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Outcome of modified interlaminar decompression: A conservative decompressive surgery for lumbar spine stenosis.

ABSTRACT: Objective:To evaluate the outcomes of modified interlaminar decompression in patients with degenerative lumbar spinal stenosis (LSS). Methods:This descriptive observational study was conducted at the Department of Neurosurgery, Lady Reading Hospital Peshawar from July 2014 to June 2018. All patients with degenerative LSS who underwent modified interlaminar decompression during the study period were included in the study. The patients were followed up to one year after surgery. The data was entered into a structured questionnaire designed according to the study which was then analyzed using SPSS version 21. Results:A total of 182 LSS cases were included in the study and 236 levels were operated during the study period. According to the records increased prevalence of LSS was found among males i.e. 58.8%. The common level with degenerative stenosis involved was L4-5. Good to excellent outcomes were observed in 93.9% patients in the 1st follow-up visit. The most common complication of surgery was dural tear followed by wound infection. Conclusion:Modified interlaminar decompression is a conservative surgical technique, proved to be a potential approach with acceptable complications, satisfactory outcomes and it is easy to learn.

SUBMITTER: Azam F

PROVIDER: S-EPMC7260903 | biostudies-literature | 2020 May-Jun

REPOSITORIES: biostudies-literature

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Outcome of modified interlaminar decompression: A conservative decompressive surgery for lumbar spine stenosis.

Azam Farooq F Sharafat Seema S Khan Zahid Z Ali Mumtaz M

Pakistan journal of medical sciences 20200501 4

<h4>Objective</h4>To evaluate the outcomes of modified interlaminar decompression in patients with degenerative lumbar spinal stenosis (LSS).<h4>Methods</h4>This descriptive observational study was conducted at the Department of Neurosurgery, Lady Reading Hospital Peshawar from July 2014 to June 2018. All patients with degenerative LSS who underwent modified interlaminar decompression during the study period were included in the study. The patients were followed up to one year after surgery. The ...[more]

PMID: 32494252

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Project description:Background:The indications of different endoscopic and endoscopically assisted translaminar approaches for lumbar spinal stenosis are not well-defined, and validated protocols for the use of the transforaminal over the interlaminar approach are lacking. Methods:We performed a retrospective study employing an image-based patient stratification protocol of stenosis location (type I-central canal, type II-lateral recess, type III-foraminal, type IV-extraforaminal) and clinical outcomes on 249 patients consisting of 137 (55%) men and 112 (45%) women with an average age of 56.03±16.8 years who underwent endoscopic surgery for symptomatic spinal stenosis from January 2013 to February 2019. The average follow-up of 38.27±27.9 months. The primary clinical outcome measures were the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and modified Macnab criteria. Results:The frequency of stenosis configuration in decreasing order was as follows: type I-121/249; 48.6%, type III-104/249; 41.8%, type II-15/249; 6%, and type IV-9/249; 3.6%. The transforaminal approach (137/249; 55.0%) was used in most type II to IV lesions followed by the interlaminar approach (78/249; 31.3%), and the full endoscopic approach (12/249; 4.8%), and the endoscopically assisted translaminar approach (8/249; 3.2%) which was exclusively used for type I lesions. Macnab outcomes analysis showed Excellent in 47 patients (18.9%), Good in 178 (71.5%), Fair in 18 (7.2%) and Poor in 6 (2.4%), respectively. Paired two-tailed t-test showed statistically significant VAS (5.46±2.1; P<0.0001) and ODI (37.1±16.9; P<0.0001) reductions as a result of the endoscopic decompression surgery. Cross-tabulation of the Macnab outcomes versus the endoscopic approach and surgical technique confirmed beneficial association of the approach selection with Excellent (P=0.001) and Good (P<0.0001) outcomes with statistically significance. Conclusions:This study suggests that in the hands of skilled endoscopic spines surgeon use of an image-based stenosis location protocol may contribute to obtaining Excellent and Good clinical outcomes in a high percentage (93%) of patients suffering from lumbar stenosis related radiculopathy. Additional comparative studies should examine the prognostic value of choosing the endoscopic approach on the basis of the proposed four-type stenosis protocol by correlating its impact on outcomes with preoperative diagnostic injections and intraoperative direct visualization of symptomatic pain generators under local anesthesia and sedation.

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:BackgroundWe aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS).MethodsThe study was an additional analysis in the NORDSTEN Spinal Stenosis Trial. In total, 230 men and 207 women (mean age 66.8 (SD 8.3)) were included. All patients underwent an MRI including T1- and T2-weighted sequences. Grade of foraminal stenosis was dichotomized into none to moderate (0-1) and severe (2-3) category using Lee's classification system. The Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and numeric rating scale (NRS) for back and leg pain were collected at baseline and at 2-year follow-up. Primary outcome was a reduction of 30% or more on the ODI score. Secondary outcomes included the mean improvement on the ODI, ZCQ, and NRS scores. We performed multivariable regression analyses with the radiological variates foraminal stenosis, Pfirrmann grade, Schizas score, dural sac cross-sectional area, and the possible plausible confounders: patients' gender, age, smoking status, and BMI.ResultsThe cohort of 437 patients presented a high degree of degenerative changes at baseline. Of 414 patients with adequate imaging of potential foraminal stenosis, 402 were labeled in the none to moderate category and 12 in the severe category. Of the patients with none to moderate foraminal stenosis, 71% achieved at least 30% improvement in ODI. Among the patients with severe foraminal stenosis, 36% achieved at least 30% improvement in ODI. A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. When investigating outcome as continuous variables, a similar association between severe foraminal stenosis and less improved ODI with a mean difference of 9.28 points (95%CI 0.47, 18.09; p=0.04) was found. Significant association between severe foraminal stenosis and less improved NRS pain in the lumbar region was also detected with a mean difference of 1.89 (95% CI 0.30, 3.49; p=0.02). No significant association was suggested between severe foraminal stenosis and ZCQ or NRS leg pain.ConclusionIn patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI.Trial registrationThe study is registered at ClinicalTrials.gov (22.11.2013) under the identifier NCT02007083.

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Outcome of modified interlaminar decompression: A conservative decompressive surgery for lumbar spine stenosis.

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Outcome of modified interlaminar decompression: A conservative decompressive surgery for lumbar spine stenosis.

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