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Microdecompression versus Open Laminectomy and Posterior Stabilization for Multilevel Lumbar Spine Stenosis: A Randomized Controlled Trial.

ABSTRACT: Background:Lumbar spinal stenosis most often results from a gradual, degenerative ageing process. Open or wide decompressive laminectomy was formerly the standard treatment. However, in recent years, a growing tendency towards less invasive decompressive procedures has emerged. The purpose of this study was to compare the results of microdecompression with those of open wide laminectomy and posterior stabilization for patients with symptomatic multilevel lumbar spinal stenosis who failed to respond to conservative treatment. Methods:This randomized controlled study was conducted between January 2016 and October 2018. One hundred patients were involved in this study. All these patients suffered from radicular leg pain with MRI features of multilevel lumbar spinal stenosis and were treated by conservative treatment of medical treatment and physiotherapy without benefit for 6 months. Those patients were divided into two groups: Group A, 50 microdecompression, and Group B, 50 patients who were treated by open wide laminectomy and posterior stabilization. Both groups of patients were followed up with ODI (Oswestry disability index) and VAS (visual analogue score) for the back and leg pain for one year. Results:The results showed that both groups got significant improvement regarding the Oswestry disability index. Regarding back pain, there was a significant improvement in both groups with better results in group A due to minimal tissue injury as the advantage of the minimal invasive technique. In both groups, there was marked improvement of radicular leg pain postoperatively. Conclusions:Both microdecompression and wide open laminectomy with posterior stabilization were effective in treatment of multilevel lumbar spinal stenosis with superior results of microdecompression regarding less back pain postoperatively with less blood loss and soft tissue dissection. Clinical trial number: NCT04087694.

SUBMITTER: Hamawandi SA

PROVIDER: S-EPMC6885236 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Microdecompression versus Open Laminectomy and Posterior Stabilization for Multilevel Lumbar Spine Stenosis: A Randomized Controlled Trial.

Hamawandi Sherwan A SA Sulaiman Injam Ibrahim II Al-Humairi Ameer Kadhim AK

Pain research & management 20191107

<h4>Background</h4>Lumbar spinal stenosis most often results from a gradual, degenerative ageing process. Open or wide decompressive laminectomy was formerly the standard treatment. However, in recent years, a growing tendency towards less invasive decompressive procedures has emerged. The purpose of this study was to compare the results of microdecompression with those of open wide laminectomy and posterior stabilization for patients with symptomatic multilevel lumbar spinal stenosis who failed ...[more]

PMID: 31827656

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Project description:ObjectiveTo test the equivalence for clinical effectiveness between microdecompression and laminectomy in patients with central lumbar spinal stenosis.DesignMulticentre observational study.SettingProspective data from the Norwegian Registry for Spine Surgery.Participants885 patients with central stenosis of the lumbar spine who underwent surgery at 34 Norwegian orthopaedic or neurosurgical departments. Patients were treated from October 2006 to December 2011.InterventionsLaminectomy and microdecompression.Main outcome measuresThe primary outcome was change in Oswestry disability index score one year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), perioperative complications, and duration of surgical procedures and hospital stays. A blinded biostatistician performed predefined statistical analyses in unmatched and propensity matched cohorts.ResultsThe study was powered to detect a difference between the groups of eight points on the Oswestry disability index at one year. 721 patients (81%) completed the one year follow-up. Equivalence between microdecompression and laminectomy was shown for the Oswestry disability index (difference 1.3 points, 95% confidence interval -1.36 to 3.92, P<0.001 for equivalence). Equivalence was confirmed in the propensity matched cohort and full information regression analyses. No difference was found between groups in quality of life (EQ-5D) one year after surgery. The number of patients with complications was higher in the laminectomy group (15.0% v 9.8%, P=0.018), but after propensity matching for complications the groups did not differ (P=0.23). The duration of surgery for single level decompression was shorter in the microdecompression group (difference 11.2 minutes, 95% confidence interval 4.9 to 17.5, P<0.001), but after propensity matching the groups did not differ (P=0.15). Patients in the microdecompression group had shorter hospital stays, both for single level decompression (difference 1.5 days, 95% confidence interval 1.7 to 2.6, P<0.001) and two level decompression (0.8 days, 1.0 to 2.2, P=0.003).ConclusionAt one year the effectiveness of microdecompression is equivalent to laminectomy in the surgical treatment of central stenosis of the lumbar spine. Favourable outcomes were observed at one year in both treatment groups.Trial registration ClinicalTrials.gov NCT02006901.

Project description:STUDY DESIGN: Retrospective cohort study. CLINICAL QUESTION: This study aimed to describe the outcome of stabilization surgery with dynamic instrumentation for degenerative disc disease. The results were compared with age- and gender-matched peers treated with traditional fusion with rigid instrumentation. If necessary, additional nerve elements decompression was undertaken in both groups. METHODS: This study analyzed the success rates of 25 patients aged 47.4 years (mean 95% confidence interval: 43.1-51.7) treated with stabilization of the involved vertebral dynamic unit(s) with either dynamic or rigid instrumentation with or without additional decompression. Clinical outcome was assessed with Oswestry disability index (ODI) and visual analogue scale (VAS) for back pain, leg pain, and activity level. Satisfaction outcome was measured with Stauffer and Coventry overall satisfaction criteria and VAS for satisfaction. Health-related quality of life was estimated with Short Form-36 (SF-36) questionnaires. Fusion rate and adjacent level(s) was checked with x-ray. Complications recorded in patients' files were evaluated and revision surgeries were stated as treatment failures. RESULTS: At the 4-year follow-up (range, 2-5 years) significant improvement was noted on some subjective parameters in both groups. No statistical differences were seen between the groups at final follow-up. Five patients (42%) in the rigid group and two patients (20%) in the dynamic group were rated good or excellent according to the overall Stauffer and Coventry satisfaction criteria. Radiologically, seven patients (58%) in the rigid group were undoubtedly fused and all the involved discs in the dynamic group continued to degenerate. Adjacent segments showed loss of disc height in both groups but only loss of upper adjacent discs in the rigid group was statistically significant. Two patients in the dynamic group and one patient in the rigid group required reoperation because of the pedicle screw misplacement. CONCLUSION: The results of this study indicate no significant difference between dynamic and rigid stabilization of the lumbar spine for patients with degenerative disc disease (DDD). However, the study is underpowered and further studies on larger and homogeneous group of patients should be undertaken. [Table: see text].

Dataset Information

Microdecompression versus Open Laminectomy and Posterior Stabilization for Multilevel Lumbar Spine Stenosis: A Randomized Controlled Trial.

Publications

Microdecompression versus Open Laminectomy and Posterior Stabilization for Multilevel Lumbar Spine Stenosis: A Randomized Controlled Trial.

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