽  
Jaro Karppinen ◽  
Kenneth Man Chee Cheung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Large Scale ◽  
Leg Pain ◽  
Decompression Surgery ◽  
Study Cohort ◽  
The Past ◽  
Canal Diameter

Aims To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. Methods This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions. Results Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively. Conclusion This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: Bone Joint J 2021;103-B(1):131–140.

scholarly journals Short-term comparison of preoperative and postoperative pain after indirect decompression surgery and direct decompression surgery in patients with degenerative spondylolisthesis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Akihiko Hiyama ◽  
Hiroyuki Katoh ◽  
Daisuke Sakai ◽  
Masahiro Tanaka ◽  
Masato Sato ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Interbody Fusion ◽  
Rating Scale ◽  
Degenerative Spondylolisthesis ◽  
Operation Time ◽  
Decompression Surgery ◽  
Low Back ◽  
Short Term ◽  
Indirect Decompression

Abstract The purpose of this study was to compare the short-term clinical outcomes between extreme lateral interbody fusion (XLIF) and minimally invasive surgery (MIS)–transforaminal interbody fusion (TLIF) in patients with degenerative spondylolisthesis with stenosis. One hundred-six patients were enrolled; 44 were treated with MIS–TLIF (direct decompression group; DP), and 62 were treated with XLIF (indirect decompression group; IDP). Perioperative indexes included operation time and intraoperative bleeding. Perioperative indexes preoperative and postoperative numeric rating scale (NRS) scores for low back pain (NRS-BP), leg pain (NRS-LP), and leg numbness (NRS-LN), and the preoperative score on the Japanese version of the painDETECT questionnaire (PDQ-J) were also assessed. The average follow-up period for the collection of NRS scores was 12.6 months. The operation time was significantly shorter in the IDP than in the DP group (109.9 ± 35.4 vs. 153.3 ± 50.9 min; p < 0.001). Intraoperative blood loss was also significantly less in the IDP group than in the DP group (85.4 ± 125.4 vs. 258.3 ± 220.4 mL; p < 0.001). The PDQ-J score and preoperative NRS scores (NRS-BP, NRS-LP, and NRS-LN) did not differ significantly between groups. Less improvement in the NRS-BP (ΔNRS-BP) was observed in the DP group than in the IDP group (p < 0.05). Although pain improved after surgery in both groups, IDP surgery was advantageous in minimizing bleeding and preserving posterior support elements such as the facet joints, lamina, and paraspinal muscles. These findings suggest that this may have contributed to the higher rate of improvement in low back pain compared with DP surgery.

scholarly journals Decompressive laminectomy with instrumented posterolateral fusion for degenerative lumbar disease in elderly, is it safe and beneficial?

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ahmed A. Arab ◽  
Mohammed H. Eltantawy ◽  
Ashraf El-Desouky
Keyword(s):  
Back Pain ◽  
Oswestry Disability Index ◽  
Visual Analog Score ◽  
Posterolateral Fusion ◽  
Neurogenic Claudication ◽  
Decompression Surgery ◽  
Instrumented Fusion ◽  
Lumbar Decompression ◽  
Degenerative Lumbar Disease ◽  
Lumbar Decompression Surgery

Abstract Background With improvement of health care in last decades, the age of general population increased. As the elderly with degenerative lumbar disease needs to remain physically active for more years, lumbar decompression surgery with instrumented fusion is further considered and is gaining wide acceptance as it provides good results with relative minimal risk. This study aim to evaluate the safety and efficacy of lumbar decompression with instrumented fusion in elderly Results This is a prospective non-randomized clinical study conducted from July 2014 to July 2019. The included patients had chronic low back pain, radiculopathy, and/or neurogenic claudication due to degenerative lumbar disease with failed conservative management. They underwent lumbar decompression with instrumented posterolateral fusion. All patients were at least 55 years old at time of surgery and were clinically assessed as regard perioperative risk and morbidity, besides assessment of pre- and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI). Data was collected and analyzed. Thirty-five patients were included in this study with mean age of 63 years. All patients presented with back pain, 77.1% with radiculopathy, and 60% with neurogenic claudication. Preoperative comorbidity was present in 60% of cases, where hypertension, diabetes, and cardiac troubles were 31.4%, 31.4%, and 14.3% respectively. The average operated level was 3.1. The complication rate was 11.4% with 2 cases with dural tear (5.7%), 2 cases with CSF leakage (5.7%), 1 case with wound seroma (2.8%), and 1 case with wound infection. Postoperative new comorbidity occurred in 5 cases (14.3%). Visual analog score (VAS) and Oswestry disability index (ODI) were recorded preoperatively and 18 months postoperatively; as regards pain, VAS improved significantly from 7.8 ± 0.87 to 1.8 ± 1.04 (P value< 0.00001), and ODI improved significantly from 58.1 ± 11 to 17.5 ± 8.3 (P value< 0.00001). Conclusion Lumbar decompression surgery with posterolateral instrumented fusion is a safe and effective surgery in elderly, as it provides significant results and gives them a chance for better quality of life. Preoperative comorbidity could be dealt with, and it should not be considered as a contraindication for surgery in this age group.

A PROSPECTIVE STUDY OF PATIENT-REPORTED OUTCOMES FOR TWO YEARS AFTER LUMBAR SURGERY AUGMENTED WITH DIAM®INTERSPINOUS IMPLANT

2012 ◽  
Vol 15 (03) ◽  
pp. 1250018 ◽  
Author(s):  
Rebecca J. Crawford ◽  
Quentin J. Malone ◽  
Roger I. Price
Keyword(s):  
Back Pain ◽  
Clinical Pathways ◽  
Degenerative Spondylolisthesis ◽  
Leg Pain ◽  
Decompression Surgery ◽  
Single Center ◽  
Prospective Longitudinal Study ◽  
Lateral Recess Stenosis ◽  
Patient Reported ◽  
Prospective Longitudinal

Purpose: The device for intervertebral assisted motion (DIAM™) is an interspinous (ISP) implant used to augment surgical decompression of lumbar degenerative conditions: Lumbar spinal stenosis [LSS; foraminal (FS) or central canal (CS)], herniated and degenerated disc disease, facet joint pain syndrome (FJPS) and minor degenerative spondylolisthesis (DS). Limited evidence guides its use in defined clinical indications, while few studies demonstrate effect according to clinically meaningful change (MCID). This prospective longitudinal study examined the efficacy of DIAM-augmented decompression surgery in the broad application of a single-center clinical reality. Methods: Eighty-one consecutive cases [37F, 44M; 52 years (SD 13)] were examined for two years after DIAM-augmented decompression surgery. Patient-reported pain [back and leg; visual analogue scale (VAS)], function [Oswestry disability index (ODI)], and satisfaction (Likert scale) were serially examined and referenced to contemporary MCID thresholds. Subjects were classified into anatomical and diagnostic categories and analyzed according to subgroups to better inform clinical pathways. Serial change was assessed with Scheffe post-hoc test; change scores with unpaired t-tests and descriptive statistics (p < 0.05). Results: Subjects reported 20.4% (SD 29.5; p < 0.0001) mean improvement in back pain, 20.3% (SD 30.6; p < 0.0001) in leg pain, and 15.1% (SD 20.8; p < 0.0001) in function at two years postoperatively. Greatest improvement was seen at six weeks for back pain (by 30.5%; p < 0.0001) and leg pain (by 29.4%; p < 0.0001) and three months for function (by 18.7%; p < 0.0001). Leg pain deteriorated between six weeks and 18 months (p < 0.05). There were more responders at one compared to two years after surgery. FS cases showed superior improvement compared to DS subjects (p < 0.05). Cases receiving multiple adjunctive surgical decompressions in addition to their DIAM had superior improvement than those receiving a single procedure (p < 0.05). Conclusions: Clinical improvement in back pain, leg pain and function were achieved to two years in a single-center cohort of 81 cases with lumbar degenerative disease who received DIAM-augmented decompression surgery. Subsets of the sample had a superior sustained response including foraminal/lateral recess stenosis patients and cases treated with > 1 adjunctive decompression techniques. The need for assessing homogeneous cohorts in future studies is emphasized.

scholarly journals Percutaneous endoscopic ventral facetectomy: An innovative substitute of open decompression surgery for lateral recess stenosis surgical treatment?

2018 ◽  
Vol 9 (3) ◽  
pp. 188 ◽  
Author(s):  
Stylianos Kapetanakis ◽  
Nikolaos Gkantsinikoudis ◽  
JannisV Papathanasiou ◽  
Georgios Charitoudis ◽  
Tryfon Thomaidis
Keyword(s):  
Surgical Treatment ◽  
Decompression Surgery ◽  
Lateral Recess ◽  
Lateral Recess Stenosis
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