Lumbar Canal Decompression Research Articles

Systemic Inflammatory Markers and Clinical Outcomes of Open versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion.

The purpose of this study is to preliminarily assess the change in perioperative systemic inflammatory markers and clinical outcomes between open TLIF and BE-TLIF procedures. In total, 38 patients who underwent single-level lumbar fusion surgery (L4-5 or L5-S1) were retrospectively reviewed. 19 patients were treated by the BE-TLIF technique, while the other patients were managed using open TLIF. The perioperative serum C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), and platelet/lymphocyte ratio (PLR) of the two groups were compared to determine if there was a statistical difference. Meanwhile, clinical evaluations were conducted to assess various factors including operative duration, estimated blood loss (EBL), drainage catheter stay, length of hospitalization, visual analogue scale (VAS), and Oswestry disability index (ODI) scores. The perioperative analysis revealed that BE-TLIF cases experienced a longer operative duration than open TLIF cases (open TLIF: 138.63 ± 31.59 min, BE-TLIF: 204.58 ± 49.37 min, p < 0.001). Meanwhile, the EBL showed an increased trend in the BE-TLIF group (260.7 ± 211.9 mL) in comparison with the open TLIF group (200.9 ± 211.9 mL) (p =0.485). In terms of systemic inflammatory markers, the mean postoperative CRP, NLR, LMR, and PLR were lower in the BE-TLIF group than in the open TLIF group, although these differences were not statistically significant (p > 0.05). The VAS and ODI scores in both groups were significantly improved after surgery (p < 0.05). There was no significant difference found between BE-TLIF and open TLIF in terms of systemic inflammatory markers, and clinical outcomes. Overall, BE-TLIF can be considered a viable choice for lumbar canal decompression and interbody fusion for less invasion. It is worth noting that BE-TLIF does have a longer operation time, indicating that there is still potential for further improvement in this technique.

The anatomic study and surgical technique for canal decompression with “pedicle-plasty” strategy in lumbar burst fractures with pedicle rupture

ABSTRACT In the treatment of lumbar burst fractures with nerve injury, fusion is often required to rebuild spinal stability, but it can lead to the loss of motor units and increase the occurrence of adjacent segment diseases. Thus, a novel approach of lumbar canal decompression with “pedicle-plasty” strategy (DDP) was needed in clincal treatment. Firstly, image measurement analysis, the images of 60 patients with lumbar spine CT examinations were selected to measure osteotomy angle (OA), distance from the intersection of osteotomy plane and skin to the posterior midline (DM),transverse length of the osteotomy plane (TLOP), and sagittal diameter of the outer edge of superior articular process (SD). Secondary, cadaver study, distance between the intermuscular space and midline (DMSM), anterior and posterior diameters of the decompression (APDD), and lateral traction distance of the lumbosacral plexus (TDLP) were measured on 10 cadaveric specimens. Finally, procedure of DDP was demonstrated on cadaver specimens. OA ranged from 27.68°+4.59° to 38.34°+5.97°, DM ranged from 43.44+6.29 to 68.33+12.06 mm, TLOP ranged from 16.84+2.19 to 19.64+2.36 mm, and SD ranged from 22.49+1.74 to 25.53+2.21 mm. DMSM ranged from 45.53+5.73 to 65.46+6.43 mm. APDD were between 10.51+3.59 and 12.12+4.54 mm, and TDLP were between 3.28+0.81 and 6.27+0.62 mm.DDP was successfully performed on cadaveric specimens. DDP, as a novel approach of decompression of burst fractures with pedicle rupture, can fully relieve the occupation and at the same time preserve the spinal motor unit because of no resection of intervertebral discs and no destruction of facet joints,and has certain developmental significance.

Abstract #28 Descriptive Report on Safety When Performing Intraoperative Neurophysiological Monitorization During Indirect Lumbar Canal Decompression

It is important for forensic toxicologists to remember that even if drug and metabolite results are accurately determined, the interpretation of these results may be problematic because of numerous non-analytical factors. Included among these factors that may influence the interpretation of analyte concentration are tolerance and addiction, post-mortem redistribution, age, hysteresis, adulterants, contaminants, and diluents. This Chapter provides an overview of these factors, and the effects they may have on interpretation.

From clinic to hypothesis, an innovative operation for the treatment of lumbar spinal stenosis in a minimal invasive way

Concerning the damage to back muscles and posterior ligament complex (PLC) by posterior open approach for lumbar spinal stenosis (LSS), the oblique lateral intervertebral fusion (OLIF) is pretty popular nowadays. However, oblique lateral approach has obvious drawbacks, which are limited vision and operative scope for achieving spinal canal decompression. Herein, we present a hypothesis that lumbar canal decompression can be well achieved by OLIF combined with spinal endoscope operative system. Nerval decompression and spinal reconstruction are achieved in a minimal invasive way, which may play an instructive role for the treatment of serious LSS.

PRELIMINARY RESULTS OF VERTEBRAL CANAL DECOMPRESSION BY SPINOUS PROCESS SPLITTING

ABSTRACT Objective Considering that the technique of spinous process splitting has been advocated as a less invasive treatment of lumbar stenosis, the objective of this study was to evaluate the preliminary results of this technique in the surgical treatment of lumbar canal stenosis. Methods Twenty patients with lumbar spinal canal stenosis who underwent surgical treatment for lumbar canal decompression with the spinous process splitting technique were assessed in the preoperative period and on postoperative days 1, 7 and 30 for VAS for lower back and lower limbs pain and radiographic evaluation of the operated segment. Results The mean visual analogue scale score for lumbar pain in the preoperative assessment was 4.2 ± 3.37 and 0.85 ± 0.88, 1.05 ± 1.19 and 1.15 ± 1.04 after 1, 7 and 30 postoperative days, respectively. The mean VAS score for lower limb pain was 8 ± 1.72 preoperatively, and 0.7 ± 1.13, 0.85 ± 1.04, and 1.05 ± 1 after 1, 7, and 30 postoperative days, respectively. There were no radiographic signs of instability of the vertebral segment operated in the radiographic evaluation. Conclusions Decompression of the lumbar canal through the spinous process splitting technique in patients with lumbar canal stenosis had good immediate and short-term results in relation to low back and lower limbs pain. Level of evidence IV; Therapeutic Study.

Surgical versus Conservative Management of Lumbar Canal Stenosis in Elderly

Background: Degenerative lumbar spinal stenosis is one of the common diseases in elderly, also may occur in younger ages. Usually presents with back pain, lower limbs pain and claudication pain. Diagnosis is confirmed by radiological studies such as plain X rays LSS, CT. LSS or MRI LSS. Objective: The aim of this prospective study was to evaluate the surgical versus conservative management of lumbar canal stenosis in old patient (age of 60 years old or more). Methods: A prospective comparative study was conducted on 100 old patients that were divide into two groups, each group 50 patients. The first 50 patients underwent surgical lumbar canal decompression and the other 50 patients underwent conservative management. Results: This study showed that elderly patients with moderate to severe lumbar stenosis without spondylolisthesis got benefit from surgery. They showed reduction in pain reported in the lower limbs (VAS Leg with p < 0.05) and improved function (Oswestry with p < 0.05) whoever there was no significance change regarding visual analogue scale (VAS) between the two groups. In addition, there was no significant difference between the result between 6 month and oneyear follow up. Conclusion: In patients with lumbar stenosis in old age, there was improvement in leg pain and function in patients underwent surgical posterior decompression but there was no difference in back pain compared to patients underwent conservative management.

ANALGESIC EFFICACY OF EPIDURAL MORPHINE AND CLONIDINEIN PATIENTS UNDERGOING DECOMPRESSION OF THE LUMBAR CANAL: A PROSPECTIVE RANDOMIZED TRIAL

ABSTRACT Objective: To evaluate the postoperative analgesic efficacy in patients undergoing lumbar canal decompression using epidural morphine and clonidine at the Hospital Santa Casa de Vitória - ES, Brazil. Methods: Prospective, randomized study of 60 patients with stenosis of the lumbar canal up to two levels with surgical indication, in which decompression of the canal was performed in association with lumbar arthrodesis. In group 1 we performed conventional postoperative analgesia and in group 2, in addition to conventional analgesia, we associated epidural morphine and clonidine. We used VAS as a means of analyzing pain intensity at 1, 12, and 36 hours after surgery. The statistical analysis was performed using Microsoft Office/Excel and the software GraphPad Prism (San Diego, CA, USA). Results: The mean age of patients was 47 years, and 52% were female. The mean VAS in the first hour, 12th, and 36th hours after surgery in the control group was 5.44, 2.13, and 0.55 respectively. In the morphine-clonidine group it was 6.96; 2.21 and 0.60. Comparing one group with another in its absolute values through the Mann-Whitney test, as well as comparing the pain variations between the 1st and 12th hour (1h X 12h) and between the 12th hour and 36th hour (12h x 36h ) through Student’s t test it became clear that there was no statistical difference between groups (p &gt; 0.05). Conclusions: The addition of epidural morphine and clonidine to conventional analgesia is not beneficial to reduce postoperative pain in patients undergoing lumbar canal decompression.

Radiological improvements in global sagittal alignment after lumbar decompression without fusion.

A retrospective, radiographical study. To evaluate short-term radiological changes in sagittal alignment after lumbar decompression without fusion for lumbar canal stenosis. Although the importance of global sagittal balance is underscored recently, little is known about the changes in sagittal alignment after lumbar canal decompression. We retrospectively reviewed 88 patients who underwent lumbar decompression without fusion at a single institution between November 2008 and May 2013, with a minimum follow-up of 5 months. Standing radiographs at the preoperative period and the final follow-up were assessed. Radiological parameters included the sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt, pelvic incidence (PI), occipital 7th cervical angle, and thoracic kyphosis, which were measured by 2 spine surgeons. The Zurich Claudication Questionnaire and visual analogue scale scores were obtained to assess the patient-based clinical outcomes. Both LL and thoracic kyphosis significantly increased postoperatively, whereas SVA, PI-LL (PI minus LL), and pelvic tilt significantly decreased (P<0.05). There were no significant differences between the preoperative and postoperative occipital 7th cervical angle and PI. The amount of increment in LL was greater in patients with small preoperative LL. The improvement in SVA was greater in those with a large preoperative SVA. The Zurich Claudication Questionnaire and visual analogue scale scores showed no significant correlation with the radiological parameters. Lumbar decompression without fusion can induce a reactive improvement in the lumbar and global sagittal alignment even if a sagittal imbalance exists preoperatively. 4.

Polymethylmethacrylate (PMMA) Augmentation Of A Cannulated And Fenestrated Pedicle Screw Fixation For Stabilization Of The Lumbar Degenerative Disease Accompanied With Osteoporosis

Objective: To explore the clinical efficacy of the use of polymethylmethacrylate (PMMA) augmentation of a cannulated and fenestrated pedicle screwfixation for the treatment of lumbar degenerative disease accompanied withosteoporosis. Methods: Thirty-one patients of lumbar degenerative disease accompanied with osteoporosisfrom Jun 2008 to Jan 2013 were selected .They were 11 males and 20 females withaverage age of 73. 5 years including lumbar degenerative stenosis 14 cases，lumbar intervertebral discherniation combined with segmental instability 9 cases，lumbar degenerative spondylolisthesis 6 cases，andlumbar degenerative scoliosis 2 cases. The patients were treated with lumbar canal decompression, fusion and polymethylmethacrylate (PMMA) augmentation of a cannulated and fenestrated pedicle screw fixationaccording to their clinicalfeature and imaging. Results: All cases were followed up for 40 months (range,36-48months). No screw breakage, rod breakage, screw extraction, loosening, pseudoarticulation formation, or incision infection wasfound.The postoperative VAS score wasremarkably lower than preoperative score (P < 0.05). The JOAscore were improved significantly (P < 0.05). Conclusion: For patients suffering from lumbar degenerative disease accompanied with osteoporosis，PMMA augmentation of a cannulated and fenestrated pedicle screwfixation was helpful for increasing the stabilization of screw and preventing from loosen and dislocation of the screws，therefore beneficial for improvement and maintenance of clinical efficacy. Key word: Osteoporosis; cannulated and fenestrated pedicle screw; PMMA; Lumbar degenerative disease

Epidural fentanyl for postoperative analgesia after lumbar canal decompression: a randomized controlled trial

Postoperative back pain is common after decompression surgery for lumbar stenosis and often delays discharge from hospital. Achieving regional analgesia by intraoperative delivery of epidural opiates after lumbar canal decompression is a promising approach to reduce postoperative pain and enhance early mobilization. However, there have been concerns about opiate-related complications, such as respiratory depression and urinary retention in what is generally an elderly population of patients. To assess the analgesic efficacy of bolus epidural fentanyl administered intraoperatively after lumbar decompression for degenerative canal stenosis. Patient-blinded randomized controlled trial conducted at two university neurosurgical centers. Adults (older than 18 years) with neurogenic claudication and/or lower limb radiculopathy and concordant lumbar spinal canal stenosis demonstrated on magnetic resonance imaging. Patients with previous lumbar spinal surgery, a contraindication to fentanyl, or requiring instrumentation were excluded. The primary outcome measure was patient-reported Visual Analogue Score (VAS) for pain recorded preoperatively, in recovery, and on the first and second postoperative days if the patient remained in the hospital. Secondary outcomes were duration of surgery, length of stay, and any side effects or complications. Patients underwent a one to three level lumbar canal decompression as required, via a midline incision, under general anesthesia. Before wound closure either no drug (control) or a 100-μg bolus of fentanyl was administered via an epidural catheter inserted 10 cm rostral to the operated level. Patients were blinded to group allocation, and analysis was by intention to treat. The trial was approved by the National Health Service Research Ethics Service and the Medicines and Healthcare products Regulatory Agency. No commercial or other source of funding was received. Sixty patients were randomized, 29 to fentanyl and 31 to control. Demographics, duration of surgery, and preoperative VAS were not significantly different between the groups. VAS in recovery was significantly lower in patients treated with fentanyl (mean [standard deviation]: 2.6[2.7] vs. 4.7 [2.4]; p=.003). Later VAS and postoperative length of stay were similar between groups. More patients in the fentanyl group required temporary urinary catheterization, but there was no significant difference in the incidence of side effects. Bolus epidural fentanyl provides effective short-term postoperative analgesia after lumbar canal decompression and may be a useful adjunct to pain management in patients undergoing lumbar spine surgery.

Commentary: Postoperative analgesia after lumbar laminectomy: is there a role for single-shot epidural fentanyl?

<h3>Commentary on</h3> Guilfoyle MR, Mannion RJ, Mitchell P, Thomson S. Epidural fentanyl for postoperative analgesia after lumbar canal decompression: a randomized controlled trial. Spine J 2012;12:646–51 (<i>in this issue</i>).

Minimally Invasive Lumbar Decompression

Prospective observational study. To describe our experience with the first 50 cases of minimally invasive lumbar canal decompression in terms of patient outcome up to 2 years, the learning curve incurred, and complications when compared with our most recent 50 cases. Lumbar canal stenosis is a common condition in the elderly population, the symptoms of which respond well to surgical decompression. A minimally invasive approach offers potential short and long-term benefits to patients but the technique is associated with a learning curve and equivalence to open surgery regarding efficacy and complications needs to be demonstrated. Fifty patients (mean age 70 y) who presented with clinical and radiological features of lumbar canal stenosis and who had failed a period of conservative management underwent lumbar canal decompression through a paramedian oblique, muscle splitting approach using a 16 to 18 mm operating tube and microscope. Outcome was assessed using the Oswestry Disability Index and Short Form-36 at 3 months, 1 year, and 2 years. Significant clinical improvements were seen at 3 months that were sustained at 1 and 2 years. Clinical outcome improved whereas operative time and complications fell as experience increased, helping to define the learning curve with this technique. Minimally invasive lumbar decompression seems to offer patients a clinical benefit comparable to that observed in published open series, with potential advantages in terms of postoperative pain and recovery. However, there is a learning curve and whether this technique offers long-term benefits with regard to a reduction in back pain or postoperative spondylolisthesis is not yet known.

Letter to the Editor concerning “A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle” (A. Colak et al., Eur Spine J (2008) 17:1745–1751)

Dear Sir, I have read the paper of Dr. Simsek which was published in European Spine Journal (2008) 17:1745–1751 and compliment the authors on preparing this publication. In the discussion on p 1750 the problem is addressed of determining the degree of facetectomy required for relief of the lateral spinal stenosis, and it is stated that no satisfactory guideline has been established. However, when responding to the question “How do you know that decompression is complete?” I submit that there are two clinical observations that can be made during surgery. The first is that in the early stages of its exposure in the stenotic canal, the nerve root is extremely sensitive and, when touched with a blunt probe, it will cause the leg on the affected side to go into a vigorous spasm. The second observation is that, as the stenosis is finally relieved, the collapsed perineural veins refill rapidly, and within minutes of this perineural vein refilling, manipulation of the nerve root no longer elicits vigorous muscular contractions in the leg. To the question as to how one knows that the decompression is complete, the answer is that when the surgeon observes the dramatic rapid refilling of the perineural veins on the posterior surface of the exposed nerve root and the nerve root loses its extreme sensitivity [1]. In addition, I will mail you a copy of a CD film I prepared on Techniques of Lumbar Canal Decompression, which complements this current paper in the European Spine Journal and deals with the surgical techniques for the relief of lumbar spinal canal stenosis [2]. I hope you will find it of interest.

Tratamento da discite na criança

The authors reviewed nine patients presenting with discitis during infancy, demonstrating that its diverse forms of presentation lead to a delayed and difficult diagnosis. This study reports that initial radiographs may not show any alterations, enhancing the importance of scintillography or magnetic resonance for these cases. One patient was submitted to surgical treatment for lumbar canal decompression due to the presence of a disk abscess. The remaining patients were treated conservatively only with an appropriate antibiotic therapy, immobilization and restriction of physical activity. All of the young patients had a satisfactory evolution and stated no complaints about sequels during their final evaluation.