Decompression For Lumbar Spinal Stenosis Research Articles

Pain and Functional Outcome After Microsurgical Decompression of Lumbar Spinal Stenosis: Very Short- and Long-Term Postoperative Analysis.

Multicenter, prospective observational cohort study. 109 patients with lumbar spine stenosis (LSS) undergoing minimally invasive decompression in 6 different centers (Germany, Italy, USA). The demographic, surgical and clinical data was collected. Patients were examined preoperatively, immediately postoperatively, at 6 and 12 months after surgery with regard to pain (back and legs) and functional outcomes (ODI, SF-36, EQ5D). The mean age of the cohort was 67 ± 11 years, with a BMI of 31.8 ± 6.6kg/m². Most patients (93%) underwent single-level decompression, and postoperative adverse events occurred in 17% of cases. Significant initial reductions in back (6.0 ± 2.8 to 2.4 ± 2.1) and leg pain (6.4 ± 2.1 to 2.1 ± 2.5) were observed (P < 0.001). However, pain levels increased significantly by the 12-month period, reaching 3.9 ± 2.7 for back pain and 3.9 ± 2.4 for leg pain (P < 0.001). Functional scores (ODI) improved from 43 ± 18 at baseline to 36 ± 18 post-treatment but showed no further significant change (P = 0.509) by 12 months. Health status (EQ5D index) improved from 0.53 ± 0.33 to 0.82 ± 0.16 immediately post-treatment but declined to 0.75 ± 0.21 by 12 months (P = 0.011). SF36 physical scores also showed initial improvement but plateaued at follow-ups. Notably, high BMI and prior spine surgery were associated with worse outcomes. Although minimally invasive decompression without fusion initially led to a significant improvement in patients with LSS, the results deteriorated significantly over the course of the observation period. Future studies should focus on strategies to ensure sustained improvement in symptoms in patients with lumbar stenosis undergoing decompression procedure.

Evaluation of the therapeutic effect of decompression with or without fusion on lumbar spinal stenosis caused by degenerative lumbar spondylolisthesis: a systematic review and meta-analysis

As a common clinical disease, lumbar spinal stenosis (LSS) is currently the preferred surgical treatment, and there are various opinions. We conducted a study on whether fusion should be performed simultaneously with decompression for lumbar spinal stenosis caused by low-grade degenerative lumbar spondylolisthesis and compared the efficacy and safety of the two surgeries. We conducted literature searches on Cochrane Library, Embase, PubMed, Scoups, and China National Knowledge Infrastructure databases to search for randomized controlled trials and observational studies that compared decompression alone and decompression plus fusion in the treatment of lumbar spinal stenosis with low-grade lumbar spondylolisthesis. We conducted a meta-analysis on surgical duration, hospital stay, incidence of complications, intraoperative blood loss, lower back and leg pain scores, and Oswestry disability index (ODI) scores. We ultimately included 8 articles, including 2 randomized controlled trials and 6 observational studies. Additional fusion did not benefit patients in relieving lower back pain (P=0.05) and leg pain (P=0.12), and there was no significant difference in ODI (P=0.12) and perioperative complication rate (P=0.10) between the two. However, Decompression alone was significantly better than the decompression plus fusion group in terms of surgical time (P=0.0008), hospital stay (P<0.0001), and intraoperative blood loss (P<0.00001). In this article, decompression alone has shorter surgical and hospitalization time, and less intraoperative bleeding compared to decompression plus fusion. And there was no significant difference in pain score and disability index between the two surgeries during follow-up. Therefore, we can say that for patients with lumbar spinal stenosis caused by low-grade lumbar spondylolisthesis, decompression alone is not inferior to decompression plus fusion.

Efficacy of endoscopic interlaminar decompression in lumbar spinal stenosis: a retrospective study.

This retrospective study evaluated the clinical effectiveness of endoscopic interlaminar decompression for lumbar spinal stenosis in 40 patients treated from February 2020 to January 2022. The procedure was successful in all cases, with only one dural sac injury reported and no other complications. Postoperative Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) scores improved significantly (P<0.05), and the modified Macnab criteria showed an 87.5% rate of excellent and good outcomes at follow-up. No patients required revision surgery. Overall, the endoscopic interlaminar approach proved to be effective, safe, and supported early recovery.

Learning curve and complications of unilateral biportal endoscopy unilateral laminectomy bilateral decompression for lumbar spinal stenosis

Learning curve and complications of unilateral biportal endoscopy unilateral laminectomy bilateral decompression for lumbar spinal stenosis

Sagittal Realignment Following Decompression for Lumbar Spinal Stenosis in Elderly Patients: A Comprehensive EOS Imaging Analysis.

This study investigated whether decompression surgery for lumbar spinal stenosis can effectively improve sagittal alignment in elderly patients. With the growing focus on sagittal balance in spinal surgery, this study aimed to evaluate post-decompression alignment changes and identify the factors influencing these changes using the EOS imaging system. A retrospective analysis was conducted on 49 elderly patients who underwent decompression surgery alone for lumbar spinal stenosis. Radiologic parameters, measured using the EOS system, and clinical outcomes were assessed preoperatively, at two weeks postoperatively, and at one year postoperatively. Patients were grouped based on the improvement of the sagittal vertical axis (SVA) by 25 mm or more. A multivariate analysis was performed to identify factors affecting sagittal alignment changes. Significant sagittal alignment improvements were observed postoperatively, including a notable increase in thoracic kyphosis and a decrease in SVA observed at one year. Clinical outcomes, such as the Oswestry disability index (ODI) and EQ-5D, significantly improved at both two weeks and one year postoperatively compared to preoperative values (all p-values < 0.05). Multivariate analysis revealed that greater preoperative SVA and higher ODI were significant predictors of sagittal alignment changes (odds ratio [OR] for SVA = 1.014, OR for ODI = 1.034). Decompression surgery for lumbar spinal stenosis in elderly patients can result in significant improvements in sagittal alignment and clinical outcomes. The study suggests that decompression alone is a viable surgical option for elderly patients, particularly those with a greater preoperative sagittal imbalance and disability, even in the absence of major deformities.

The impact of smoking on patient-reported outcomes following lumbar decompression: an analysis of the Quality Outcomes Database.

Smoking has been shown to negatively impact spinal health, as well as the outcomes of spinal fusion. Published reports show conflicting data regarding whether smoking negatively impacts patient outcomes following lumbar decompression. The objective of this study was to investigate whether smoking affects the outcomes of patients undergoing lumbar decompression for spinal stenosis or herniated disc. The Quality Outcomes Database was queried for patients with spinal stenosis or lumbar disc herniation who underwent one- or two-level lumbar decompression without fusion. All patients had preoperative and 12-month outcome measures and were divided into groups of nonsmokers and current smokers. Outcomes were compared between the two groups, as well as the percentage of patients reaching the minimal clinically important difference (MCID) threshold for numeric rating scale (NRS) back and leg pain scores and the Oswestry Disability Index (ODI). Of 17,271 patients, 14,233 were nonsmokers and 3038 were current smokers. Smokers had worse baseline NRS back and leg pain, ODI, and EQ-5D scores and experienced slightly less improvement in all measures following lumbar decompression (p ≤ 0.009), although changes were largely similar, and a high percentage of patients achieved the MCID thresholds for NRS back pain (78% nonsmokers vs 75% smokers), NRS leg pain (79% nonsmokers vs 73% smokers), and ODI (74% nonsmokers vs 68% smokers). Comparison of propensity-matched cohorts did not identify any difference in outcomes in smokers versus nonsmokers. In patients undergoing lumbar decompression for spinal stenosis or herniated disc, smokers demonstrated slightly less improvement in outcomes compared with nonsmokers, and a high proportion of both groups achieved meaningful improvement with surgery. While smoking cessation should be strongly encouraged in all patients, lumbar decompression procedures for spinal stenosis and herniated disc should not be denied to smokers.

Efficiency of Lidocaine Intramuscular and Intraosseous Trigger Point Injections in the Treatment of Residual Chronic Pain after Degenerative Lumbar Spinal Stenosis Decompression Surgery.

Introduction: Despite the long-term use of intramuscular and intraosseous lidocaine trigger point injections (LTPI) in the treatment of patients with low back pain, there have been no studies examining their efficiency in treatment of residual pain after degenerative lumbar spinal stenosis (DLSS) decompression surgery. The purpose of our research is to examine the LTPI efficiency in the treatment of residual lumbar pain after DLSS decompression surgery and to compare the analgesic and recovery effects of intramuscular and intraosseous LTPI administered in the L4-S1 region and in the posterior superior iliac spine (PSIS) after treatment and during four months of follow-up. Materials and Methods: We observed 99 patients (F:50, M:49) aged 42 to 59 years with residual neurological disorders after DLSS decompression surgery. In all patients, the pain syndrome exceeded 6 points on the VAS and averaged 7.2 ± 0.11 points. The control group (n = 21) underwent only pharmacotherapy. In addition to pharmacotherapy, the LTPI group underwent intramuscular LTPI in L4-S1 (n = 20), intramuscular LTPI in the PSIS (n = 19), intraosseous LTPI in L5, S1 (n = 20), and intraosseous LTPI in the PSIS (n = 19). A neurological examination was carried out before treatment, 7 days after completion of treatment, and at the end of the second and fourth months of the follow-up period. Results: In the control group, intramuscular LTPI in L4-S1 subgroup, intramuscular LTPI in PSIS subgroup, intraosseous LTPI in L5, S1 subgroup, and intraosseous LTPI in PSIS subgroup, the severity of pain decreased after treatment by 27.1% (p ≤ 0.05), 41.7% (p ≤ 0.01), 50.7% (p ≤ 0.01), 69% (p ≤ 0.01), and 84.7% (p ≤ 0.01), respectively, and at the end of the second month of follow-up, by 14.3% (p > 1), 29.2% (p ≤ 0.05), 38% (p ≤ 0.01), 53.5% (p ≤ 0.01), and 72.2% (p ≤ 0.01), respectively. Reduction of neurogenic claudication, regression of sensory deficit, increase of daily step activity, and improvement of quality of life after treatment were noted in intramuscular LTPI subgroups by 19.6% (p ≤ 0.05), 36.4 (p ≤ 0.05), 40.3% (p ≤ 0.01), and 21.0% (p ≤ 0.05), respectively, and in interosseous LTPI subgroups by 48.6% (p ≤ 0.01), 67.4% (p ≤ 0.01), 68.3% (p ≤ 0.01), and 46% (p ≤ 0.01), respectively. Conclusions: LTPI is highly effective in the treatment of patients with residual pain after DLSS decompression surgery. High analgesic effect, significant regression of sensory deficits and gait disorders, and remarkable improvement of daily step activity and quality of life are noted not only after the end of LTPI treatment but also continue for at least 2 months after treatment. Intraosseous LTPI is more effective than intramuscular LTPI by 92%, and LTPI in PSIS is more effective than LTPI in L4-S1 by 28.6%.

Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis.

Systematic review and meta-analysis. Interspinous process devices (IPD) were used as a treatment in selected patients with lumbar spinal stenosis (LSS). However, the use of IPD was still debated that it had significantly higher reoperation rates compared to traditional decompression. Therefore, the purpose of the meta-analysis was to evaluate the effectiveness and safety of IPD treatment in comparison to traditional treatment. The databases were searched of PubMed, Embase and the Cochrane, Chinese National Knowledge Infrastructure, Chongqing VIP Database and Wan Fang Database up to January 2024. Relevant studies were identified by using specific eligibility criteria and data was extracted and analyzed based on primary and secondary endpoints. A total of 13 studies were included (5 RCTs and 8 retrospective studies). There was no significant difference of Oswestey Disability Index (ODI) score in the last follow-up (MD = -3.81, 95% CI: -8.91-1.28, P = .14). There was significant difference of Visual Analog Scale (VAS) back pain scoring in the last follow-up (MD = -1.59, 95% CI: -3.09--0.09, P = .04), but there existed no significant difference of leg pain in the last follow-up (MD = -2.35, 95% CI: -6.15-1.45, P = .23). What's more, operation time, bleeding loss, total complications and reoperation rate had no significant difference. However, IPD had higher device problems (odds ratio [OR] = 9.00, 95% CI: 2.39-33.91, P = .001) and lesser dural tears (OR = 0.32, 95% CI: 0.15-0.67, P = .002) compared to traditional decompression. Although IPD had lower back pain score and lower dural tears compared with traditional decompression, current evidence indicated no superiority for patient-reported outcomes for IPD compared with alone decompression treatment. However, these findings needed to be verified in further by multicenter, double-blind and large sample RCTs.

Polytomous Rasch Analyses of Surgeons' Decision-Making on Choice of Procedure in Endoscopic Lumbar Spinal Stenosis Decompression Surgeries.

With the growing prevalence of lumbar spinal stenosis, endoscopic surgery, which incorporates techniques such as transforaminal, interlaminar, and unilateral biportal (UBE) endoscopy, is increasingly considered. However, the patient selection criteria are debated among spine surgeons. This study used a polytomous Rasch analysis to evaluate the factors influencing surgeon decision-making in selecting patients for endoscopic surgical treatment of lumbar spinal stenosis. A comprehensive survey was distributed to a representative sample of 296 spine surgeons. Questions encompassed various patient-related and clinical factors, and responses were captured on a logit scale graphically displaying person-item maps and category probability curves for each test item. Using a Rasch analysis, the data were subsequently analyzed to determine the latent traits influencing decision-making. The Rasch analysis revealed that surgeons' preferences for transforaminal, interlaminar, and UBE techniques were easily influenced by comfort level and experience with the endoscopic procedure and patient-related factors. Harder-to-agree items included technological aspects, favorable clinical outcomes, and postoperative functional recovery and rehabilitation. Descriptive statistics suggested interlaminar as the best endoscopic spinal stenosis decompression technique. However, logit person-item analysis integral to the Rasch methodology showed highest intensity for transforaminal followed by interlaminar endoscopic lumbar stenosis decompression. The UBE technique was the hardest to agree on with a disordered person-item analysis and thresholds in category probability curve plots. Surgeon decision-making in selecting patients for endoscopic surgery for lumbar spinal stenosis is multifaceted. While the framework of clinical guidelines remains paramount, on-the-ground experience-based factors significantly influence surgeons' selection of patients for endoscopic lumbar spinal stenosis surgeries. The Rasch methodology allows for a more granular psychometric evaluation of surgeon decision-making and accounts better for years-long experience that may be lost in standardized clinical guideline development. This new approach to assessing spine surgeons' thought processes may improve the implementation of evidence-based protocol change dictated by technological advances was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the International Society for Minimal Intervention in Spinal Surgery (ISMISS), the Mexican Spine Society (AMCICO), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Society (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS).

Efficacy of Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Meta-Analysis With Single-Arm Analysis and Comparative Analysis With Microscopic Decompression and Uniportal Endoscopic Decompression.

Biportal endoscopic decompression is a minimally invasive surgical technique for lumbar spinal stenosis (LSS). This meta-analysis aimed to evaluate the efficacy and safety of biportal endoscopic decompression through both a single-arm analysis and a comparative analysis. A comprehensive literature search was conducted to identify eligible studies reporting the outcomes of biportal endoscopic decompression for LSS. Single-arm analysis and comparisons with microscopic and uniportal endoscopic decompression were performed. Evaluated outcomes included visual analog scale (VAS) scores for back pain and leg pain, Oswestry Disability Index (ODI) scores, operation time, estimated blood loss, duration of hospital stay, and adverse events. Single-arm analysis demonstrated significant improvements in VAS back pain, VAS leg pain, and ODI scores after biportal endoscopic decompression at postoperative 1-day to 36-month follow-up (all P < .001), compared with preoperative levels. The pooled mean single-level operation time was 71.44 min, and the pooled mean hospital stay was 3.63 days. The overall adverse event rate was 4.0%, with dural tear being the most common complication (3.0%). Compared with microscopic decompression, biportal endoscopic decompression showed significantly lower VAS back pain at 1-month ( P < .001) and 6-month ( P < .001) follow-up; lower VAS leg pain at 1-month ( P = .045) follow-up; lower ODI scores at 3-month ( P < .001), 12-month ( P = .017), and >12-month ( P = .007) follow-up; lower estimated blood loss ( P = .003); and shorter hospital stay ( P < .001). Adverse event rates did not differ between the techniques. No significant differences were observed between biportal endoscopic and uniportal endoscopic decompression groups for most efficacy and safety outcomes. Biportal endoscopic decompression emerges as a safe and effective alternative for LSS, presenting potential advantages over the microscopic technique and comparable efficacy with the uniportal endoscopic technique.

Left-digit bias in surgical decision-making for lumbar spinal stenosis

BACKGROUND CONTEXTLeft-digit bias is a behavioral heuristic or cognitive “shortcut” in which the leftmost digit of a number, such as patient age, disproportionately influences surgical decisions. PURPOSETo determine if left-digit bias in patient age influences the decision to perform arthrodesis with instrumentation vs decompression in lumbar spinal stenosis (LSS). DESIGNRetrospective cohort. PATIENT SAMPLEPatients with an ICD-10 diagnosis of lumbar stenosis or spondylolisthesis identified in the 2017-2021 National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURESThe primary outcome was the percent of patients who underwent arthrodesis with instrumentation (AwI). Matched age group comparisons without left-digit differences (ie, 76/77 vs 78/79, 80/81 vs 82/83, etc.) were performed to isolate the effect of the heuristic. Secondary outcomes including peri-operative events and complications were also compared within AwI and decompression cohorts. METHODSUsing CPT codes, procedures were classified as either AwI or decompression. Patients were grouped into 6 cohorts based on 2-year age windows (74/75, 76/77, 78/79, 80/81, 82/83, 84/85). The cohorts were propensity matched with neighboring age groups based on the presence of spondylolisthesis, demographics, and comorbidities. The primary comparison was between those aged 78/79 vs 80/81. RESULTSAfter matching, the primary cohort consisted of two groups of 1,550 patients (aged 78/79 and 80/81). Patients aged 80/81 were less likely to undergo AwI than patients aged 78/79 (23.5% vs 27.2%, p=.021). AwI procedures occurred at similar rates between age groups with the same left digit. Within the decompression and AwI cohorts, there were no differences in secondary outcomes between patients aged 78/79 and 80/81. CONCLUSIONSLSS patients aged 80/81 are less likely to undergo AwI than patients aged 78/79, regardless of comorbidities. This was not seen when comparing patients with similar left digits in age. Until objective measures of physiologic capacity are established, left-digit bias may influence clinical decisions.

Clinical and Radiological Outcomes of Full-Endoscopic Decompression for Lumbar Spinal Stenosis With Grade I Degenerative Spondylolisthesis: A Retrospective Study With a Minimum 1-Year Follow-up

BACKGROUND AND OBJECTIVES: Decompression without fusion is a surgical option for the treatment of lumbar spinal stenosis (LSS) with grade I degenerative spondylolisthesis (DS). However, the outcomes of full-endoscopic decompression remain unknown. This study aimed to investigate the clinical and radiological outcomes of lumbar full-endoscopic decompression for spinal stenosis with grade I DS. METHODS: A total 43 patients with LSS with grade I DS who underwent lumbar full-endoscopic unilateral laminotomy for bilateral decompression and were followed up for a minimum of 1 year were retrospectively reviewed. Data on demographic characteristics, operative details, radiological images, clinical outcomes, and complications were analyzed. RESULTS: Pain, evaluated using the visual analog scale, was significantly reduced in patients undergoing full-endoscopic decompression in both the leg and back; the Oswestry Disability Index scores also improved (P &lt; .001). MacNab's outcome classification was excellent or good in 95% of patients. One patient eventually needed the fusion surgery, and two patients required further diskectomy surgery because of recurrent symptoms. During follow-up, an increase in the vertebral slip was observed in 46.5% of the patients, but it was not statistically significant (P = .46). The progression of DS, defined as percentage of slip &gt;5%, was observed only in 7% of the patients. An increase in vertebral slip was not associated with the clinical outcomes. There was no difference in radiological outcomes, such as angular motion (P = .36) and translation (P = .13), compared with the preoperative state. The operation did not exacerbate spinal instability. Rather, fewer patients had spinal instability postoperatively. CONCLUSION: Endoscopic decompression alone has comparably good clinical outcomes with those of other surgical techniques in patients with LSS and DS. Few postoperative spinal instability occurred. Rather, the number of patients with instability decreased postoperatively. Full-endoscopic decompression may be a treatment option for patients with grade 1 DS.

Antithrombotic therapy and spinal surgery: a retrospective cohort study of 289 consecutive elderly patients with degenerative lumbar stenosis.

Lumbar spinal stenosis (LSS) is a disabling degenerative process of the spine, mainly affecting older patients. LSS manifests with low-back and leg pain and neurogenic claudication. Disability and impairment in activities of daily living are consequences of the progressive narrowing of the lumbar spinal canal. Surgical decompression has been shown to be superior to conservative management. Nonetheless, intraoperative and postoperative blood loss in elderly patients taking antiplatelet or anticoagulant drugs owing to cardiovascular comorbidities may be a special issue. This study describes and compares early outcomes after surgical procedures in different groups of patients receiving antithrombotic drugs. The authors' study retrospectively recruited 289 consecutive patients aged ≥ 65 years who received lumbar decompression for spinal stenosis between January 2021 and May 2022. First, 183 patients taking antiplatelet therapy were divided into two groups according to the rationale for use: primary versus secondary prophylaxis of cardiovascular events (group 1 vs group 2). Primary prevention was stopped preoperatively, or secondary prevention was not discontinued during the perioperative period. Secondly, 106 patients who were not taking antiplatelet mediation were divided into two groups, depending on whether preoperative low-molecular-weight heparin had not been administered or had been (group A vs group B). Intraoperative blood loss, surgical time, and postoperative hospitalization were analyzed. No significant statistical differences were observed between groups 1 and 2 in terms of intraoperative blood loss and time of surgery, or between groups A and B in terms of all analyzed variables. No early or delayed complications were observed, perioperatively or during the postoperative 3-month follow-up period. The results of this study suggest that the use of anticoagulant and antiplatelet therapies in elective decompressive surgery could be devoid of early complications and could be safely continued perioperatively.

Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques

BackgroundDisc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis.MethodsThis was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups.ResultsPostoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003).ConclusionThe incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.

The association between disability and physical performance, pain intensity, and pain-related anxiety in patients after lumbar decompression surgery: a cross-sectional study

BackgroundMost patients with lumbar spinal stenosis improve significantly within 6 months of lumbar decompression surgery, however, unfavorable long-term disability may persist in some patients. It was unclear which potential influencing factors were more likely to be associated with disability. This study aimed to assess the association between disability and physical performance, pain, and pain-related anxiety in patients after lumbar decompression surgery.MethodsPatients who underwent decompression for lumbar spinal stenosis were included. Participants completed the visual analog scale, Oswestry Disability Index, and Pain Anxiety Symptoms Scale-20 to collect pain intensity, disability, and pain-related anxiety information. For physical performance assessment, participants performed timed up and go (TUG), functional reach test (FRT), 6-min walking test, and modified Sorensen test, 6–12 months after lumbar decompression surgery. The associations were examined with bivariate and multivariable linear regression analyses.ResultsA total of 80 patients were included. A significant association between disability and pain-related anxiety, the FRT, and the modified Sorensen test scores was confirmed in multivariable analyses. Both bivariate (r = − 0.75) and multivariable (β = 0.60, 95% CI, 0.24, 0.54; P = 0.00) analyses confirmed that pain-related anxiety was the strongest indicator of disability. The association between disability and pain intensity, TUG, and 6-min walking test scores was not confirmed.ConclusionPain-related anxiety should be considered in the rehabilitation programs after lumbar decompression surgery. The evaluation of all aspects of physical performance following lumbar decompression surgery is also recommended.

Unilateral laminotomy with bilateral spinal canal decompression: systematic review of outcomes and complications

BackgroundUnilateral laminotomy with bilateral spinal canal decompression has gained popularity recently.AimTo systematically review the literature of unilateral laminotomy with bilateral spinal canal decompression for lumbar spinal stenosis (LSS) aiming to assess outcomes and complications of the different techniques described in literature.MethodsOn August 7, 2022, Pubmed and EMBASE were searched by 2 reviewers independently, and all the relevant studies published up to date were considered based on predetermined inclusion and exclusion criteria. The subject headings “unilateral laminotomy”, “bilateral decompression” and their related key terms were used. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.ResultsA total of seven studies including 371 patients were included. The mean age of the patients was 69.0 years (range: 55–83 years). The follow up duration ranged from 1 to 3 years. Rate of postoperative pain and functional improvement was favorable based on VAS, JOA, JOABPEQ, RMDW, ODI and SF-36, for example improved from a range of 4.2–7.5 preoperatively on the VAS score to a range of 1.4–3.0 postoperatively at the final follow up. Insufficient decompression was noted in 3% of the reported cases. The overall complication rate was reported at 18–20%, with dural tear at 3.6–9% and hematoma at 0–4%.ConclusionUnilateral laminotomy with bilateral decompression has favorable short- and mid-term pain and functional outcomes with low recurrence and complication rates. This, however, needs to be further confirmed in larger, long-term follow-up, prospective, comparative studies between open, and minimally invasive techniques.

Ten-step minimally invasive slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation

BackgroundUnilateral laminotomy for bilateral decompression (ULBD) is a MIS surgical technique that offers safe and effective decompression of lumbar spinal stenosis (LSS) with a long-term resolution of symptoms. Advantages over conventional open laminectomy include reduced expected blood loss, muscle damage, mechanical instability, and less postoperative pain. The slalom technique combined with navigation is used in multi-segmental LSS to improve the workflow and effectiveness of the procedure.MethodsWe outline ten technical steps to achieve a slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation. In a retrospective case series, we included patients with multi-segmental LSS operated in our institution using the sULBD between 2020 and 2022. The primary outcome was a reduction in pain measured by Visual Analogue Scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI).ResultsIn our case series (N = 7), all patients reported resolution of initial symptoms on an average follow-up of 20.71 ± 9 months. The average operative time and length of hospital stay were 196.14 min and 1.67 days, respectively. On average, VAS (back pain) was 4.71 pre-operatively and 1.50 on long-term follow-up of an average of 19.05 months. VAS (leg pain) decreased from 4.33 to 1.21. ODI was reported as 33% pre-operatively and 12% on long-term follow-up.ConclusionThe sULBD with navigation is a safe and effective MIS surgical procedure and achieves the resolution of symptoms in patients presenting with multi-segmental LSS. Herein, we demonstrate the ten key steps required to perform the sULBD technique. Compared to the standard sULBD technique, the incorporation of navigation provides anatomic localization without exposure to radiation to staff for a higher safety profile along with a fast and efficient workflow.

Consecutive Case Series of Uniportal Full-endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: Relationship between Decompression Range and Functional Outcomes.

Uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE-ULBD for single-segment LSS and to explore the relationship between the decompression range and functional outcomes. Single-segment LSS patients who had undergone UFE-ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc-flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross-sectional area (DSCA), were collected. The independent sample t-tests, paired sample t-tests, chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses were used. Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow-up period was 12 months. At the last follow-up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent-good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm2 (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria. UFE-ULBD can provide satisfactory clinical and radiological outcomes in single-segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE-ULBD.

Application of Unilateral Double-Channel Endoscopic Lamina Fenestration Decompression in Lumbar Spinal Stenosis

Objective: This paper aims to observe and explore the application effect of unilateral double-channel endoscopic lamina fenestration decompression in the clinical treatment of patients with lumbar spinal stenosis. Methods: The study period is from January 2020 to December 2022, 60 patients with lumbar spinal stenosis were recruited and divided into the control group (traditional interlaminar fenestration) and the study group (unilateral double-channel endoscopic lamina fenestration decompression) according to the method of coin tossing, with 30 cases in each group. The operation time, perioperative blood loss, incision diameter, total hospitalization time, postoperative complications, Japanese Orthopedic Association (JOA), Numerical Rating Scale (NRS) pain score, and excellent rate of lumbar recovery were compared. Results: The operation time of the study group was longer than that of the control group, the amount of perioperative blood loss was lower than that of the control group, the incision diameter was smaller than that of the control group, and the total hospitalization time was shorter than that of the control group (P &lt; 0.05). Postoperative complications such as dural tear, cerebrospinal fluid leakage, infection, and paravertebral muscle injury in the study group were less than those in the control group (P &lt; 0.05). The JOA score of the study group was higher than that of the control group, and the NRS score was lower than that of the control group 6 months after operation (P &lt; 0.05). The operation effect was evaluated according to the modified MacNab standard 6 months after operation, and the excellent rate of lumbar spine recovery in the study group was higher than that in the control group (P &lt; 0.05). Conclusion: Unilateral double-channel endoscopic fenestration decompression of the lamina has a definite application effect, it can significantly reduce postoperative complications of lumbar spinal stenosis, and promote the recovery of lumbar spine function. It has the advantages of mild pain, high safety, less bleeding, small incision, and other advantages, which can be recommended in the treatment of lumbar spinal stenosis.

Associations between future health expectations and patient satisfaction after lumbar spine surgery: a longitudinal observational study of 9929 lumbar spine surgery procedures

ObjectiveThis study aimed to investigate the associations between general health expectations and patient satisfaction with treatment for the two common spine surgery procedures diskectomy for lumbar disk herniation (LDH) and...