Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series (original) (raw)
Related papers
Turkish Neurosurgery, 2011
AIm: The aim of implantation of interspinous device is to unload the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome of surgery. mAterIAl and methOds: After microsurgical decompression, Coflex™ device was applied. Patients were evaluated at a month after surgery and last follow-up using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Foraminal height and lumbar lordosis angle were recorded. results: The mean preoperative VAS was 7.85 and fell to 1.7 a month after surgery (p<0.0001). At the last follow-up the mean VAS score was 1.65 (p<0.0001). The mean foraminal heights were measured 19.95 mm preoperatively and 25.05 mm a month after surgery (p<0.0001). The mean foraminal height was 21.60 mm at the last follow-up (p=0.002). The mean lumbar lordosis were measured 32.05 and 34.3 degrees at preoperative and a month after surgery respectively (p=0.155). The mean lumbar lordosis was 32 (±5.99) degrees at the last follow-up (p=0.974). COnClusIOn: Using the Coflex device is a minimal invasive, effective and safe procedure. Restoration of the foraminal height may not be a responsible factor for clinical improvement. We think microsurgical decompression looks responsible of the good clinical outcome and using interspinous device is unnecessary. Comparative clinical studies can be informative.
Unilateral Approach Bilateral Microdecompression for Degenerative Lumbar Spinal Stenosis
Comprehensive medicine, 2024
Objective: Degenerative lumbar spinal stenosis is a frequent cause of back and leg pain in elderly patients. Degenerative spinal stenosis may be due to intervertebral disk bulging, joint facet hypertrophy, thickening of the ligamentum flavum, and spondylolisthesis. The aim of this study is to investigate the results of unilateral approach bilateral microdecompression for degenerative lumbar spinal stenosis patients. Materials and Methods: We observed 78 patients who have back and/or leg pain with neurogenic claudication. The patients were scored by visual analog scale (VAS), oswestry disability index (ODI) score, and walking distance (WD). The surgical technique used in all stenotic levels was unilateral approach bilateral microdecompression. All patients were questioned and examined before surgery, post-operative 2 nd year. Results: Thirty-nine males and 39 females total of 78 patients with the mean age of 64.3±7.2 were investigated. There was no statistically significance according to gender and age. Pre-operative mean VAS, ODI and WD values were 8.9±1.1, 65±17.20, 42±21.30 and post-operative 2 nd year values were 1.2±0.23, 17±1.91, 1800±617.13. All three parameters were found statistically significant when compared between pre-operative and post-operative values (p<0.05). Conclusion: The results of the unilateral approach bilateral microdecompression for treating lumbar spinal stenosis are satisfying because you can achieve sufficient decompression with minimal invasive technique without dissecting and damaging the opposite side tissues.
Percutaneous Decompression of Lumbar Spinal Stenosis with a New Interspinous Device
CardioVascular and Interventional Radiology, 2012
Objective This study was designed to evaluate the feasibility of the implantation of a new interspinous device (Falena) in patients with lumbar spinal stenosis. The clinical outcomes and imaging results were assessed by orthostatic MR during an up to 6-month follow-up period. Methods Between October 2008 and February 2010, the Falena was implanted at a single level in 26 patients (17 men; mean age, 69 (range, 54-82) years) who were affected by degenerative lumbar spinal stenosis. All of the patients were clinically evaluated before the procedure and at 1 and 3 months. Furthermore, 20 patients have completed a 6-month follow-up. Pain was assessed before and after the intervention using the Visual Analogue Scale score and the Oswestry Disability Index questionnaire. Orthostatic MR imaging was performed before the implantation and at 3 months to assess the correlation with the clinical outcome. Results The mean ODI score decreased from 48.9 before the device implantation to 31.2 at 1 month (p \ 0.0001). The mean VAS score decreased from 7.6 before to 3.9 (p \ 0.0001) at 1 month and 3.6 at 3 months after the procedure (p = 0.0115). These values were stable at 6 months evaluation. No postimplantation major complications were recorded. MRI evaluation documented in most cases an increased size of the spinal canal area. Similarly a bilateral foraminal area improvement was found. The variation of the intervertebral space height measured on the posterior wall was not significant. Conclusions In our preliminary experience with the Falena in a small cohort of patients, we obtained clinical and imaging results aligned to those reported with similar interspinous devices.
Journal of Bone and Joint Surgery - British Volume, 2010
We describe a modified technique of micro-decompression of the lumbar spine involving the use of an operating microscope, a malleable retractor and a high-speed burr, which allows decompression to be performed on both sides of the spine through a unilateral, hemi-laminectomy approach. The first 100 patients to be treated with this technique have been evaluated prospectively using a visual analogue score for sciatica and back pain, the MacNab criteria for patient satisfaction, and functional assessment with the Oswestry Disability Index. After a period of follow-up from 12 months to six years and four months, sciatica had improved in 90 patients and back pain in 84 patients. Their result was graded as good or excellent by 82 patients according to the MacNab criteria, and 75 patients had subjective improvement in their walking distance. Late instability developed in four patients. Lumbar micro-decompression has proved to be safe, with few complications. Postoperative instability requi...
Clinical Neurology and Neurosurgery, 2014
Interspinous distraction devices provide an effective treatment for patients suffering from lumbar spinal stenosis and/or degenerative disk disease. The aim of this multicenter study was the prospective evaluation of patients treated for symptomatic lumbar spinal stenosis with interspinous process decompression (IPD) implants compared with a population of patients managed with conservative treatment. 542 patients affected by symptomatic lumbar spine degenerative disease were enrolled in a controlled trial. 422 patients underwent surgical treatment consisting of X-STOP device implantation, whereas 120 control cases were managed conservatively. Both patient groups underwent follow-up evaluations at 6, 12, 24, and 36 months using the Zurich Claudication Questionnaire, the Visual Analog Scale score and spinal lumbar X-rays, CT scans and MR imaging. One-year follow-up evaluation revealed positive good results in the 83.5% of patients treated with IPD with respect to 50% of the nonoperative group cases. During the first three years, in 38 out of the 120 control cases, a posterior decompression and/or spinal fixation was performed because of unsatisfactory results of the conservative therapy. In 24 of 422 patients, the IPD device had to be removed, and a decompression and/or pedicle screw fixation was performed because of the worsening of neurological symptoms. Our results support the effectiveness of surgery in patients with stenosis. IPD may offer an effective and less invasive alternative to classical microsurgical posterior decompression in selected patients with spinal stenosis and lumbar degenerative disk diseases.
Asian Spine Journal, 2020
In this retrospective review study, the authors systematically reviewed the literature to elucidate the efficacy and complications associated with decompression and interspinous devices (ISDs) used in surgeries for lumbar spinal stenosis (LSS). LSS is a debilitating condition that affects the lumbar spinal cord and spinal nerve roots. However, a comprehensive report on the relative efficacy and complication rate of ISDs as they compare to traditional decompression procedures is currently lacking. The PubMed database was queried to identify clinical studies that exclusively investigated decompression, those that exclusively investigated ISDs, and those that compared decompression with ISDs. Only prospective cohort studies, case series, and randomized controlled trials that evaluated outcomes using the Visual Analog Scale (VAS), Oswestry Disability Index, or Japanese Orthopedic Association scores were included. A random-effects model was established to assess the difference between pr...
Journal of Turkish Spinal Surgery, 2020
Bilateral decompression via a unilateral approach (BDUA) was initially described by Young et al. (4) and then was modified by McCulloch (5). In this technique, the risk of iatrogenic instability is reduced by preserving the facet joints. Unilateral stabilization and contralateral decompression were considered to be effective in terms of operation time, surgical complications, and patient benefit visual analogue scale in comparison to other surgical techniques for the treatment of lumbar spinal stenosis. There is no doubt that a fusion procedure should be performed in the presence of accompanying instability. However, in spinal stenosis cases without instability and spondylolisthesis less than grade 1, the role of spinal fusion is controversial. This is so because spinal instrumentation in degenerative spine may cause adjacent segment degeneration and disease. Therefore, procedures such as bilateral foraminotomy, BDUA, and
2012
AIm: The aim of implantation of interspinous device is to unload the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome of surgery. mAterIAl and methOds: After microsurgical decompression, Coflex™ device was applied. Patients were evaluated at a month after surgery and last follow-up using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Foraminal height and lumbar lordosis angle were recorded. results: The mean preoperative VAS was 7.85 and fell to 1.7 a month after surgery (p<0.0001). At the last follow-up the mean VAS score was 1.65 (p<0.0001). The mean foraminal heights were measured 19.95 mm preoperatively and 25.05 mm a month after surgery (p<0.0001). The mean foraminal height was 21.60 mm at the last follow-up (p=0.002). The mean lumbar lordosis were measured 32.05 and 34.3 degrees at preoperative and a month after surgery respectively (p=0.155). The mean lumbar lordosis was 32 (±5.99) degrees at the last follow-up (p=0.974). COnClusIOn: Using the Coflex device is a minimal invasive, effective and safe procedure. Restoration of the foraminal height may not be a responsible factor for clinical improvement. We think microsurgical decompression looks responsible of the good clinical outcome and using interspinous device is unnecessary. Comparative clinical studies can be informative.
Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis
JAMA Network Open
IMPORTANCE Operations for lumbar spinal stenosis is the most often performed surgical procedure in the adult lumbar spine. This study reports the clinical outcome of the 3 most commonly used minimally invasive posterior decompression techniques. OBJECTIVE To compare the effectiveness of 3 minimally invasive posterior decompression techniques for lumbar spinal stenosis. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial used a parallel group design and included patients with symptomatic and radiologically verified lumbar spinal stenosis without degenerative spondylolisthesis. Patients were enrolled between February 2014 and October 2018 at the orthopedic and neurosurgical departments of 16 Norwegian public hospitals. Statistical analysis was performed in the period from May to June 2021. INTERVENTIONS Patients were randomized to undergo 1 of the 3 minimally invasive posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy, and spinous process osteotomy. MAIN OUTCOMES AND MEASURES Primary outcome was change in disability measured with Oswestry Disability Index (ODI; range 0-100), presented as mean change from baseline to 2-year follow-up and proportions of patients classified as success (>30% reduction in ODI). Secondary outcomes were mean change in quality of life, disease-specific symptom severity measured with Zurich Claudication Questionnaire (ZCQ), back pain and leg pain on a 10-point numeric rating score (NRS), patient perceived benefit of the surgical procedure, duration of the surgical procedure, blood loss, perioperative complications, number of reoperations, and length of hospital stay. RESULTS In total, 437 patients were included with a median (IQR) age of 68 (62-73) years and 230 men (53%). Of the included patients, 146 were randomized to unilateral laminotomy with crossover, 142 to bilateral laminotomy, and 149 to spinous process osteotomy. The unilateral laminotomy with crossover group had a mean change of −17.9 ODI points (95% CI, −20.8 to −14.9), the bilateral laminotomy group had a mean change of −19.7 ODI points (95% CI, −22.7 to −16.8), and the spinous process osteotomy group had a mean change of-19.9 ODI points (95% CI, −22.8 to-17.0). There were no significant differences in primary or secondary outcomes among the 3 surgical procedures, except a longer duration of the surgical procedure in the bilateral laminotomy group. (continued) Key Points Question Are any of the 3 most common minimally invasive procedures for surgical treatment of lumbar spinal stenosis superior to the others? Findings In this randomized clinical trial of 437 patients at 16 public hospitals in Norway, there was no difference in the clinical results from the 3 most commonly performed minimally invasive decompression techniques investigated after 2 years. Meaning These findings suggest that surgeons can choose decompression techniques according to their skills and preferences.
Interspinous Process Decompression: Expanding Treatment Options for Lumbar Spinal Stenosis
BioMed Research International, 2016
Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy. For the ODI, effect sizes were allvery large(>1.0) for Superion and laminectomy at 2, 3, and 4 years. For ZCQ, the 2-year Superion symptom severity (1.26) and physical function (1.29) domains werevery large; laminectomy effect sizes werevery large(1.07) for symptom severity andlargefor physical function (0.80). Current projections indicate a marked increase in the num...