Fusion For Lumbar Spinal Stenosis Research Articles

Risk factors for persistent numbness following decompression surgery for lumbar spinal stenosis

ObjectiveDecompression surgery is a mainstay of surgical treatment for lumbar spinal stenosis (LSS). However, up to 30% of patients have low satisfaction due to residual symptoms. In the clinical setting, improvements in leg pain are more significant than those in leg numbness. Residual numbness could be related to the relatively low satisfaction rate. However, few studies have focused on numbness; thus, elucidating the risk factors and rate of residual numbness would benefit surgeons and patients. This study aimed to clarify the risk factors for and rate of residual numbness after decompression surgery. Patients and MethodsWe retrospectively reviewed prospectively collected data from consecutive patients who underwent lumbar decompression without fusion for LSS at a single institution between January 2014 and March 2016. Patients were included if preoperative and final follow-up questionnaires and radiographs were available. A minimum one-year follow-up was required. We evaluated the Numeric Rating Scale (NRS) scores of low back pain, leg pain, and leg numbness preoperatively and at the final follow-up visit. Residual numbness was defined as a postoperative NRS ≥ 1, whereas persistent numbness was defined as a postoperative NRS ≥ 5. We compared the clinical data of patients with or without residual numbness to those of patients with or without persistent numbness. Multivariate logistic regression analysis was performed to identify risk factors for residual and persistent numbness. ResultsA total of 116 patients (73 men, 43 women) were included. Of them, 60% had residual numbness with a mean follow-up period of 25 months. Only durotomy differed significantly between patients with and those without residual numbness. However, the significance did not persist after logistic regression analysis. A total of 16% had persistent numbness. Diabetes mellitus, intraoperative durotomy, and preoperative NRS of numbness were identified as risk factors. There were no differences in smoking status, presence of spondylolisthesis or scoliosis, or severity of stenosis. ConclusionsWe found three risk factors for persistent numbness following decompression surgery for LSS; diabetes mellitus and durotomy were modifiable, whereas preoperative numbness was not. Our findings would help surgeons minimize the incidence of persistent numbness by adequately controlling diabetes and avoiding durotomy during surgery. Providing information about the potential for residual numbness during the informed consent process is important to ensuring realistic patient expectations.

Analysis of Lumbar Sagittal Curvature in Spinal Decompression and Fusion for Lumbar Spinal Stenosis Patients under Roussouly Classification.

To evaluate the clinical significance of spinal decompression and fusion for lumbar spinal stenosis in old patients under Roussouly classification, 160 old patients (>60 year old) with lumbar spinal stenosis underwent spinal decompression, and fusion were retrospectively studied. According to Roussouly classification, patients were divided into 4 groups, in which Roussouly types I, II, and IV were the nonstandard group and Roussouly type III was the standard group. Visual analog scale (waist, leg) and Oswestry disability index (ODI) scores were recorded before operation and at the final follow-up. All patients improved the sagittal curvature: for patients in Roussouly types I and II, there were statistically significant differences in terms of postoperative global lordosis (GL), global kyphosis (GK), sacral slope (SS), sagittal vertical axis (SVA), and pelvic tilt (PT) compared with that before surgery (all P < 0.001); patients in Roussouly type IV obtained similar results with type III after surgery. The four groups showed significant improvement in ODI and VAS scores at final follow-up (all P < 0.001). After regrouping at the final follow-up, the proportion of the standard type (Roussouly type III) patients was increased compared with preoperative. In conclusion, Roussouly classification has important guiding significance in spinal decompression and fusion for old patients (>60 years) with lumbar spinal stenosis.

Risk factors for 90-day reoperation and readmission after lumbar surgery for lumbar spinal stenosis

The objective of this study was to evaluate the incidence and risk factors for 90-day readmission and reoperation after elective surgery for lumbar spinal stenosis (LSS). The authors performed a retrospective consecutive cohort analysis of patients undergoing posterior lumbar decompression with or without fusion for LSS with claudication from January 2014 through December 2015. Data were collected on 1592 consecutive patients. The mean age at surgery was 67.4 ± 10.1 years and 45% of patients were female. The 90-day reoperation rate was 4.7%, and 69.3% of the reoperations occurred within the first 30 days. The 90-day readmission rate was 7.2%. Multivariable analysis showed that postoperative development of a surgical site infection (SSI; odds ratio [OR] 14.09, 95% confidence interval [CI] 7.86–25.18), acute kidney injury (AKI; OR 6.76, 95% CI 2.39–19.57), and urinary tract infection (UTI; OR 3.96, 95% CI 2.43–6.37), as well as a history of congestive heart failure (CHF; OR 3.03, 95% CI 1.69–5.28), were significant risk factors for readmission within 90 days. Male sex (OR 0.60, 95% CI 0.38–0.92) was associated with decreased odds for readmission. With regards to reoperation, development of SSI (OR 25.06, 95% CI 13.54–46.51), sepsis (OR 7.63, 95% CI 1.52–40.59), UTI (OR 2.54, 95% CI 1.31–4.76), and increased length of stay (LOS; OR 1.25, 95% CI 1.17–1.33) were found to be significant risk factors. A subsequent analysis found that morbid obesity (OR 6.99), history of coronary artery disease (OR 2.263), increased duration of surgery (OR 1.004), and LOS (OR 1.07) were significant risk factors for developing an SSI. Overall, this study found rates of 4.7% and 7.2% for reoperation and readmission, respectively, within 90 days: 30.7% of the reoperations and 44.7% of the readmissions occurred beyond the first 30 days. A diagnosis of SSI, AKI, UTI, and history of CHF were significant factors for readmission, while male sex was associated with decreased odds for readmission. A diagnosis of SSI, sepsis, UTI, and increased LOS were found to be significant predictors for reoperation. Understanding 90-day complication rates is imperative because there has been increased discussion and healthcare policy extending the global postoperative window to 90 days. Current literature supports a readmission rate of 3%–9% after spine surgery. However, this literature either is limited to a 30-day window or does not stratify between different types of spine surgeries. AKI = acute kidney injury; BPH = benign prostate hyperplasia; CAD = coronary artery disease; CHF = congestive heart failure; CI = confidence interval; CMS = Centers for Medicare and Medicaid Services; COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; EBL = estimated blood loss; LOS = length of stay; LSS = lumbar spinal stenosis; OR = odds ratio; POUR = postoperative urinary retention; SSI = surgical site infection; UTI = urinary tract infection.

Wide Variability in Patient-Reported Outcomes Measures After Fusion for Lumbar Spinal Stenosis: A Systematic Review.

Study Design:Systematic review.Objectives:The purpose of this study is to review outcomes reporting methodology in studies evaluating fusion for lumbar spinal stenosis.Methods:A systematic review of PubMed and Embase databases was conducted from January 2007 to June 2017 for English language studies with minimum of 2 years postoperative follow-up reporting outcomes after fusion for lumbar spinal stenosis. Two reviewers assessed each study; those meeting inclusion criteria were examined for pertinent data. Outcome measures were categorized into relevant domains: pain/symptomatology, function/disability, and surgical satisfaction. Return to work reporting was also recorded.Results:Of 123 studies meeting inclusion criteria, 76% included posterior-only fusion, 32% included posterior/transforaminal interbody fusion, and 5% included anterior/lateral interbody fusion (non-mutually exclusive). There was significant variation in patient-reported outcomes (PROs) used—studies reported 31 unique PROs assessing at least one domain: 22 evaluating pain, 23 evaluating function, and 3 evaluating surgical satisfaction. Most commonly utilized PROs were the Oswestry Disability Index (73% of studies), Visual Analog Scale (55%), and 36-Item Short Form Survey (32%). The remaining 28 measures were used in 14% of studies or fewer. PROs specific to symptoms of lumbar spinal stenosis, such as the Zurich Claudication Questionnaire, were only used rarely (7/123 studies). Only 14% of studies reported on time to return to work.Conclusions:The literature surrounding fusion in the setting of lumbar stenosis is characterized by substantial variability in outcomes reporting. Very few studies utilized measures specific to lumbar spinal stenosis. Efforts to standardize outcomes reporting would facilitate comparisons of surgical interventions.

Impact of decompression surgery without fusion for lumbar spinal stenosis on sagittal spinopelvic alignment: minimum 2-year follow-up.

The importance of global sagittal alignment is well known. Patients with lumbar spinal stenosis (LSS) generally tend to bend forward to relieve their neurological symptoms, i.e., they have a positive sagittal vertical axis (SVA). We hypothesized that the positive SVA associated with LSS is symptom related and should improve after surgery. However, little is known about the changes in sagittal alignment in LSS patients after decompression surgery. In this study the authors aimed to evaluate midterm radiographical changes in sagittal spinopelvic alignment after decompression surgery for LSS and to determine the factors influencing the improvement in sagittal spinopelvic alignment. The authors retrospectively reviewed 89 patients who underwent lumbar decompression without fusion between January 2014 and September 2015 with a minimum follow-up of 2 years. Standing whole-spine radiographs at the preoperative stage and at the final follow-up were examined. We analyzed SVA, lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), thoracolumbar kyphosis (TLK), and thoracic kyphosis (TK). LL and TK were significantly increased postoperatively. SVA and PI minus LL (PI-LL) were significantly decreased. There were no significant differences between the preoperative and postoperative PT, PI, SS, or TLK. Twenty-nine patients had preoperative sagittal malalignment with SVA > 50 mm. Thirteen of the 29 patients improved to SVA < 50 mm after decompression surgery. Lower ASA grade, preoperative higher LL, and lower PI-LL were related to patient improvement. A receiver operating characteristic curve for the preoperative PI-LL had an area under the curve value of 0.821, indicating moderate accuracy (p = 0.003). A cutoff value for preoperative PI-LL of 19.2° showed a sensitivity of 93.5% and a specificity of 71.4%. Lumbar decompression can lead to a reactive improvement in the lumbar and global sagittal alignment. However, some of the sagittal malalignment in LSS was irreversible. Preoperative PI-LL was a useful predictor to distinguish reversible from irreversible sagittal malalignment.

Impact of sagittal spinopelvic alignment on clinical outcomes and health-related quality of life after decompression surgery without fusion for lumbar spinal stenosis.

Patients with lumbar spinal stenosis (LSS) tend to bend forward to relieve neurological symptoms. They therefore have a positive sagittal vertical axis (SVA). The importance of the SVA value is well known in the field of adult spinal deformity; however, little is known about its impact on LSS. The authors sought to investigate the impact of sagittal spinopelvic alignment on clinical outcome and health-related quality of life (HRQOL) after decompression surgery for LSS. The authors retrospectively reviewed 83 patients who underwent lumbar decompression without fusion between January 2014 and September 2015 with a minimum follow-up of 2 years. Standing whole-spine radiographs were examined preoperatively and at final follow-up. Based on the SVA, patients were allocated to a sagittal balance group (group B; SVA < 50 mm) or a sagittal imbalance group (group I; SVA ≥ 50 mm). The authors compared the groups using Japanese Orthopaedic Association (JOA), Zurich Claudication Questionnaire (ZCQ), Roland-Morris Disability Questionnaire (RMDQ), and the 8-item Short Form Health Survey (SF-8) scores. Preoperative groups B (group pre-B) and I (group pre-I) included 58 and 25 patients, respectively. Preoperative sagittal malalignment had negative effects on the JOA score recovery rate, postoperative ZCQ physical function domain score, and numeric rating scale (NRS) score of postoperative low-back pain (LBP), but no significant effects were observed for RMDQ and SF-8 domain scores. Postoperatively, groups B (group post-B) and I (group post-I) included 60 and 23 patients, respectively. Group post-I had a significantly worse JOA score recovery rate, postoperative symptom severity domain score in the ZCQ, and NRS score for postoperative LBP. Similarly, the postoperative RMDQ score and the Physical Component Summary score of the SF-8 were significantly worse in group post-I. Positive SVA had significantly negative effects on clinical outcome and HRQOL in LSS patients after lumbar decompression surgery.

单纯减压手术有效改善腰椎管狭窄症脊柱矢状面的形态

单纯减压手术有效改善腰椎管狭窄症脊柱矢状面的形态

Does sagittal imbalance impact the surgical outcomes of short-segment fusion for lumbar spinal stenosis associated with degenerative lumbar scoliosis?

BackgroundThe degenerative lumbar scoliosis (DLS) patients who mainly complained about neurogenic claudication due to spinal canal stenosis are well-indicated for short segment fusion (SSF) at the affecting levels. However, it is unclear whether we should consider global sagittal balance or not. The aim of this study was to evaluate the impact of sagittal balance on the surgical outcomes of degenerative lumbar scoliosis (DLS) patients who underwent SSF. MethodsWe retrospectively reviewed 70 DLS patients who underwent SSF (less than 3 levels) and could be followed for at least 2 years. The PI-LL, PT, SVA, and T1 pelvic angle (TPA) were measured using standing whole spine X-rays preoperatively (PreO) and at final follow-up (FFU). Surgical outcomes were assessed with the improvement in Japanese Orthopaedic Association score (JOAs) for low back pain (LBP), and the level of LBP was measured using the visual analogue scale (LBP-VAS). We analysed the relationships between the radiographic parameters and the surgical outcomes. ResultsWe divided the patients into the three groups (poor/fair/good) based on the JOAs. The analysis with the Jonckheere-Terpstra trend test indicated that the following radiographic parameters had a significant trend with surgical outcomes in each group: (poor/fair/good; p value); PreO PI-LL (26/20/17°; P = 0.04), SVA (46/75/35.5 mm; P = 0.02), TPA (28/27/23°; p = 0.04), FFU PI-LL (33/25/8.5°; P = 0.004), SVA (93/90.5/32.5 mm; P = 0.001), and TPA (33/29/25°; P = 0.007). Additionally, LBP-VAS had a significant correlation between the three groups at final follow-up (P = 0.004). There were significant correlations between improvement in JOAs and PI-LL, SVA, and TPA both PreO and at FFU (P < 0.05). ConclusionsSagittal spinal imbalance and spinopelvic malalignment significantly impact the surgical outcomes of SSF for DLS. Preoperative evaluation of spinopelvic alignment and sagittal balance is of critical importance when SSF are performed for DLS patients.

A cost-effectiveness analysis of bilateral decompression via unilateral approach versus instrumented total laminectomy and fusion for lumbar spinal stenosis

To compare the clinical and economic results of two different surgical approaches (bilateral decompression via unilateral approach and instrumented total laminectomy and fusion) in the treatment of lumbar spinal stenosis. The clinical, surgical, and economic aspects of 100 surgically treated patients with lumbar spinal stenosis were retrospectively reviewed. Decompression was performed at 158 levels in 100 patients. The most commonly decompressed levels were L4-5 and L3-4. Significant difference was observed between pre- and postoperative visual analog scale scores in both groups (p < 0.05). In Group 1 (instrumented total laminectomy and fusion), the mean surgery cost was 2539.2 USD (mean procedure cost: 1440.1 USD, mean implant cost: 1099.2 USD). In Group 2 (bilateral decompression via unilateral approach) the mean surgery cost was 998.5 USD. The cost difference was significant (p < 0.05). Both instrumented total laminectomy and fusion and bilateral decompression via unilateral approach performed with and without stabilization showed similar clinical results in patients with lumbar spinal stenosis. However, the cost of surgery was found to be 2.5-fold higher in the instrumented total laminectomy and fusion group. This study supports the concept that minimally invasive spine surgery is cost-effective.

P63 - Decompression Alone vs Decompression and Fusion for Lumbar Spinal Stenosis in a Workers' Compensation Setting

P63 - Decompression Alone vs Decompression and Fusion for Lumbar Spinal Stenosis in a Workers' Compensation Setting

A rethink of fusion surgery for lumbar spinal stenosis.

Lumbar spinal stenosis is one of the most common spinal disorders in elderly patients, how to choose decompression alone or decompression plus fusion is still controversial. It was reported that the rate of decompression alone for lumbar stenosis was decreased, whereas the rate of decompression plus fusion was increased recently. Two recent multicenter RCTs papers published in the same issue of N Engl J Med compare the outcomes of decompression alone or decompression plus fusion for lumbar spinal stenosis currently. We combined the results from these two studies using the Stata software, we found that the decompression plus fusion had a significantly more blood loss and longer operative time. And no significant difference was found in the parameters of length of hospital stay, SF-36 Physical Component Summary, Oswestry Disability Index, Visual analogue scales of back pain and leg pain between decompression alone group and decompression plus fusion group. Therefore, based on the current evidence, we advocate a rethink on the decompression plus fusion trend chosen by surgeons, the indications of fusion should be restricted to the lumbar stenosis patients accompanied with spinal instability or deformity.

Treatment of intrasacrospinal muscular approach and midline approach in lumbar interbody fixation with fusion for lumbar spinal stenosis

Objective To explore the clinical effect about the treatment of intrasacrospinal muscular approach and midline approach in lumbar interbody fixation with fusion for lumbar spinal stenosis. Methods Forty-two cases lumbar spinal stenosis were reviewed retrospectively in Meitan General Hospital from February 2009 to February 2014.All cases were divided into intrasacrospinal muscular approach and midline approach group(Group A, n=19) and midline approach group(Group B, n=23) according to the different surgical approach.Operation time, the amount of blood loss, post-operative drainage were compared.The VAS score of low back pain and leg pain preoperative and 6 months after operation were recorded.All cases were followed up for more than one year to evaluate fusion status. Results All cases were followed up for 13.0-20.0 months, with an average of (16.0±1.2)months, all patients had bony fusion.Operation time, the amount of blood loss, post-operative drainage of Group A were significantly less than of Group B, the differences were significant((95.1±4.5) min vs.(110.4±6.6) min, (75.2±5.1) ml vs.(159.8±7.2) ml, (53.6±4.3) ml vs.(86.2±14.1) ml; t=1.565, 6.087, 2.371; P<0.05). VAS of back pain and leg pain at 6 months after operation of Group A showed better results than of Group B, the differences were significant((1.43±0.76) points vs.(1.39±1.00) points, (2.78±1.23) points vs.(2.52±0.88) points; t=1.982, 1.774; P<0.05). Interbody fusion was obtained in two groups at the end of the last follow-up. Conclusion The intrasacrospinal muscular approach and midline approach for lumbar interbody fixation with fusion for lumbar spinal stenosis is better in less injury to paraspinal muscle, less blood loss and less post-operative drainage, which contributes a rapid recovery. Key words: Intrasacrospinal muscular approach; Midline approach; Lumbar interbody fusion; Lumbar spinal stenosis

腰部脊柱管狭窄症に対する多椎間固定術の低侵襲化:―XLIF/OLIF と従来のTLIF との比較―

腰部脊柱管狭窄症に対する多椎間固定術の低侵襲化:―XLIF/OLIF と従来のTLIF との比較―

Effect of Incidental Durotomy on Cost and Length of Stay in Primary, Short, Posterior Lumbar Fusion for Lumbar Spinal Stenosis: An Analysis of 17,232 Cases

Introduction The incidence of durotomy and its economic impact during primary short lumbar fusion is not well described. The purpose of this study was to determine the incidence of and factors associated with durotomy in primary one- or two-level lumbar fusions performed for lumbar spinal stenosis and its impact on cost and hospital resource utilization. Material and Methods The Nationwide Inpatient Sample (NIS), was queried using ICD-9 codes for all primary one- or two-level lumbar fusions performed in adults for lumbar spinal stenosis between 2009 and 2011; only elective cases without concurrent diagnoses of vertebral infection, fracture, or tumor were included. Chi-square and t-tests were used as appropriate to compare categorical and continuous variables, respectively. Multivariate regression analysis was performed to identify factors independently associated with incidental durotomy, as well as total hospital charges and costs, as well as length of stay (LOS). Results A total of 17,232 procedures performed were identified, of which 801 had an incidental durotomy (rate of 4.65%). The rate of dural tears in teaching hospitals (5.09%; 95% CI: 4.66–5.55) was significantly higher as compared with nonteaching hospitals (4.19%; 95% CI: 3.77–4.66) ( p = 0.006). Multivariate regression analysis revealed that the odds of experiencing a dural tear increased by 2% with each year of increasing age (unit odds 1.02; 95% CI: 1.01–1.03). Incidental durotomy was associated with a mean 1.40-day (95% CI: 1.22–1.59) increase in hospital stay, a mean $10,885 (95% CI: $6,592–$15,177) increase in total hospital charges, and a mean $3,873 (95% CI: $2,502–$5,242) increase in estimated total costs (all differ from no durotomy group with p &lt; 0.0001). Conclusion In this large retrospective series, the rate of incidental durotomy during primary short lumbar fusion for LSS fell within the range of previously reported rates. We have identified increasing age and surgery in a teaching hospital as factors associated with higher rates of durotomy. These findings are important given the significant financial and health care resource costs associated with dural tears.

Limited Unilateral Decompression and Pedicle Screw Fixation with Fusion for Lumbar Spinal Stenosis with Unilateral Radiculopathy: A Retrospective Analysis of 25 Cases.

ObjectiveLumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy.MethodsPatients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images.ResultsTwenty-five patients were included. The mean preoperative VAS score was 6.6±1.6 and 4.6±3.1 for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, 1.32±1.2) and the back (VAS score, 1.75±1.73) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively (6.60±6.5; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01).ConclusionLimited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine.

Comparison between Instrumented and Uninstrumented Posterolateral Fusion for Lumbar Spinal Stenosis and Spondylolisthesis

Comparison between Instrumented and Uninstrumented Posterolateral Fusion for Lumbar Spinal Stenosis and Spondylolisthesis

Comparison of adjacent segment degeneration after successful posterolateral fusion with unilateral or bilateral pedicle screw instrumentation: a minimum 10-year follow-up

Background contextIn the instrumented fusion, adjacent segment facet joint violation or impingement by pedicle screws is unavoidable especially in cephalad segment, despite taking specific intraoperative precautions in terms of surgical approach. In such circumstances, unlike its original purpose, unilateral pedicle screw instrumentation can contribute to reduce the degeneration of cephalad adjacent segment by preventing contralateral cephalad adjacent facet joint from the unavoidable injury by pedicle screw insertion. However, to our knowledge, no long-term follow-up study has compared adjacent segment degeneration (ASD) between unilateral and bilateral pedicle screw instrumented fusion. PurposeTo compare ASD after successful posterolateral fusion using either unilateral or bilateral pedicle screw instrumentation for patients with lumbar spinal stenosis and/or Grade 1 spondylolisthesis. Study designRetrospective case-control study. Patient sampleOne hundred forty-seven patients who had undergone one- or two-level posterolateral fusion with unilateral or bilateral pedicle screw instrumentation for lumbar spinal stenosis with or without low-grade spondylolisthesis and achieved successful fusion, with a minimum 10-year follow-up. Outcome measureThe occurrence of radiologic ASD, Oswestry disability index (ODI) scores, and revision rates. MethodsA total of 194 consecutive patients were contacted and encouraged to visit our hospital and to participate in our study. Radiologic ASD was evaluated at three motion segments: cephalad adjacent segment (first cephalad adjacent segment), one cephalad to cephalad adjacent segment (second cephalad adjacent segment), and caudal adjacent segment. Clinical outcomes were compared by ODI scores and revision rates. ResultsIn total, 147 of 194 (75.8%) patients were available for at least 10 years of radiologic and clinical follow-up. Adjacent segment degeneration (in first cephalad or caudal adjacent segment) was noted in 55.9% (33 of 59 patients) of the unilateral group and 72.7% (64 of 88 patients) of the bilateral group (p=.035). The occurrence of ASD in each first cephalad and caudal adjacent segment was not significantly different between groups but that in second cephalad adjacent segment was significantly different between groups (p=.004). Clinical outcomes according to ODI showed significant difference between groups (p=.016), especially when ODI scores were compared in patients with ASD (p=.004). ConclusionsIn a minimum 10-year follow-up retrospective study of posterolateral fusion for lumbar spinal stenosis and/or Grade 1 spondylolisthesis, unilateral pedicle screw instrumentation showed a lower rate of radiologic ASD, especially in second cephalad adjacent segment, and a better clinical outcome by ODI.

Bacterial wound contamination during simple and complex spinal procedures. A prospective clinical study

Spinal procedures have a potential of intraoperative contamination. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have been used to diagnose postoperative infections after spinal surgery. However, it has not been demonstrated if there is an association between surgical site contamination and clinical manifestation of postoperative infection based on inflammatory markers and patients' clinical course. The purpose of this prospective study was to evaluate the association between surgical site contamination and the development of a postoperative infection in simple and complex surgical procedures. C-reactive protein and ESR levels were observed. The correlation between their values, surgical time, type of surgical procedures, and contaminated surgical sites was investigated. Prospective clinical study. The study consisted of 40 patients divided into two groups. Group A included 20 patients (mean age, 46.2 years; 12 women and 8 men) who underwent an open discectomy for a lumbar herniated disc. Group B consisted of 20 patients (mean age, 67.9 years; 11women and 9 men) who underwent a decompression and instrumented fusion for lumbar spinal stenosis. They were followed up for an average of 26.7 months (range, 11-40 months). Samples were obtained for cultures in standard time intervals during surgery. The types of bacteria cultured were evaluated, and CRP and ESR levels were measured. Simple lumbar discectomy (Group A, 20 patients) and instrumented lumbar decompression for degenerative lumbar stenosis (Group B, 20 patients) were performed in a prospective consecutive series of patients. All patients were operated by the same surgeon in the same operating room. Surgical site preparation in each patient was done by a standard manner. Samples were obtained for cultures in standard time intervals during surgery. C-reactive protein and ESR levels were measured preoperatively on the 3rd, 7th, and 21st postoperative days, and the clinical course of each patient was recorded. From 40 patients, three patients in Group A and five patients in Group B, a total of eight patients (20%) had positive cultures for bacteria. There was no statistical significance between contamination and duration of surgery in both groups. None of the patients with positive intraoperative cultures developed any clinical signs of superficial or deep postoperative spinal infection, and no additional antibiotic treatment was administered. Three patients with negative cultures developed a postoperative infection. There were no differences in CRP and ESR values between patients with contamination and noncontamination in both groups. C-reactive protein and ESR levels were significantly elevated in complex procedures (Group B) than in simple procedures (Group A). Statistical analysis of CRP and ESR values in both groups and types of bacteria cultured intraoperatively are presented. The results of this study demonstrate that intraoperative contamination can occur during simple and complex spinal procedures. In the absence of postoperative signs of infection in patients with intraoperative contamination, there is no need of continuing antibiotic treatment. Postoperative kinetics of CRP and ESR showed to be the same in patients with and without intraoperative contamination. Higher levels of inflammatory markers were noted in complex spinal procedures where instrumentation was applied.

Risk factors for adjacent segment disease following lumbar fusion for lumbar spinal stenosis

Risk factors for adjacent segment disease following lumbar fusion for lumbar spinal stenosis

Endoscopic decompression combined with interspinous process implant fusion for lumbar spinal stenosis

To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association (JOA) score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine.The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.