Degenerative Lumbar Spinal Stenosis Research Articles

Lumbar lordosis reduction and disc bulge may correlate with multifidus muscle fatty infiltration in patients with single-segment degenerative lumbar spinal stenosis

ObjectivesTo investigate the correlation between fatty infiltration in the multifidus muscle related to the involved nerve root and structural parameters associated with stenosis in patients with degenerative lumbar spinal stenosis (DLSS). Patients and methodsSixty-four patients with single-segment DLSS at L4-5 were retrospectively enrolled. The fatty infiltration rate (FIR) of the multifidus muscle at L5-S1, lumbar lordosis and the cross-sectional area (CSA) of the structural parameters at L4-5, such as dural sac, disc bulge, ligamentum flava and vertebral body of L5 were measured on magnetic resonance images using ImageJ software. All enrolled patients were divided into an FIR < 25 % group and an FIR ≥ 25 % group according to the FIR of the multifidus muscle at L5-S1. The propensity scores matching and adjustment of potential covariates were performed to reduce the confounding bias between the two groups. ResultsLumbar lordosis in the FIR ≥ 25 % group was significantly lower than that in the FIR＜25 % group in both cohorts. The mean differences in lumbar lordosis of 14.16 degrees between the two groups in the complete cohort and of 14.23 degrees in the matched cohort remained significant after adjustment. The disc bulge CSA/ vertebral body CSA in the FIR ≥ 25 % group was greater than that in the FIR＜25 % group in both cohorts. The mean differences in the disc bulge CSA/ vertebral body CSA between the two groups of 0.67 in the complete cohort and 0.96 in the matched cohort were statistically significant after adjustment. There was no significant difference in the dural sac CSA/ vertebral body CSA and ligamentum flava CSA/ vertebral body CSA between the two groups in either cohort regardless of adjustment. Logistic regression analysis for FIR ≥ 25 % in the multifidus muscle at L5-S1 exhibited that the disc bulge CSA/ vertebral body CSA were independent risk factors with odds ratio (OR) of 8.52, while lumbar lordosis were independent protective factors (OR = 0.72). ConclusionsThe disc bulge at the stenosis segment and lumbar lordosis reduction may be correlated with fatty infiltration in the multifidus muscles at L5-S1 in patients with L4-5 single-segment DLSS.

The limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis with instability

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ± 10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients’ functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients’ functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.

Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

BackgroundThe quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique.ObjectivesThe aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis.Subjects and methodsCases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction.ResultsThere was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome.ConclusionComparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis

BackgroundRecent demographic changes have led to a large population of older adults, many of whom experience degenerative disc diseases. Degenerative lumbar spinal stenosis (DLSS) is associated with considerable discomfort and limitations in activities of daily living (ADL). Symptomatic DLSS is one of the most frequent indications for spinal surgery. The aim of this study was to identify sociodemographic variables, morphological markers, depression as well as fear of movement that predict ADL performance and participation in social life in patients with DLSS.MethodsSixty-seven patients with DLSS (mean age 62.5 years [11.7], 50.7% females) participated in the study. Predictor variables were age, gender, duration of disease, three morphological markers (severity of the lumbar stenosis, the number of affected segments and presence of spondylolisthesis) as well as self-reported depression and fear of movement. Dependent variables were pain interference with the performance of ADLs, ADLs and participation in social life. Correlations between predictor and dependent variables were calculated before stepwise, linear regression analyses. Only significant correlations were included in the linear regression analyses.ResultsVariance explained by the predictor variables ranged between 12% (R2 = .12; pain interference-physical) and 40% (R2 = .40; ADL requiring lower extremity functioning; participation). Depression and fear of movement were the most powerful predictors for all dependent variables. Among the morphological markers only stenosis severity contributed to the prediction of ADLs requiring lower extremity functioning.ConclusionDepression and fear of movement were more important predictors of the execution of ADLs and participation in social life compared to morphological markers. Elevated depressive symptoms and fear of movement might indicate limited adaptation and coping regarding the disease and its consequences. Early monitoring of these predictors should therefore be conducted in every spine centre. Future studies should investigate whether psychological screening or a preoperative psychological consultation helps to avoid operations and enables better patient outcomes.

Weight-bearing MRI of the Lumbar Spine: Spinal Stenosis and Spondylolisthesis.

Symptoms of degenerative lumbar spinal stenosis include back pain, radiculopathy, claudication, and muscular fatigue that tend to be predominant in the standing position or during walking. Lumbar spondylolisthesis is also a well-known cause of spinal stenosis, lateral recess, and neural foraminal narrowing that tends to become more severe in the upright position. This indicates a functional positional component of both spinal stenosis and spondylolisthesis. Lumbar spinal stenosis and spondylolisthesis are typically evaluated by magnetic resonance imaging (MRI) performed in the supine position with a pillow under the patient's lower limbs that slightly flexes the lumbar spine and ameliorates symptoms. Because these two entities tend to be aggravated in the upright position, it seems rational to also consider performing diagnostic imaging in these patients in the upright position. This article reviews the use of weight-bearing MRI for lumbar spinal stenosis and spondylolisthesis.

Patients undergoing surgery for lumbar spinal stenosis experience unique courses of pain and disability: A group-based trajectory analysis.

ObjectiveIdentify patient subgroups defined by trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis, and investigate the construct validity of the subgroups by evaluating for meaningful differences in clinical outcomes.MethodsWe recruited patients with degenerative lumbar spinal stenosis from 13 surgical spine centers who were deemed to be surgical candidates. Study outcomes (leg and back pain numeric rating scales, modified Oswestry disability index) were measured before surgery, and after 3, 12, and 24 months. Group-based trajectory models were developed to identify trajectory subgroups for leg pain, back pain, and pain-related disability. We examined for differences in the proportion of patients achieving minimum clinically important change in pain and disability (30%) and clinical success (50% reduction in disability or Oswestry score ≤22) 12 months from surgery.ResultsData from 548 patients (mean[SD] age = 66.7[9.1] years; 46% female) were included. The models estimated 3 unique trajectories for leg pain (excellent outcome = 14.4%, good outcome = 49.5%, poor outcome = 36.1%), back pain (excellent outcome = 13.1%, good outcome = 45.0%, poor outcome = 41.9%), and disability (excellent outcome = 30.8%, fair outcome = 40.1%, poor outcome = 29.1%). The construct validity of the trajectory subgroups was confirmed by between-trajectory group differences in the proportion of patients meeting thresholds for minimum clinically important change and clinical success after 12 postoperative months (p < .001).ConclusionSubgroups of patients with degenerative lumbar spinal stenosis can be identified by their trajectories of pain and disability following surgery. Although most patients experienced important reductions in pain and disability, 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. These findings may inform appropriate expectation setting for patients and clinicians and highlight the need for better methods of treatment selection for patients with degenerative lumbar spinal stenosis.

Full Endoscopic Uniportal Unilateral Laminotomy for Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: Highlight of Ligamentum Flavum Detachment and Survey of Efficacy and Safety in 2 Years of Follow-up

Conventional laminectomy for spine decompression involves inherent complications resulting from perioperative traumatization of posterior structures. Minimally invasive decompression was developed to address these issues. Full endoscopic spine surgery has shifted the paradigm from disc pathology to spinal stenosis by overcoming the limitation of bony procedures with evolving endoscopic instruments. However, a steep learning curve restricts the development of endoscopic decompression. The purpose of this study is to describe full endoscopic uniportal unilateral laminotomy for bilateral decompression through the interlaminar approach and to evaluate its efficacy and safety in 2 years of follow-up. A total of 106 patients (45 men, 61 women) with degeneration lumbar stenosis involving 165 segments were enrolled from April 2015 to June 2017, and treated by full endoscopic uniportal unilateral laminotomy for bilateral decompression. We made an 8-mm incision and used a general-size endoscope (working channel 4.3 mm) to avoid neurological compromise during the demonstration. The visual analogue scale (VAS) results for back pain revealed a significant reduction from preoperative 6.8 ± 2.1 to 1.7 ± 1.7 after 2 years (P < 0.001). The VAS results for leg pain revealed a significant reduction from preoperative 7.6 ± 1.3 to 1.3 ± 1.6 after 2 years (P < 0.001). The Oswestry Disability Index showed significant improvement from preoperative 62.0 ± 13.9 to 14.6 ± 15.7 after 2 years (P<0.001). The average operation time was 68.9 ± 10.0 minutes per level. One case had iatrogenic durotomy, 1 case underwent revision surgery due to incomplete decompression, and 2 cases had delayed wound healing. This procedure obtained successful and satisfactory outcomes for patients, and was more feasible for surgeons.

Effect of Facet Joint Effusion on Clinical and Radiographic Outcomes of Decompression for Degenerative Lumbar Spinal Stenosis

Effect of Facet Joint Effusion on Clinical and Radiographic Outcomes of Decompression for Degenerative Lumbar Spinal Stenosis

A comparison study of two channels during MIS-TLIF in degenerative lumbar spinal stenosis treatment

Objective To compare the clinical effects between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by Microendoscopic discectomy (MED) and Quadrant for the treatment of degenerative lumbar spinal stenosis (DLSS). Methods All of 59 patients suffered from DLSS treated surgically from May 2015 to October 2017 were reviewed. According to the surgery method, all cases were divided into MED group (27 cases) and Quadrant channel group (32 cases). All patients were followed up for an average of 18.5 months (11-29 months). Comparison was made on the operative time, intraoperative blood loss, postoperative drainage, postoperative time in bed, postoperative creatine kinase (CK), fusion rate and the degree of muscle fibrosis shown in MRI, as well as visual analogue scale (VAS)score and Oswestry dysfunction index (ODI) score in two groups. Results The duration of operation in MED group was significantly longer than that in Quadrant group (161.7±22.4 min vs. 145.6±19.4 min, t=4.541, P 0.05). ODI was lower in MED group than that in Quadrant group after 6 months and 12 months.The fusion rate was88.9%(24/27) in MED group and 93.8%(30/32) in Quadrant channel group. There was no statistical difference in fusion rate of two groups. 10 patients in MED group and 12 patients in Quadrant group underwent MRI examination of lumbar spine one year after operation. The ratio of postoperative and preoperative atrophy of multiplex muscle area was measured. Muscle atrophy of lower back muscle was lighter in MED group (0.12±0.05 vs. 0.22±0.04, t=-2.428, P<0.05). For intraoperative and postoperative complications, 1 case of dural sac rupture occurred in both groups. Gelatin sponge immediately with fibrin glue was used for plugging up, no postoperative cerebrospinal fluid leakage was found. In Quadrant channel group, 1 case had less blood supply of skin incision edges and epidermal necrosis while the other case had fat liquefaction. Conclusion Compared with the aid of Quadrant, MIS-TLIF assisted with MED had less blood loss, less trauma and faster recovery and could reduce the incidence of postoperative incision complication. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Spinal Stenosis; Surgical procedures, minimally invasive; Spinal fusion

Acupuncture vs Noninsertive Sham Acupuncture in Aging Patients with Degenerative Lumbar Spinal Stenosis: A Randomized Controlled Trial

BackgroundAcupuncture is commonly used to treat degenerative lumbar spinal stenosis in Asian countries. However, rigorous data regarding the efficacy and safety of acupuncture for aging patients are currently lacking. MethodsEighty patients older than 50 years were assigned randomly to the acupuncture group or the noninsertive sham acupuncture for 24 treatments over an 8-week period. Measurements were obtained at baseline and 4 and 8 weeks of treatment; and 3 and 6 months after completion of treatment. The primary outcome was a change in the 24-point Roland Morris Disability Questionnaire scores at the end of treatment. The secondary outcomes included disability, pain intensity, symptoms, and dysfunction. ResultsAt the end of treatment, mean changes in the Roland Morris Disability Questionnaire were −4.1 (95% CI, −4.9 to −3.3) in the acupuncture group and −1.5 (95% CI, −2.3 to −0.7) in the sham group, with a statistically significant between-group difference: −2.6 (95% CI, −3.7 to −1.4). Acupuncture was superior to sham acupuncture in reducing pain intensity (between-group difference: −2.9 [95% CI, −3.8 to −2.0] in leg and buttock pain, vs −2.3 [95% CI, −3.0 to −1.5] in back pain), symptoms and dysfunction (between-group difference: −0.9 [95% CI, −1.2 to −0.6] in symptom subscale, and −0.8 [95% CI, −1.1 to −0.5] in dysfunction subscale). ConclusionsAcupuncture provides immediate functional recovery and pain relief for degenerative lumbar spinal stenosis. However, current evidence is insufficient to support the suggestion that acupuncture could offer clinical benefits as compared with noninsertive sham acupuncture for degenerative lumbar spinal stenosis.

How I do it: bilateral lumbar spinal canal microsurgical decompression via unilateral approach.

Bilateral lumbar spinal canal decompression via unilateral approach is a surgical way to treat degenerative spinal canal stenosis. We report the treatment of degenerative lumbar spinal canal stenosis by removing overgrown ligaments, bone, and other compromising tissue on both sides of the spinal canal, using one side approach, avoiding surgical trauma of the counter side of the spine. This technique allows to achieve perfect results using common microsurgical instruments and Caspar distractor for one or multilevel surgery.

Effect of body mass index on surgical times of lumbar laminoplasty and lower limb arthroplasties

BackgroundObesity is an important factor affecting incidence and development of musculoskeletal degenerative changes. In addition, obese patients are considered less favorable surgical candidates for decompression surgery in degenerative lumbar spinal canal stenosis and lower limb arthroplasty. The purpose was to assess disease characteristics of lumbar spinal canal stenosis as well as lower limb osteoarthritis, and to investigate surgical times based on body mass index (BMI) in lumbar decompressive surgery and lower limb arthroplasties.MethodsA total of 1161 patients with a diagnosis of lumbar canal stenosis (LCS), hip osteoarthritis (HOA) and knee osteoarthritis (KOA) were enrolled. The present investigation was conducted as a retrospective study using routinely collected data. All patients underwent primary decompressive surgery (laminoplasty: LAM) or lower limb arthroplasty (total hip arthroplasty: THA and total knee arthroplasty: TKA). All of the patients were divided into 3 groups based on BMI (kg/m2) (Group A: ≤ 24.9; Group B: 25–29.9; Group C: ≥ 30) within each disease category. To assess disease characteristics, age, gender, and BMI were evaluated for each disease category. Moreover, surgical times for LAM, THA and TKA were also assessed based on BMI classification.ResultsA total of 269, 470, and 422 patients were allocated to the HOA category, the KOA category, and the LCS category, respectively. The KOA category included the oldest patients and largest BMI, compared to the HOA and the LCS categories. Regarding gender difference, LCS was more common in males than in females, while opposite phenomenon was observed in the HOA and the KOA categories. The heaviest group (Group C) was significantly younger than Groups A or B in TKA and LAM. Surgical time was significantly longer in patients with overweight or obese patients than in those with normal weight in TKA and LAM, while BMI didn’t affect the time in THA.ConclusionsDisease characteristics of the KOA category and the LCS category were notably affected by BMI, and surgical times in TKA and LAM were significantly longer for overweight or obese patients, whereas THA was less affected by BMI concerning disease characteristics and surgical time.

Risk factors of degenerative lumbar scoliosis in patients with lumbar spinal canal stenosis.

Lumbar spinal canal stenosis (LSCS) associated with degenerative scoliosis has being increasingly aware by the public and studied by many researchers. Degenerative changes leading to spinal stenosis can precede a spinal deformity which will develop into the de novo scoliosis. There are few studies focusing on the risk factors contributing to the degenerative lumbar scoliosis (DLS) in lumbar spinal stenosis patients.From September, 2017 to December, 2017, 181 patients who were diagnosed with LSCS in the outpatient department of our hospital were enrolled in this retrospective investigation. The patients were divided into 2 groups: DLS group (Cobb angle >10°) and LSCS group. Sex, age, smoking status (yes or no), occupation (heavy or light labor), body mass index (BMI), bone mineral density (BMD) and radiographic parameters including the lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), coronal vertical axis, and sagittal vertical axis (SVA) are all evaluated as potential risk factors. Multivariate logistic regression analysis and receiver-operating characteristic curves were used to identify potential risk factors.Forty-five of 181 patients were diagnosed with DLS and involved in the DLS group. There were significant differences between the 2 groups in BMI (P < .001), LL (P = .0046), BMD (P < .001), SVA (P < .001), and TK (P = .047). BMD < −1.85 g/cm2 (adjusted odds ratio [AOR] 0.030, 95% confidence interval [CI] 0.008–0.107, P < .001), BMI >25.57 kg/m2 (AOR 1.270, 95% CI 1.040–1.551, P = .019), and SVA >3.98 cm (AOR 3.651, 95% CI 2.226–5.990, P < .001) had good accuracy to predict the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.Degenerative lumbar scoliosis has a high incidence in degenerative lumbar spinal stenosis. BMD <−1.85 g/cm2, BMI >25.57 kg/m2, and SVA >3.98 cm were the potential risk factors for the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.

Severity of degenerative lumbar spinal stenosis affects pelvic rigidity during walking

BACKGROUND CONTEXTTo understand the role of compensation mechanisms in the development and treatment of symptomatic degenerative lumbar spinal stenosis (DLSS), pelvic stability during walking should be objectively assessed in the context of clinical parameters. PURPOSETo determine the association among duration of symptoms, lumbar muscle atrophy, disease severity, pelvic stability during walking, and surgical outcome in patients with DLSS scheduled for decompression surgery. STUDY DESIGN/SETTINGProspective observational study with intervention. PATIENT SAMPLEPatients with symptomatic DLSS. OUTCOME MEASURESOswestry Disability Index score; duration of symptoms; lumbar muscle atrophy; severity grade; pelvis rigidity during walking. METHODSPatients with symptomatic DLSS were analyzed on the day before surgery and 10 weeks and 12 months postoperatively. Duration of symptoms was categorized as: <2years, <5years, and >5years. Muscle atrophy at the stenosis level was categorized according to Goutallier. Bilateral cross-sectional areas of the erector spinae and psoas muscles were quantified from magnetic resonance imaging. Stenosis grade was assessed using the Schizas classification. Pelvic tilt was measured in standing radiographs. Pelvic rigidity during walking was assessed as root mean square of the pelvic acceleration in each direction (anteroposterior, mediolateral, and vertical) normalized to walking speed measured using an inertial sensor attached to the skin between the posterior superior iliac spine. RESULTSBody mass index but not duration of symptoms, lumbar muscle atrophy, pelvic rigidity, and stenosis grade explained changes in Oswestry Disability Index from before to after surgery. Patients with greater stenosis grade had greater pelvic rigidity during walking. Lumbar muscle atrophy did not correlate with pelvic rigidity during walking. Patients with lower stenosis grade had greater muscle atrophy and patients with smaller erector spinae and psoas muscle cross-sectional areas had a greater pelvis tilt. CONCLUSIONSGreater pelvic rigidity during walking may represent a compensatory mechanism of adopting a protective body position to keep the spinal canal more open during walking and hence reduce pain. Pelvic rigidity during walking may be a useful screening parameter for identifying early compensating mechanisms. Whether it can be used as a parameter for personalized treatment planning or outcome prognosis necessitates further evaluation.

179. Predictors of clinical outcome following surgery for lumbar spinal stenosis: a study of postoperative pain and disability trajectories

BACKGROUND CONTEXT On average, patients experience important reductions in pain and disability following surgery for degenerative lumbar spinal stenosis (LSS). However, variability in the postoperative course of symptoms suggests many patients do not fit the average symptom trajectory. PURPOSE To identify patient subgroups defined by trajectories of pain and disability following surgery for LSS and investigate the construct validity of the subgroups by evaluating meaningful differences in clinical outcomes. Identify predictors of belonging to the poor outcomes subgroup for disability, leg pain and back pain. STUDY DESIGN/SETTING Retrospective analysis of prospectively collected data. PATIENT SAMPLE Patients with LSS were recruited from 13 surgical spine centers participating in the Canadian Spine Outcomes and Research Network registry. OUTCOME MEASURES Leg and back pain numeric rating scales and the modified Oswestry disability index were measured before surgery and at 3, 12, and 24 months following surgery. METHODS Patients were fit into pain and disability trajectory subgroups with group-based trajectory modeling. Differences in the proportion of patients achieving minimum clinically important change in pain and disability (30%) and clinical success (50% reduction in disability or Oswestry score ≤22) were examined. Generalized linear mixed models adjusted for age and sex, were used to identify associations between subgroup membership and preoperative demographic, clinical history, health status and surgical factors. The subgroup with excellent outcomes was used as the reference group; associations were reported with relative risk ratios (RR). RESULTS The group-based trajectory models identified 3 unique pain trajectories each (excellent, fair and poor) for leg pain, back pain and disability. Depending on outcome 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. The construct validity of the trajectory subgroups was supported by differences in the proportion of patients meeting thresholds for minimum clinically important change and clinical success (p CONCLUSIONS The percentage of patients with poor outcomes highlights the need for better methods of treatment selection for patients with LSS. The predictors of having poor outcomes suggests it is time to look beyond pathology/surgical factors only and include mental health variables as an integral part of the surgical decision-making process in an effort to avoid patients at increased risk for surgical failure. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Late Week Surgery Is Associated With Longer Length of Stay in Patients Undergoing Laminectomy for Degenerative Lumbar Stenosis

Abstract INTRODUCTION As episode-based payment initiatives are becoming more prevalent, it becomes critical for providers to reduce unnecessary costs. Prolonged length of stay (LOS) can be a major driver of cost following elective spine surgery. While prolonged LOS may be medically indicated, the present study sought to assess how an overlooked variable, the day of the week that the surgery was performed, may influence LOS. METHODS A retrospective review was performed for all patients undergoing level 1 to 2 laminectomy surgery for degenerative lumbar spinal stenosis within a single large healthcare system from March 1, 2016 to February 1, 2019. The weekday of surgery was classified as a binary variable: early (Monday/Tuesday) vs late week (Thursday/Friday). Multiple regression models were fit to assess the association of hospital LOS and weekday of surgery. Additional covariates such as primary insurer, surgery location, Elixhauser comorbidity score, postoperative complications, and discharge disposition were also included in candidate models. RESULTS A total of 1087 subjects fit the inclusion criteria and had a median LOS of 2 d (IQR: 1-3). The final model accounted for 53% of variation in LOS. Late week surgery was a significant predictor of longer LOS (12%, 95% CI: 5.5–20%) after controlling for other covariates. Additionally, late week surgery and discharge disposition demonstrated a significant interaction, where patients requiring a Skilled Nursing Facility/Inpatient Rehabilitation (SNF/Rehab) placement were predicted to have 32% longer LOS (95% CI: 9.1–60.2). Medicaid insurance, greater comorbidities, surgery at main campus, and postoperative complications were also significantly associated with longer LOS. CONCLUSION These results suggest that late-week surgery is associated with a significantly longer LOS compared to early-week surgery while holding other predictors constant. Since the increased LOS of late-week surgery is most pronounced for SNF/Rehab discharges, optimization of scheduling algorithms or presurgical authorization of SNF/Rehab based on SNF/Rehab risk may mitigate longer LOS and their associated expenditures.

Psychological predictors of quality of life and functional outcome in patients undergoing elective surgery for degenerative lumbar spine disease

To quantify the correlation between patients' psychopathological predisposition, disability and health-related quality of life (QOL) after surgery for degenerative lumbar spine disease. We prospectively included patients undergoing decompression for degenerative lumbar spinal stenosis, spondylolisthesis or disc herniation with additional fusion of up to two segments. Patients completed a structured psychological assessment including the Center for Epidemiological Studies Depression Scale (ADS-K), Post-Traumatic Stress Scale-10 (PTSS-10), State Trait Anxiety Inventory-State Anxiety and State Trait Anxiety Inventory-Trait Anxiety (STAI-S and STAI-T) and Anxiety Sensitivity Index-3 (ASI-3) before surgery, after 3 and 12months. Outcome measures included EuroQol 5D (EQ), Short Form-36 (SF-36) and Oswestry Disability Index (ODI) scores. In total, 245 patients between March 2013 and November 2017 received surgery, of which 180 (73.5%) fully completed follow-up after 3months and 12months. QOL scores significantly increased by 3months (EQ: +0.2; p < 0.001; SF-36 PCS: +7.0; p < 0.001; SF-36 MCS: +3.3; p = 0.018), a benefit which was retained at 12months, without statistically significant difference between fused and non-fused patients. Depressed patients exhibited impaired mean scores of EQ (0.58 vs. 0.36; p < 0.001) and ODI mean scores (35.5 vs. 51.9; p < 0.001) at baseline, which significantly improved and converged with scores of non-depressed patients after 12months. Linear regression analysis identified statistically significant predictors in age, STAI-T and SF-36 MCS for post-operative QOL and disability. Despite exhibiting pronounced psychological distress preoperatively, patients may significantly benefit from surgery with an outcome equal to psychologically healthy patients after 12months. These slides can be retrieved under Electronic Supplementary Material.

Comparison of bilateral decompression via unilateral laminotomy and conventional laminectomy for single-level degenerative lumbar spinal stenosis regarding low back pain, functional outcome, and quality of life - A Randomized Controlled, Prospective Trial

BackgroundConventional posterior open lumbar surgery is associated with considerable trauma to the paraspinal muscles. Severe damage to the paraspinal muscles could cause low back pain (LBP), resulting in poor functional outcomes. Thus, several studies have proposed numerous surgical techniques that can minimize damage to the paraspinal muscles, particularly unilateral laminotomy for bilateral decompression. The purpose of this study is to compare the degree of postoperative LBP, functional outcome, and quality of life of patients between bilateral decompression via unilateral laminotomy (BDUL; group U) and conventional laminectomy (CL; group C).MethodsOf 87 patients who underwent diagnostic and decompression surgery, 50 patients who met the inclusion and exclusion criteria and were followed up for > 2 years were enrolled. The patients were asked to record their visual analog scale pain score after 6, 12, and 24 months postoperatively. BDUL was used for group U, whereas CL was used for group C. The patients were randomly divided based on one of the two techniques, and they were followed up for over 2 years. Functional outcomes were assessed by the Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), and SF-36.ResultsOperation time was significantly shorter in group U than in group C (p = 0.003). At 6, 12, and 24 months, there was no significant difference between the two groups in terms of spine-related pain (all p > 0.05). Functional outcomes using ODI and RMDQ and quality of life using SF-36 were not significantly different between the groups (all p > 0.05).ConclusionsRegarding single-level decompression for degenerative lumbar spinal stenosis, group U had the advantages of shorter operation time than group C, but not in terms of back pain, functional outcome, and quality of life.

Percutaneous Interspinous Spacer in Spinal-Canal-Stenosis Treatment: Pros and Cons.

A comprehensive description of the literature regarding interspinous process devices (IPD) mainly focused on comparison with conservative treatment and surgical decompression for the treatment of degenerative lumbar spinal stenosis. Recent meta-analysis and articles are listed in the present article in order to establish IPD pros and cons.

Evaluation of Transforaminal Lumbar Interbody Fusion and Posterolateral Lumbar Fusion In Treatment Of Degenerative Lumbar Disorders With Instrumentation

Background: degenerative lumbar disorders affect millions of people causing low back pain, which can restrict mobility and daily activities. Lumbar fusion operations are used as a treatment of degenerative lumbar disorders. However, the better choice among fusion techniques is still controversial. Objective: to compare the clinical and radiological outcome of Transforaminal Lumbar Interbody Fusion (TLIF) and Posterolateral fusion (PLF) in the treatment of degenerative lumbar spine stenosis and degenerative spondylolisthesis. Patients and Methods: a prospective study was conducted on 40 patients with degenerative lumbar spondylolisthesis and degenerative lumbar spine stenosis. Twenty patients underwent transforaminal lumbar interbody fusion and 20 patients underwent posterolateral fusion. Patients were followed up using the visual analogue scale (VAS) for back and leg pain and Oswestry Disability Index (ODI). Final fusion assessment was done according to Bridwell criteria. Results: ODI and VAS of leg and back pain improved in the two groups with no significant differences between the two groups whether after six or twelve months of follow up. TLIF group shows a high grade of fusion according to Bridwell grading criteria for spinal fusion and significantly better than the PLF group of patients either in six-month follow up (p=0.045) or twelve-month follow up (p=0.04). Conclusion: both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. TLIF is superior to PLF with regard to achieving radiographic fusion. There is no significant clinical or functional outcome to support the use of TLIF over PLF in the treatment of degenerative lumbar disorders.