Tag: Lumbar decompression

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Same-day spine surgery at an ambulatory surgical center versus hospital outpatient department

J Neurosurg Spine 44:835–846, 2026

This clinical study compares safety, complications, and patient-reported outcomes for same-day anterior cervical arthrodesis/arthroplasty and lumbar decompression performed in ambulatory surgical centers (ASC) versus hospital outpatient departments (HOPD) using a propensity-matched statewide registry. Primary outcomes included complication rates, return to OR, ED visits, and readmissions; secondary outcomes assessed PROMs and return-to-work at 90 days and 1 year.

Matched analysis of 3,351 lumbar decompressions and 806 anterior cervical procedures found no differences in PROs between ASC and HOPD, comparable safety for anterior cervical surgery, but a slightly higher rate of return to OR—driven by reherniation—for lumbar decompression performed in ASCs. Authors recommend future cost-effectiveness and patient-selection research.

Objective Compare safety and outcomes of same-day discharge anterior cervical arthrodesis/arthroplasty (1–2 levels) and lumbar decompression performed in an ambulatory surgical center (ASC) versus a hospital outpatient department (HOPD).

Design/Data source Retrospective, propensity-matched comparative cohort analysis using the statewide Michigan Spine Surgery Improvement Collaborative (MSSIC) registry for cases from Jan 1, 2021 to Jun 30, 2023.

Matching approach HOPD:ASC cohorts matched 4:1 using BMI, ASA class, and number of operative levels to improve comparability and power.

Primary outcomes Assessed any complication, return to operating room (OR) within 90 days, and ED visit or readmission within 30 and 90 days; secondary outcomes included PROs at 90 days/1 year and return to work.

Sample size (matched) Included 3351 lumbar decompressions (2679 HOPD, 672 ASC) and 806 anterior cervical cases (644 HOPD, 162 ASC).

Cervical results No significant ASC vs HOPD differences for complications, PROs at 90 days or 1 year, or return to work at 90 days or 1 year (p > 0.05).

Lumbar results (safety) ASC had higher rates of any complication (8% vs 5.5%) and return to OR (4.9% vs 2.1%) than HOPD in univariate analysis, and this persisted in multivariate analysis (IRR 1.5 for any complication; IRR 2.3 for return to OR).

Lumbar results (driver & outcomes) Elevated return-to-OR risk in ASC was driven primarily by lumbar reherniation requiring reoperation (3.2% ASC vs 1.0% HOPD), while PROs at 90 days and 1 year were otherwise similar between settings.

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Five-year follow-up after minimally invasive transforaminal lumbar interbody fusion versus decompression alone for grade 1 spondylolisthesis: are there any differences in outcomes?

J Neurosurg Spine 43:547–556, 2025

This multicenter, prospective registry study compares 60-month outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) versus minimally invasive tubular decompression for Meyerding grade 1 degenerative spondylolisthesis. Patient-reported outcomes (ODI, NRS for back/leg pain, EQ-5D, NASS satisfaction) improved significantly in both cohorts, with MIS TLIF showing greater back-pain reduction and higher satisfaction rates.

Durability differs: MIS TLIF had a markedly lower 5-year reoperation rate than MIS decompression (2.8% vs 15.5%), and multivariable analysis found fusion reduced reoperation odds despite similar long-term PROs. Authors conclude both MIS approaches benefit selected patients, but fusion offers superior reoperation durability.

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Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression

 Neurosurgery 91:331–338, 2022

Sagittal spinopelvic alignment (SSPA) parameters are essential for the diagnosis of adult spinal deformities (ASDs) and their progression. Certain clinical symptoms that occur in patients with lumbar spinal stenosis (LSS) and herniated nucleus pulposus (HNP) may distort the SSPA and mimic ASD.

OBJECTIVE: To differentiate SSPA in symptomatic patients from asymptomatic patients within 10 minutes in the standing position.

METHODS: This retrospective cohort study evaluated changes in SSPA after simple lumbar decompression surgery in patients with LSS and HNP. Relative sagittal alignment (RSA), relative pelvic version, relative lumbar lordosis (RLL), Lordosis Distribution Index (LDI), and global alignment and proportion (GAP) values were calculated using the conventional Schwab classification method. First, the preoperative and postoperative SSPA parameters were compared. Second, patients were subgrouped into symptomatic within 10 minutes of standing (SP group) and other symptoms of LSS and HNP as controls. Changes in SSPA parameters after symptom relief after simple lumbar decompression surgery were compared between the two groups.

RESULTS: Overall, all SSPA parameters improved after surgery. However, after subgrouping, patients in the control group did not show significant SSPA alterations, except for LDI, whereas patients in the SP group significantly improved in terms of their RSA, RLL, LDI, and GAP values after symptom relief after surgery.

CONCLUSION: Patients with pain on standing within 10 minutes showed significant correction in RSA, RLL, and GAP values after simple lumbar decompression. Therefore, it is important to observe such clinical symptoms to avoid misdiagnosis of ASD.

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Association between payer status and patient-reported outcomes in adult patients with lumbar spinal stenosis treated with decompression surgery

J Neurosurg Spine 30:198–210, 2019

Insurance disparities can have relevant effects on outcomes after elective lumbar spinal surgery. The aim of this study was to evaluate the association between private/public payer status and patient-reported outcomes in adult patients who underwent decompression surgery for lumbar spinal stenosis.

METHODS A sample of 100 patients who underwent surgery for lumbar spinal stenosis from 2012 to 2014 was evaluated as part of the prospectively collected Quality Outcomes Database at a single institution. Outcome measures were evaluated at 3 months and 12 months, analyzed in regard to payer status (private insurance vs Medicare/Veterans Affairs insurance), and adjusted for potential confounders.

RESULTS At baseline, patients had similar visual analog scale back and leg pain, Oswestry Disability Index, and EQ- 5D scores. At 3 months postintervention, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.11, p < 0.001) and more leg pain (mean difference 1.26, p = 0.05). At 12 months, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.14, p < 0.001). There were no significant differences at 3 months or 12 months between groups for back pain (p = 0.14 and 0.43) or disability (p = 0.19 and 0.15). Across time points, patients in both groups showed improvement at 3 months and 12 months in all 4 functional outcomes compared with baseline (p < 0.001).

CONCLUSIONS Both private and public insurance patients had significant improvement after elective lumbar spinal surgery. Patients with public insurance had slightly less improvement in quality of life after surgery than those with private insurance but still benefited greatly from surgical intervention, particularly with respect to functional status.

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Is Eighty the New Sixty? Outcomes and Complications after Lumbar Decompression Surgery in Elderly Patients over 80 Years of Age

World Neurosurg. (2018) 112:e555-e560.

An increasing demographic aging of the general population results in a rising incidence of octogenarians and nonagenarians with spine disease. Patients older than 65 years represent the majority of patients with degenerative lumbar spine disease in our daily clinical routine. Surgical treatment is undertaken reluctantly because of an increased rate of comorbidities. We therefore assessed complication rates of lumbar decompression in regard to neurological outcome and medical conditions in patients age 80 years or older in a retrospective singlecenter series.

METHODS: Data for 244 patients (124 female, 120 male; mean age, 83.1  3 years; age range, 80e95 years) who underwent decompressive surgery for lumbar spinal stenosis or disc herniation between April 2007 and February 2016 were assessed retrospectively. Age at surgery, neurologic deficits (preoperative and postoperative), relevant medical comorbidities and previous lumbar decompression, intraoperative and postoperative complications (e.g., surgery-related, medical), duration of surgery, length of hospital stay, and rate of revision surgeries were recorded.

RESULTS: Surgery was performed for lumbar stenosis (184 patients; 75.4%), lumbar disc herniation (13 patients; 5.3%) or both (47 patients; 19.3%). Seventy-six patients (31.3%) patients experienced preoperative neurologic deficits; 48 (63.2%) of these patients improved, 28 (36.8%) of them were unchanged after surgery, and none deteriorated. New transient, postoperative, neurologic deficits occurred in 6 patients (2.5%). All 55 (22.5%) intraoperative complications were mild to moderate, and no severe surgical complications occurred. Two hundred fifteen patients (88%) had relevant medical disorders. Nineteen (7.7%) postoperative medical complications were reported in 17 patients (7%), of which 14 (73.7%) were severe and 5 (26.3%) were mild (4 pulmonary embolisms, 6 pneumonias, 3 myocardial infarctions, 1 postoperative renal failure, 5 urinary tract infections). Medical complications that necessitated intensive care unit treatment and resulted in lethal outcome were seen in 2 patients (0.8%).

CONCLUSION: Despite their age, the vast majority of octogenarians and nonagenarians benefited from lumbar decompression surgery. Mild to moderate intraoperative complications were relatively frequent, whereas severe intraoperative complications did not occur. The majority of medical complications was severe, but the incidence was acceptable, and the postoperative outcome was still favorable in most patients

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Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

J Neurosurg Spine 26:158–162, 2017

Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS).

Methods: The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N 2 QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m 2 (obese) or < 30 kg/m 2 (nonobese). Demographic, surgical, and health-related quality of life data were compared.

Results: In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts.

Conclusions: Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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Results After Lumbar Decompression With and Without Discectomy: Comparison of the Transspinous and Conventional Approaches

Neurosurgery 66[ONS Suppl 1]:ons152-ons160, 2010 DOI: : 10.1227/01.NEU.0000365826.15986.40

OBJECTIVE: To evaluate the efficacy of the transspinous approach compared with the conventional approach in single-level lumbar laminotomies with and without discectomies.
METHODS: Forty consecutive patients underwent single-level lumbar decompression with or without a discectomy. The first 20 patients underwent surgery by the conventional approach (11 with discectomy and 9 without), and the transspinous approach was used in the remaining 20 patients (11 with discectomy and 9 without). Results between the groups were assessed by comparing the following measures: length of inpatient hospital stay, postoperative pain and analgesia use, estimated blood loss, rate of postoperative disability and complications, and incision length.
RESULTS: The groups did not differ significantly with respect to age, level of pathology, insurance status, or type of analgesia used. The primary outcome was physical disability, measured using the Roland-Morris Disability Questionnaire. The secondary outcome was pain intensity, measured using the Brief Pain Inventory. Patients who underwent the transspinous approach had better outcomes across all measures with significance appreciated in those who underwent transspinous decompression with discectomies. Other statistically significant differences were identified in incision length and postoperative analgesia use at the end of 1 week. No statistically significant differences were identified in the rates of complications, estimated blood loss, inpatient narcotic analgesia use, or length of inpatient hospital stay.
CONCLUSION: Patients who underwent single-level lumbar decompression with or without discectomy had similar outcomes as those who underwent the conventional approach. Although of modest clinical significance, the transspinous approach may afford early mobilization and reduced postoperative pain while providing a satisfactory neurological and functional outcome.

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