Tag: Spinal stenosis

Posted on

Lumbar Multifidus Intramuscular Fat Concentrations are Associated With Recovery Following Decompressive Surgery for Lumbar Spinal Stenosis

Spine 2026;51:25–33

This longitudinal cohort study investigates whether preoperative intramuscular fat (IMF) in lumbar paraspinal muscles predicts five-year recovery and surgical success after decompressive surgery for lumbar spinal stenosis causing intermittent neurogenic claudication. Using automated MRI segmentation and quantitative IMF thresholds, outcomes included global perceived effect, Zurich Claudication Questionnaire-based surgical success, pain VAS, and disability scores.

Key findings show lower preoperative multifidus IMF (but not erector spinae IMF) was associated with higher rates of perceived recovery, surgical success, and reduced long-term disability over five years. No consistent relationship was found between IMF and leg or back pain trajectories; results were adjusted for age, BMI, sex, smoking, reoperation, and surgical technique.

Lumbar multifidus intramuscular fat (IMF): Lower preoperative IMF in the lumbar multifidus muscle is associated with higher rates of perceived recovery and surgical success after decompression surgery for lumbar spinal stenosis (LSS) over a five-year period.

Erector spinae IMF: Preoperative IMF levels in the erector spinae muscle are not significantly associated with recovery or surgical success following LSS surgery.

Disability outcomes: Patients with nonsevere IMF in the right lumbar multifidus experience less postoperative disability for up to five years compared to those with severe IMF.

Pain outcomes: No significant association exists between preoperative paraspinal IMF (either muscle) and the clinical course of leg or back pain intensity after surgery.

IMF quantification method: Automated MRI-based quantification and categorization of IMF (<50% = nonsevere, ≥50% = severe) using computer vision models enables objective assessment of paraspinal muscle health.

Prognostic value: Assessing lumbar multifidus IMF preoperatively can improve prediction of which patients are at risk for poor recovery and help tailor individual interventions.

Study limitations: Missing data (up to 32% at five years), dichotomized IMF classification, and limited field-of-view for some muscles may affect precision; more detailed and larger studies are needed.

Clinical implication: Routine IMF assessment may enhance clinical decision-making and rehabilitation strategies for patients undergoing lumbar decompressive surgery.

Posted on

Oblique lumbar interbody fusion at L5S1(OLIF51)

Acta Neurochirurgica (2019) 161:1079–1083

OLIF51 retains the advantages of traditional ALIF procedure with good fusion rates and improvement in radiographic parameters and reduces its drawbacks. It has the added advantage of being a minimal access technique.

Methods Preoperative analysis of the vascular anatomy using CT angiography is mandatory. OLIF51 is done in right lateral position using specialized retractor blades and Thompson retractor system. The procedure is similar to OLIF at other levels except for the differences described here. The instruments are specialized for OLIF at L5S1.

Conclusion OLIF51 provides an excellent alternative to traditional ALIF

Posted on

Prognostic Factors for Satisfaction After Decompression Surgery for Lumbar Spinal Stenosis

Neurosurgery 82:645–651, 2018

Surgical treatment for lumbar spinal stenosis is associated with both short- and long-term benefits with improvements in patient function and pain. Even though most patients are satisfied postoperatively, some studies report that up to onethird of patients are dissatisfied.

OBJECTIVE: To present clinical outcome data and identify prognostic factors related to patient satisfaction 1 yr after posterior decompression surgery for lumbar spinal stenosis.

METHODS: This multicenter register study included 2562 patients. Patients were treated with various types of posterior decompression. Patients with previous spine surgery or concomitant fusion were excluded. Patient satisfaction was analyzed for associations with age, sex, body mass index, smoking status, duration of pain, number of decompressed vertebral levels, comorbidities, and patient-reported outcome measures,which were used to quantify the effect of the surgical intervention.

RESULTS: At 1-yr follow-up, 62.4% of patients were satisfied but 15.1% reported dissatisfaction. The satisfied patients showed significantly greater improvement in all outcome measures compared to the dissatisfied patients. The outcome scores for the dissatisfied patients were relatively unchanged or worse compared to baseline. Association was seen between dissatisfaction, duration of leg pain, smoking status, and patient comorbidities. Patients with good walking capacity at baseline were less prone to be dissatisfied compared to patients with poor walking capacity.

CONCLUSION: This study found smoking, long duration of leg pain, and cancerous and neurological disease to be associated with patient dissatisfaction, whereas good walking capacity at baseline was positively associated with satisfaction after 1 yr.

Posted on

Prospective, randomized, multicenter study with 2-year follow-up to compare the performance of decompression with and without interlaminar stabilization

J Neurosurg Spine 28:406–415, 2018

Surgical decompression is extremely effective in relieving pain and symptoms due to lumbar spinal stenosis (LSS). Decompression with interlaminar stabilization (D+ILS) is as effective as decompression with posterolateral fusion for stenosis, as shown in a major US FDA pivotal trial. This study reports a multicenter, randomized controlled trial in which D+ILS was compared with decompression alone (DA) for treatment of moderate to severe LSS.

METHODS Under approved institutional ethics review, 230 patients (1:1 ratio) randomized to either DA or D+ILS (coflex, Paradigm Spine) were treated at 7 sites in Germany. Patients had moderate to severe LSS at 1 or 2 adjacent segments from L-3 to L-5. Outcomes were evaluated up to 2 years postoperatively, including Oswestry Disability Index (ODI) scores, the presence of secondary surgery or lumbar injections, neurological status, and the presence of device- or procedure-related severe adverse events. The composite clinical success (CCS) was defined as combining all 4 of these outcomes, a success definition validated in a US FDA pivotal trial. Additional secondary end points included visual analog scale (VAS) scores, Zürich Claudication Questionnaire (ZCQ) scores, narcotic usage, walking tolerance, and radiographs.

RESULTS The overall follow-up rate was 91% at 2 years. There were no significant differences in patient-reported outcomes at 24 months (p > 0.05). The CCS was superior for the D+ILS arm (p = 0.017). The risk of secondary intervention was 1.75 times higher among patients in the DA group than among those in the D+ILS group (p = 0.055). The DA arm had 228% more lumbar injections (4.5% for D+ILS vs 14.8% for DA; p = 0.0065) than the D+ILS one. Patients who underwent DA had a numerically higher rate of narcotic use at every time point postsurgically (16.7% for D+ILS vs 23% for DA at 24 months). Walking Distance Test results were statistically significantly different from baseline; the D+ILS group had > 2 times the improvement of the DA. The patients who underwent D+ILS had > 5 times the improvement from baseline compared with only 2 times the improvement from baseline for the DA group. Foraminal height and disc height were largely maintained in patients who underwent D+ILS, whereas patients treated with DA showed a significant decrease at 24 months postoperatively (p < 0.001).

CONCLUSIONS This study showed no significant difference in the individual patient-reported outcomes (e.g., ODI, VAS, ZCQ) between the treatments when viewed in isolation. The CCS (survivorship, ODI success, absence of neurological deterioration or device- or procedure-related severe adverse events) is statistically superior for ILS. Microsurgical D+ILS increases walking distance, decreases compensatory pain management, and maintains radiographic foraminal height, extending the durability and sustainability of a decompression procedure. Clinical trial registration no.: NCT01316211 (clinicaltrials.gov)

 

Posted on

Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis

Neurosurgery 80:701–715, 2017

Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure.

OBJECTIVE: To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications.

METHODS: A systematic review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models.

RESULTS: The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality.

CONCLUSION: Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).

 

Posted on

Lumbar Spinal Stenosis Associated With Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-analysis of Secondary Fusion Rates Following Open vs Minimally Invasive Decompression

Neurosurgery 80:355–367, 2017

Decompression without fusion is a treatment option in patients with lumbar spinal stenosis (LSS) associated with stable low-grade degenerative spondylolis- thesis (DS). A minimally invasive unilateral laminotomy (MIL) for “over the top” decom- pression might be a less destabilizing alternative to traditional open laminectomy (OL). OBJECTIVE: To review secondary fusion rates after open vs minimally invasive decom- pression surgery.

METHODS: We performed a literature search in Pubmed/MEDLINE using the keywords “lumbar spondylolisthesis” and “decompression surgery.” All studies that separately reported the outcome of patients with LSS+DS that were treated by OL or MIL (transmuscular or subperiosteal route)were included in our systematic review and meta-analysis. The primary end point was secondary fusion rate. Secondary end points were total reoperation rate, postoperative progression of listhetic slip, and patient satisfaction.

RESULTS: We identified 37 studies (19 with OL, 18 with MIL), with a total of 1156 patients, that were published between 1983 and 2015. The studies’evidence was mostly level 3 or 4. Secondary fusion rates were 12.8% after OL and 3.3% after MIL; the total reoperation rates were 16.3% after OL and 5.8% after MIL. In the OL cohort, 72% of the studies reported a slip progression compared to 0% in the MIL cohort, respectively. After OL, satisfactory outcome was 62.7% compared to 76% after MIL.

CONCLUSION: In patients with LSS and DS, minimally invasive decompression is associated with lower reoperation and fusion rates, less slip progression, and greater patient satisfaction than open surgery.

 

Posted on

Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis

Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis

Acta Neurochir (2016) 158:459–463

Prevalent endoscopic spine surgeries have shown limitations especially in spinal stenosis. Biportal endoscopic surgery is introduced to manage central and foraminal stenosis with its wide range of access angle and clear view.

Methods The authors provide an introduction of this technique followed by a description of the surgical anatomy with discussion on its indications and advantages. In particular, tricks to avoid complications are also presented.

Conclusions Effective circumferential and focal decompression were achieved in most cases without damage to the spinal structural integrity with preservation of muscular and ligamentous attachments. The biportal endoscopic spinal surgery (BESS) may be safely used as an alternative minimally invasive procedure for lumbar spinal stenosis.

Posted on

Management of lumbar spinal stenosis: a survey among Dutch spine surgeons

lumbar stenosis

Acta Neurochir (2014) 156:2139–2145

Various surgical and non-surgical treatments for lumbar spinal stenosis (LSS) are widely adopted in clinical practice, but high quality randomised controlled trials to support these are often lacking, especially in terms of their relative benefit and risk compared with other treatment options. Therefore, an evaluation of agreement among clinicians regarding the indications and the choice for particular treatments seems appropriate.

Methods One hundred and six Dutch neurosurgeons and orthopaedic spine surgeons completed a questionnaire, which evaluated treatment options for LSS and expectations regarding the effectiveness of surgical and non-surgical treatments.

Results Responders accounted for 6,971 decompression operations and 831 spinal fusion procedures for LSS annually. Typical neurogenic claudication, severe pain/disability, and a pronounced constriction of the spinal canal were considered the most important indications for surgical treatment by the majority of responders. Non-surgical treatment was generally regarded as ineffective and believed to be less effective than surgical treatment. Interlaminar decompression was the preferred technique by 68 % of neurosurgeons and 52 % orthopaedic surgeons for the treatment of LSS. Concomitant fusion was applied in 12% of all surgery for LSS. Most surgeons considered spondylolisthesis as an indication and spinal instability as a definite indication for additional fusion.

Conclusions The current survey demonstrates a wide variety of preferred treatments of symptomatic LSS by Dutch spine surgeons. To minimise variety, national and international protocols based on high-quality randomised controlled trials and systematic reviews are necessary to give surgeons more tools to support everyday decision-making.

Posted on

Who Should Have Surgery for Spinal Stenosis?

Spine 2012 ; 37 : 1791 – 1802

Study Design. Combined prospective randomized controlled trial and observational cohort study of spinal stenosis (SpS) with an as-treated analysis.

Objective. To determine modifiers of the treatment effect (TE) of surgery (the difference between surgical and nonoperative outcomes) for SpS using subgroup analysis.

Summary of Background Data. The Spine Patient Outcomes Research Trial demonstrated a positive surgical TE for SpS at the group level. However, individual characteristics may affect TE. No previous studies have evaluated TE modifiers in SpS.

Methods. SpS patients were treated with either surgery (n = 419) or nonoperative care (n = 235) and were analyzed according to treatment received. Fifty-three baseline variables were used to define subgroups for calculating the time-weighted average TE for the Oswestry Disability Index (ODI) over 4 years (TE = ΔODI surgery – ΔODI nonoperative ). Variables with significant subgroup × treatment interactions ( P < 0.05) were simultaneously entered into a multivariate model to select independent TE predictors.

Results. Other than smokers, all analyzed subgroups including at least 50 patients improved signifi cantly more with surgery than with nonoperative treatment ( P < 0.05). Multivariate analysis demonstrated: baseline ODI ≤ 56 (TE –15.0 vs. –4.4, ODI > 56, P < 0.001), not smoking (TE –11.7 vs. –1.6 smokers, P < 0.001), neuroforaminal stenosis (TE –14.2 vs. –8.7 no neuroforaminal stenosis, P = 0.002), predominant leg pain (TE –11.5 vs. –7.3 predominant back pain, P = 0.035), not lifting at work (TE –12.5 vs . –0.5 lifting at work, P = 0.017), and the presence of a neurological deficit (TE –13.3 vs . –7.2 no neurological deficit, P < 0.001) were associated with greater TE.

Conclusion. With the exception of smokers, patients who met strict inclusion criteria improved more with surgery than with nonoperative treatment, regardless of other specific characteristics. However, TE varied significantly across certain subgroups, and these data can be used to individualize shared decision making discussions about likely outcomes. Smoking cessation should be considered before surgery for SpS.

Posted on

SPORT: Does Incidental Durotomy Affect Longterm Outcomes in Cases of Spinal Stenosis?

Neurosurgery 69:38–44, 2011 DOI: 10.1227/NEU.0b013e3182134171

Incidental durotomy is a familiar encounter during surgery for lumbar spinal stenosis. The impact of durotomy on long-term outcomes remains a matter of debate.

OBJECTIVE: To determine the impact of durotomy on the long-term outcomes of patients in the Spine Patient Outcomes Research Trial (SPORT).

METHODS: The SPORT cohort participants with a confirmed diagnosis of spinal stenosis, without associated spondylolisthesis, undergoing standard, first-time, open decompressive laminectomy, with or without fusion, were followed up from baseline at 6 weeks, and 3, 6, and 12 months and yearly thereafter at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database were reviewed. As of May 2009, the mean follow-up among all analyzed patients was 43.8 months.

RESULTS: Four hundred nine patients underwent first-time open laminectomy with or without fusion. Thirty-seven of these patients (9%) had an incidental durotomy. No significant differences were observed with or without durotomy in age; sex; race; body mass index; the prevalence of smoking, diabetes mellitus, and hypertension; decompression level; number of levels decompressed; or whether an additional fusion was performed. The durotomy group had significantly increased operative duration, operative blood loss, and inpatient stay. There were, however, no differences in incidence of nerve root injury, mortality, additional surgeries, or primary outcomes (Short Form-36 Bodily Pain or Physical Function scores or Oswestry Disability Index) at yearly follow-ups to 4 years.

CONCLUSIONS: Incidental durotomy during first-time lumbar laminectomy for spinal stenosis did not impact long-term outcomes in affected patients.

Proudly powered by WordPress