Laminectomy In Patients Research Articles

Patients with achondroplasia have increased risk of 90-day adverse events following laminectomy: A matched comparison using a national database.

Performing laminectomies in patients with achondroplasia-a common skeletal dysplasia-can present unique challenges. There are a limited number of studies that have reported on the adverse effects of laminectomies in patients with achondroplasia. To compare the 90-day postoperative adverse events following laminectomy in patients with and without achondroplasia. Retrospective cohort study using the 2010-2020 PearlDiver Mariner 91 administrative database was used to identify patients who underwent thoracic, thoracolumbar, or lumbar laminectomy. Patients with achondroplasia were matched 1:4 to patients without achondroplasia based on age, sex, insurance, and ECI. Univariate and multivariate logistic regression analyses assessed and compared 90-day adverse events. Odds ratios (OR), 95% confidence intervals (CI), and p-values were reported with significance set at p < 0.05. A multivariate analysis revealed that when laminectomy was performed, patients with achondroplasia were 2.82 times more likely to have 90-day AE compared to those without achondroplasia (p < 0.001). When comparing individual subtypes of adverse events, patients with achondroplasia were found to have significantly greater odds of a transfusion (OR 6.40, p < 0.001), UTI (OR 3.79, p < 0.001), disruption of wound (OR 3.71, p < 0.001), and hematoma (OR 2.94, p = 0.032). Pneumonia, cardiac arrest, AKI, other perioperative events, durotomy, and VTE were not significantly different between the two cohorts. This study uses one of the largest cohorts to compare patients with and without achondroplasia undergoing laminectomy. Patients with achondroplasia were found to have a significantly greater risk of 90-day adverse events following laminectomy compared to their matched cohort of patients without achondroplasia.

Psoas Muscle Health is Correlated With Time to Achieve MCID in Patients With Predominant Axial Back Pain Following Decompression Surgery: Early Results.

Retrospective cohort study. To determine the impact of psoas muscle health [cross-sectional area (CSA)] on achieving minimal clinically important differences (MCID) in patient-reported outcome measures (PROMs) following laminectomy for patients with predominant back pain (PBP) and leg pain (PLP). Psoas muscle health is linked to postoperative outcomes in decompression patients, with MRI-based grading of psoas CSA correlating with these outcomes. However, evidence on its impact on symptomatic recovery, measured by PROMs, is lacking. One hundred six patients with PBP (VAS back > VAS leg) and 139 patients with PLP (VAS leg > VAS back) who underwent laminectomy from 2017 to 2021 were included. Axial T2 MRI images were analyzed for psoas CSA using a validated method. Based on the lowest-quartile normalized total psoas area (NTPA) thresholds, patients were divided into "good" and "poor" muscle health groups. The correlation analyses were performed between the psoas CSA and changes in PROMs. Kaplan-Meier survival analysis was conducted to determine the probability of achieving MCID as a function of time. Of 106 patients with PBP, 83 (78.3%) had good muscle health, and 23 (21.6%) had poor muscle health. Of 139 patients with PLP, 54 (38.8%) had good muscle health, and 85 (61.1%) had poor muscle health. In the PBP group, older age was associated with poor muscle health (69.70±9.26 vs . 59.92±15.01, P =0.0002). For both cohorts, there were no differences in the rate of MCID achievement for any PROMs between the good and poor muscle health groups. In the PBP group, Kaplan-Meier analysis showed patients with good psoas health achieved MCID-VAS back and Oswestry Disability Index (ODI) in median times of 14 and 42 days ( P =0.045 and 0.015), respectively. Good psoas muscle health is linked to faster attainment of MCID, especially in patients with PBP compared with PLP after decompression surgery. III.

Retrospective Study to Compare the Effectiveness of Minimally Invasive Microscopic Unilateral Laminotomy with Microscopic Bilateral Laminotomy for Bilateral Decompression in the Early Postoperative Period in 142 Patients with Single-Level Lumbar Spinal Stenosis.

BACKGROUND We aimed to compare the effectiveness of microscopic unilateral laminotomy for bilateral decompression (ULBD) and microscopic bilateral laminotomy for bilateral decompression (BLBD) in the early postoperative period among patients with single-level lumbar spinal stenosis (LSS). MATERIAL AND METHODS A retrospective cohort study was conducted on patients with LSS who underwent ULBD or BLBD between January 2020 and December 2023, including 94 patients who underwent ULBD and 58 who underwent BLBD. Patient demographics, comorbidities, smoking status, and data related to LSS were reviewed. Preoperative and postoperative assessments on day 10 included back pain visual analog scale (VAS), walking distance, and Odom criteria. Disability was evaluated using the self-assessment Oswestry Disability Index (ODI) preoperatively and on day 30. Additionally, wound infection, postoperative modified MacNab criteria, and pain (back, leg, and hip) were recorded. RESULTS Age and sex were similar in the 2 groups. Both surgeries significantly reduced low back pain, increased walking distance, and improved Odom category on day 10, compared with baseline (P<0.001 for all). A significant decrease in 30-day ODI, compared with baseline, was observed in both groups (P<0.001 for both). The ULBD group had a significantly higher percentage of patients with wound infection (P=0.014); however, the ODI score among ULBD recipients was significantly lower (better) on day 30 (P=0.047). CONCLUSIONS ULBD may represent a less invasive, more effective, and safer surgical alternative than BLBD and classical laminectomy in patients with single-level LSS, but precautions are essential concerning wound infection.

The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ-5D-5L.

There is a lack of studies on the quality of life (QoL) after posterior laminectomy in patients with thoracic ossification of the ligamentum flavum (TOLF), and risk factors associated with poor prognosis remain controversial. Therefore, the present study was conducted to illustrate the QoL for TOLF patients after surgery and determine its relationship with their demographic, surgery-related, clinical characteristics and imaging data. One hundred and eighteen patients diagnosed with thoracic myelopathy because of TOLF were enrolled in this retrospective study. They all underwent posterior decompressive laminectomy from August 2010 to January 2022. The QoL was evaluated based on the EQ-5D-5L. Collecting gender, age, number of operations, compressed segments, Frankel grade, complications, body mass index (BMI), symptoms and duration, modified Japanese Orthopaedic Association (mJOA) score (preoperative), follow-up time and type of ossification, increased signal on Sagittal T2-weighted Images (ISST2I), occupancy rate and analyzing by Mann-Whitney U-test, Kruskal-Wallis test, the χ2 -test, and logistic regression tests. Average follow-up 70.8 months (18-149), the mean age was 59.74 ± 9.81 years and the mean score for the QoL based on the EQ-5D-5 L and visual analogue scale (VAS) score were 0.71 ± 0.28 and 78.88 ± 10.21 at the final follow-up. Moderate and severe problems were found in the pain/discomfort in 22.0% of the patients. These mobility and usual activities numbers were slightly higher (24.6% and 30.4%, respectively). The mean scores for QoL and VAS were significantly higher in patients with mild and moderate neurological impairment, normal BMI, <60 years of age, no dural tears, symptom relief at hospital discharge, unilateral and bilateral ossification on axial CT scan, ≤ 50% spinal canal occupancy on CT and MRI, and none or fuzzy on ISST2I. QoL after posterior laminectomy in TOLF patients is generally satisfactory compared to preoperative levels. Preoperative mJOA score, Age, comorbid diabetes, the major symptom is activity limitation, BMI, ISST2I, Intraoperative dural tears and spinal canal occupancy rate correlate significantly with the corresponding dimensions and are predictive. Age, spinal canal occupancy rate, ISST2I, preoperative mJOA score, BMI are significantly associated with and have predictive value for overall postoperative QoL.

Emergency Posterior Decompression for Metastatic Spine Tumors in Octogenarians: Clinical Course and Prognostic Factors for Functional Outcomes

This study aimed to describe the clinical outcome of metastatic epidural spinal cord compression in octogenarians with an acute onset of neurological illness who undergo laminectomy, further assess morbidity and mortality rates, and determine potential risk factors for a nonambulatory outcome. This retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2020. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Thirty-four patients aged 80 years and older who posterior decompression via laminectomy were enrolled in the present study. The mean Charlson Comorbidity Index was >6 (9.2 ± 2.1). The thoracic spine was the most common site of metastasis. A potentially unstable spine, determined using the Spinal Instability Neoplastic Score, was identified in 79.4% of the cases. Preoperatively, the neurological condition and functional status exhibited a notable decline (mean Motor Score of the American Spinal Injury Association grading system, 78.2 ± 16.4; mean Karnofsky Performance Index, 47.8 ± 19.5). The Motor Score of the American Spinal Injury Association grading system and Karnofsky Performance Index scores improved significantly after surgery. Motor weakness and comorbidities were unique risk factors for the loss of ambulation. Emergent decompressive laminectomy in patients with acute onset of neurological decline and potentially unstable spines improved functional outcome at discharge. Age should not be a determinant of whether to perform surgery; surgery should be performed in older patients when indicated.

Safety and feasibility of a cervical laminectomy in patients with traumatic spinal cord injury

BackgroundA cervical laminectomy can prevent further deterioration and sometimes even provide neurological improvement in patients with traumatic spinal cord injury (TSCI) without signs of instability. Although this procedure is frequently performed, the feasibility and in particular the safety of a decompression through a laminectomy after TSCI remains disputable. We sought to assess the safety and feasibility of a cervical laminectomy in patients with TSCI and without instability. MethodsThis single-center retrospective cohort study included patients who underwent a cervical laminectomy at the Erasmus Medical Centre, Rotterdam, from January 2018 to December 2020, due to a recent trauma with surgery in <24 h after diagnosis. The primary outcome included mortality, reoperation rates and neurological outcomes. ResultsOf the 51 trauma patients who had undergone a cervical laminectomy, 43 patients were included. Those patients had a mean age of 66.0 years (SD = 12.2 yr) and 37 (86.0%) patients were male, with a median ASA score of III. 3 patients (6.98%) died within 30 days, with all deaths not directly associated with the surgery, but to the preceding trauma. Two (4.65%) patients needed a reoperation. 31 of the 43 (72.1%) patients showed neurological improvement postoperatively. Of the patients who did not improve neurologically, only 1 patient experienced new neurological impairments. Median postoperative length of stay in our hospital was 92.5 h (3.9 days). ConclusionsOur results confirm the safety and feasibility of acute cervical laminectomy in patients with TSCI without suspicion of segmental instability, even with high preoperative risk scores.

Comparison of C2 dome-like laminectomy with C2 partial laminectomy for upper cervical ossification of the posterior longitudinal ligament.

To compare surgical outcomes of C2 dome-like laminectomy with C2 partial laminectomy in patients with ossification of the posterior longitudinal ligament (OPLL) up to the C2 level and above. 32 patients underwent surgical treatment for OPLL up to C2 and were divided into: C2 dome-like laminectomy group (C2-DOM group, n = 16) and C2 partial laminectomy group (C2-PL group, n = 16). The cervical curvature (CCI), dura width at C2/3, Japanese orthopedic association (JOA) score, recovery rate (RR), neck disability index (NDI) score, and visual analogue scale (VAS) score were evaluated and compared preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year, and annually thereafter. The JOA score and NDI significantly improved at the final follow-up in both groups with no significant intergroup differences. There were no significant differences in preoperative dura width at C2/3 and VAS between the two groups. At the final follow-up, dura width at C2/3 in the C2-PL group was significantly larger than the C2-DOM group, while the VAS of C2-DOM group was significantly lower than C2-PL group. The CCI in both groups decreased compared with before surgery, and there was no significant difference in CCI between the two groups. C2-DOM is less demolitive and reduces postoperative neck pain, while C2-PL can achieve more adequate decompression without increasing the risk of postoperative cervical kyphosis.

COMPAIRING CLINICAL AND RADIOLOGICAL OUTCOME OF LAMINECTOMY VS LAMINOPLASTY FOR CERVICAL SPONDYLOTIC MYELOPATHY: AN INSTITUTIONAL STUDY.

Introduction &amp; Background: Laminectomy has been a traditional approach in the operative management of patients suffering from cervical spondylotic myelopathy. Laminoplasty is an attractive alternative of laminectomy. Objective: Majority of the previous comparative studies between laminoplasty and laminectomy done in a patient suffering from cervical spondylotic myelopathy did not show any signicant difference in neurological outcome. Purpose of this study is to compare the clinical outcome and radiological results following the operation in a similar group of patient at a 12 months of follow-up. Study Design: Single centered prospective randomized blind control trial. Materials &amp; Methods: A consecutive series of twenty six patients who underwent laminoplasty for cervical spondylotic myelopathy has been compared with a similar group of twenty ve matched patients who underwent laminectomy. They were similar in age, gender and ethnicity. Results: Modied Nurick scale improved from pre-operative average of 2.51 to 1.44 in the laminoplasty group and from pre-operative average of 2.67 to 2.11 in the laminectomy group. Pain improved in 39% and 8% in laminoplasty and laminectomy group respectively. There was some loss of range of movement in laminoplasty group, although the radiological effectiveness of decompression was greater in laminoplasty group. Conclusion: Although both laminoplasty and laminectomy are effective at improving the clinical disease severity and quality of life, radiological results are more favourable in laminoplasty group. We therefore conclude that laminoplasty is an effective alternative to laminectomy in patients with cervical spondylotic myelopathy or radiculopathy.

Decompression and Interlaminar Stabilization for Lumbar Spinal Stenosis: A Cohort Study and Two-Dimensional Operative Video.

Background and Objectives: Lumbar spinal stenosis is one of the most common causes of disability in the elderly and often necessitates surgical intervention in patients over the age of 65. Our study aimed to evaluate the clinical efficacy of interlaminar stabilization following decompressive laminectomy in patients with lumbar stenosis without instability. Materials and Methods: Twenty patients with lumbar stenosis underwent decompressive laminectomy and interlaminar stabilization at our academic institution. Clinical outcomes were measured using the visual analog scale (VAS) and Oswestry disability index (ODI) at the 2-month, 6-month, and 1-year postoperative visits, and these outcomes were compared to the preoperative scores. Results: The average VAS scores for low back pain significantly improved from 8.8 preoperatively to 4.0, 3.7, and 3.9 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average VAS scores for lower extremity pain significantly improved from 9.0 preoperatively to 2.7, 2.5, and 2.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average ODI scores significantly improved from 66.6 preoperatively to 23.8, 23.3, and 24.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). There was no statistical significance for difference in VAS or ODI scores between 2 months, 6 months, and 1 year. One patient had an intraoperative durotomy that was successfully treated with local repair and lumbar drainage. Another patient had progression of stenosis and had to undergo bilateral facetectomy and fusion. Conclusions: Decompressive laminectomy and interlaminar stabilization in patients with spinal claudication and low back pain is a good surgical option in the absence of instability and may provide significant clinical improvement of pain and functional disability.

Letter to the editor regarding "Full‑endoscopic (bi‑portal or uni‑portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta‑analysis".

A recent article entitled "Full‑endoscopic (bi‑portal or uni‑portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta‑analysis" written by Pairuchvej et al. (Eur J Orthop Surg Traumatol 30(4):595-611, 2019) published in "European Journal of Orthopaedic Surgery & Traumatology" has aroused our great interest. The authors concluded that compared with minimally invasive decompression surgery, full endoscopic spinal surgery had better pain relief (back pain and leg pain) in the treatment of lumbar spinal stenosis and had a lower complication rate, but no statistical difference in oswestry disability index score and operative time between both groups. Comparing to minimally invasive spinal surgery, bi-portal endoscopic spinal surgery had better back pain relief in the early stage, while uni-portal full endoscopic spinal surgery had better pain relief in the leg and a lower rate of complications.

Evaluation of the efficacy and safety of conventional and biportal endoscopic decompressive laminectomy in patients with lumbar spinal stenosis (ENDO-B trial): a protocol for a prospective, randomized, assessor-blind, multicenter trial

BackgroundRecent studies on biportal endoscopic spine surgery in patients with lumbar spinal stenosis have reported good clinical results. However, these studies have been limited by the small sample sizes and use of a retrospective study design. Therefore, we aim to compare the efficacy and safety of biportal endoscopic decompressive laminectomy with those of conventional decompressive laminectomy in a multicenter, prospective, randomized controlled trial.MethodsThis study will include 120 patients (60 per group, aged 20–80 years) with 1- or 2-level lumbar spinal stenosis, who will be recruited from six hospitals. The study will be conducted from July 2021 to December 2024. The primary outcome (Oswestry Disability Index at 12 months after surgery) will be evaluated through a modified intention-to-treat method. The secondary outcomes will include the following: visual analog scale score for low back and lower extremity radiating pain, EuroQol 5-dimensions score, surgery satisfaction, walking time, postoperative return to daily life period, postoperative surgical scars, and some surgery-related variables. Radiographic outcomes will be analyzed using magnetic resonance imaging or computed tomography. All outcomes will be evaluated before the surgery and at 2 weeks, 3 months, 6 months, and 12 months postoperatively. This protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines for reporting of clinical trial protocols.DiscussionIt is hypothesized that the efficacy and safety of biportal endoscopic and conventional decompressive laminectomy will be comparable in patients with lumbar spinal stenosis. The results of this trial will provide a high level of evidence for the efficacy and safety of the biportal endoscopic technique in patients with lumbar spinal stenosis and facilitate the development of clinical practice guidelines. Furthermore, the results of this study may indicate the feasibility of the biportal endoscopic technique for other types of spinal surgery.Trial registrationThe ENDO-B trial is registered at Clinical Research Information Service (CRIS, cris.nih.go.kr) (KCT0006057; April 52,021).

Hemipartial Laminectomy and Bilateral Flavectomy Technique With Unilateral Approach in Patients With Cervical Spinal Stenosis Due to Ligamentum Flavum Hypertrophy: A Technique Note.

The aim of this procedure is to widen the spinal canal by using minimally invasive techniques to do hemipartial laminectomy and bilateral flavectomy in patients with cervical spinal stenosis due to ligamentum flavum hypertrophy.A 66-year-old man presented with increasing neck and right shoulder pain for one year to Koç University Hospital. He reported a three-month history of numbness in his hands. The Japanese Orthopedic Association (JOA) and Visual Analogue Scale (VAS) scores were 15 and 8, respectively. Preoperative magnetic resonance imaging (MRI) revealed spinal canal stenosis at the C3-4 level secondary to ligamentum flavum hypertrophy. Hemi-partial laminectomy at the C3 level, flavectomy, and bilateral decompression were performed using the right unilateral approach. The patient's complaints of symptoms considerably decreased three months later. The VAS and JOA scores were 2 and 16, respectively.This minimally invasive approach can be an alternative to classic laminectomy in patients who have radiculopathy and myelopathy due to posterior origin spinal stenosis in order to safely resolve pain and neurologic dysfunction.

Comparison of the effect of dexmedetomidine with remifentanil on pain after lumbar laminectomy in patients under general anesthesia

Backgrounds and objectives: Acute postoperative pain is still an issue in patients undergoing lumbar laminectomy surgery. We compared the effects of remifentanil and dexmedetomidine on pain intensity as well as the analgesic requirements in patients undergoing spinal surgery. Methods: This randomized clinical trial study was conducted on 60 patients in the age range of 20 to 60 years with ASA class one and two of the American Anesthesia Association under elective lumbar vertebrae laminectomy. Patients were divided into two groups: Remifentanil (group R) and Dexmedetomidine (group D). Before induction of anesthesia in R group patients, 0.01 می g / kg / min remifentanil was used. In group D, 0.3 dexmedetomidine was injected from µg / min / 50kg using a syringe pump. Postoperative pain score, nausea, and vomiting, mean arterial blood pressure, and heart rate at recovery times, 6, 12, and 24 hours after surgery were recorded. Results: The propofol infusion rate was significantly lower in the DEX group than in group R (P = 0.001). Pain scores except for 6h after surgery was significantly lower in group DEX. Analgesic consumption was significantly lower in group DEX (P=0.021). Mean arterial pressure during surgery, after laryngoscopy, and recovery was significantly lower in group DEX (P&lt;0.05). The mean heart rate after laryngoscopy was significantly lower in group DEX (P=0.033). Conclusion: Intraoperative infusion of DEX improved hemodynamic parameters during surgery and decreased pain score, morphine use after lumbar laminectomy surgery.

Comparing Mean Post-Operative Back Pain Score between Hemilaminectomy and Conventional Laminectomy in Patients of Lumbar Stenosis

Objective: To observe the comparative mean post-operative back-pain score between hemilaminectomy and conventional laminectomy in patients of lumbar stenosis.&#x0D; Material and Methods: The randomized controlled study was carried out in Neurosurgery Unit, Allied Hospital, Faisalabad, Pakistan. A total of 60 patients were distributed equally in two groups. Group A underwent hemilaminectomy while group B underwent conventional laminectomy. A linear median fascial incision was made on the side with more pain or symptoms. Only in the hemilaminectomy group, ipsilateral decompression was performed. It involves partial resection of adjacent parts of the hemi laminae of the superior and inferior vertebrae using operative loupes or neurosurgical microscope. Mean ±SD was calculated for quantitative data including back pain score.&#x0D; Results: Mean age was 46.2 ± 6.94 years in hemi group and 46.3 ± 6.74 years in the conventional group. We observed that in hemi group, the back pain score was 2.23 ± 0.73 and it was 2.7 ± 0.65 in the conventional group (p-value was 0.011). Significant differences (p value&lt;0.050) existed in these age ranges with respect to the back pain score in both surgery groups. A significant difference (p value &lt; 0.0001) observed only in male patients between two surgery groups for the back pain scores.&#x0D; Conclusion: Mean post-operative back pain score is significantly reduced in hemilaminectomy cases when compared with conventional laminectomy in patients of lumbar stenosis.

Risk factors of meralgia paresthetica after prone position surgery: Possible influence of operating position, laminectomy level, and preoperative thoracic kyphosis

Obesity and a prolonged surgical duration are reported risk factors for meralgia paresthetica (MP) after prone position surgery; however, this fails to explain why MP seldom occurs after prone position craniotomy. We reviewed the incidence of MP after spinal surgery and craniotomy in the prone position and investigated whether unidentified factors are involved in the mechanism of postoperative MP. Between January 2014 and March 2020, we performed 556 prone position surgeries. We excluded patients aged ≤16 years and those who were comatose or who required redo-surgery, and reviewed 446 eligible patients (124 who underwent craniotomies and 322 who underwent posterior spinal surgeries). Postoperative MP occurred in 46 (10.3%) patients with a higher incidence after spinal surgery than after craniotomy (13.7% vs. 1.6%, p < 0.001). Among the 322 patients who received posterior spinal surgery, thoracic and lumbar laminectomies were associated with a higher incidence of MP than cervical laminectomy. Analyses limited to those patients who received thoracic and lumbar laminectomies revealed that the preoperative thoracic kyphosis (TK) angle was significantly greater in patients with MP than in those without MP (average TK angle, 38.9° vs. 23.1°; p < 0.001), and that the preoperative lumbar lordosis angle did not significantly differ between the two groups. Apart from the known predisposing factors, we found that thoracolumbar-sacral laminectomy in patients with a greater TK angle is also a risk factor for MP after prone position surgery.

A Comparison of Bilateral Decompression via Unilateral Approach and Classic Laminectomy in Patients with Lumbar Spinal Stenosis in terms of postoperative back pain.

Back ground: Lumbar spinal stenosis (LSS) is a common cause of morbidity in elderly patients due to degenerative changes ofspine. Different surgical procedures have been proposed including open lumbar laminectomy and other less invasivedecompressive procedures to minimize soft tissue damage and lessen the post-operative complication. So we conducted thisstudy to find more appropriate and less invasive procedure.Objective: To compare mean post-operative back pain score in patients with lumbar spinal stenosis undergoing bilateraldecompression via unilateral approach versus classic laminectomy.Material and Methods: This randomized control trial was carried out in department of neurosurgery, Saidu Teaching HospitalSharif Swat from April 2018 to October 2018.Atotal of 60 patients having confirmed degenerative lumbar spine stenosis with painscore of &gt;5 on Visual Analogue Score (VAS) presenting in outpatient department were included in the study. Patients not willing forthe study and fulfilling the set exclusion criteria were excluded. Patients were divided in two groups randomly on basis of lotterymethod. Written informed consent was taken and VAS at presentation of all patients was recorded. In group Apatient underwentbilateral decompression via unilateral approach. In-group B patient underwent classic laminectomy. Pain evaluation in both groupsvia Visual Analogue Scoring was recorded before surgery and at 1month post-operative follow-up. Follow up was advised at a 2weeks interval and final outcome was measured at 1 month post operatively. Data collected was analyzed through SPSS 22.Results: In our study the mean age of the patients was 59.12±12.88 years, the male to female ratio was 0.9:1. Statistically highlysignificant difference was found between the study groups with pain at 1st month i.e. p-value=0.000.Conclusion: The bilateral decompression via unilateral approach had significantly reduced post-operative pain as compared toclassic laminectomy in patients with LSS.Key words: pain, classic laminectomy, bilateral decompression, unilateral approach, lumbar spinal Stenosis

A Comparison of Bilateral Decompression via Unilateral Approach and Classic Laminectomy in Patients with Lumbar Spinal Stenosis in terms of postoperative back pain.

A Comparison of Bilateral Decompression via Unilateral Approach and Classic Laminectomy in Patients with Lumbar Spinal Stenosis in terms of postoperative back pain.

Facet Arthrodesis with the FFX Device: One-Year Results from a Prospective Multicenter Study.

Facet osteosynthesis can be performed to treat facet syndrome (FS) and reduce spinal instability following laminectomy in patients with lumbar spinal stenosis (LSS). The present study evaluated clinical and radiological outcomes following facet osteosynthesis with the FFX device. Patients with FS or LSS were prospectively enrolled in a single-arm, multicenter study. The device was placed at affected levels with or without concomitant posterior lumbar interbody fusion (PLIF) procedures. The visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Computed tomography scans to assess fusion and migration were performed 1 year following surgery. Fifty-three patients (26 men/27 women) with a mean age of 65.0 ± 9.6 years (range: 37-83 years) were enrolled. A total of 205 FFX devices were implanted with 15 patients undergoing concurrent PLIF procedures. There were no intraoperative or postoperative surgical complication reported, and no patient required revision surgery. Mean VAS leg and back pain scores significantly improved from 5.57 to 2.09 (P < .001) and 5.74 to 3.13 (P < .001), respectively, between the preoperative and 1 year follow-up assessments. Mean ODI scores also significantly improved from 44.7% to 24.0% (P < .001) during the same time period. Facet fusion occurred with 86.3% of device placements after 12 months. There was 1 (0.5%) asymptomatic device migration. Eight devices (3.9%) were considered misplaced. The use of the FFX device is associated with a significant reduction in both pain and disability following surgery with a high facet joint fusion rate. 4. This is the first study reporting clinical experience using the FFX device to facilitate facet osteosynthesis. The ability of the device to relieve pain, reduce disability, and enhance lumbar facet fusion with a low rate of device misplacement and migration was demonstrated.

A comparison study of percutaneous endoscopic decompression and posterior decompressive laminectomy in the treatment of thoracic spinal stenosis

BackgroundPercutaneous endoscopic decompression (PED) is considered a minimally invasive and safe procedure in lumbar degenerative disease. Few authors report the success of PED for thoracic spinal stenosis (TSS) with thoracic myelopathy. The objective of this study was to compare the outcome of PED versus posterior decompressive laminectomy (PDL) for TSS.MethodsWe retrospectively reviewed 30 consecutive patients who underwent surgery for single-level TSS from January 1, 2015 to May 1, 2019.These patients were divided into PED (n = 16) and PDL(n = 14) group. Preoperative demographic characteristics and perioperative outcomes were reviewed. Pre- and postoperative neurological status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score and the recovery rate (RR).ResultsThe patients’ mean age was 57.3 years (27–76) in PED group and 58.8 years (34–77) in PDL group. No statistical difference was found between two groups with regards to neurological status at pre-operative and final follow-up. The RR in PED group achieved the same improvement as PDL group (87.5% vs 85.7%, P > 0.05), while the PED brought advantages in operative time(m) (86.4 vs 132.1, p < 0.05), blood loss (mL) (18.21 vs 228.57, p < 0.05),drainage volume(mL) (15.5 vs 601.4, p < 0.05), and hospital stay (d) (3.6 vs 5.6, p < 0.05).ConclusionsBoth PED and PDL showed favorable outcome in the treatment of TSS. Besides, PED had advantages in reducing traumatization. In terms of perioperative quality of life, PED could be an efficient supplement to traditional posterior decompressive laminectomy in patients with TSS.

Microscopic decompressive laminectomy versus percutaneous endoscopic decompressive laminectomy in patients with lumbar spinal stenosis: protocol for a systematic review and meta-analysis.

IntroductionLumbar spinal stenosis (LSS) is a common lumbar degenerative disease in the elderly, usually requiring surgery if conservative treatment fails. Microscopic decompressive laminectomy (MDL) and percutaneous endoscopic decompressive laminectomy (PEDL) have been widely used to treat LSS. This study aims to provide a protocol for the evaluation and comparison of the efficacy, safety and applicability between MDL and PEDL.Methods and analysisWe will search for randomised controlled trials (RCTs) comparing MDL and PEDL for treating LSS from inception to December 2019 in the following databases: PubMed, The Cochrane Library, Web of Science, Embase and China Biology Medicine. The quality of included studies will be assessed using the risk of bias tool recommended by the Cochrane Handbook 5.2.0. Subsequently, a meta-analysis will be performed using RevMan 5.3 software.Ethics and disseminationGiven the nature of this study, no ethical approval will be required. The protocol will be disseminated via a peer-reviewed journal.PROSPERO registration numberCRD42020164765.