Single-level Stenosis Research Articles

Do patients with lumbar spinal stenosis benefit from decompression of levels with adjacent moderate stenosis? A prospective cohort study from the NORDSTEN study

BackgroundLumbar spinal stenosis (LSS) is characterized by pain that radiates to the buttocks and/or legs, aggravated by walking and relieved by forward flexion. There is poor correlation between clinical symptoms and severity of stenosis on MRI, and multilevel stenosis has not been described to present worse symptoms or treatment outcomes, compared with patients with single-level stenosis. In patients with one level with severe stenosis combined with an adjacent level with moderate stenosis, the surgeon must decide whether to decompress only the narrowest level or both, to achieve the best possible outcome. The potential benefits of performing surgery on an adjacent moderate stenosis is debated, and the scientific evidence in scarce. PurposeThe aim of the present study was to investigate whether patients with a level of adjacent moderate stenosis, along with an index stenosis, benefitted from a dual-level decompression (DLD) compared with a single-level decompression (SLD). Furthermore, to investigate whether DLD patients had longer duration of surgery and hospital stay, higher rates of complications and/or lower rate of reoperations compared with SLD patients. Study designProspective cohort study. Patient sampleWe analyzed data from the Norwegian Degenerative Spondylisthesis and Spinal Stenosis study- Spinal Stenosis Trial (NORDSTEN-SST). In this randomized multicenter study, 437 patients were included, evaluating clinical outcomes of three different surgical treatment options for LSS. Patients with degenerative spondylolisthesis were excluded. MethodBased on preoperative MRI, the present analysis included all patients who had a moderate stenosis (defined as Schizas B or C) in addition to a predefined index stenosis (the level with the smallest cross-sectional area). We compared patients who, based on the surgeons` choice, received a dual-level decompression, with those receiving a single-level decompression. Outcome measuresThe primary outcome was mean change in the Oswestry Disability Index (ODI) score from baseline to 2-year follow up. Secondary outcomes were proportion of success (30% reduction in ODI score), the Numeric Rating Scales for back and leg pain (NRS), the EuroQol 5-dimensional questionnaire utility index (EQ-5D), the Zurich Claudication Questionnaire (ZCQ), the Global Perceived Effect (GPE)-scale, duration of surgery, duration of hospital stay, perioperative complications and reoperation rates. ResultsAmong the 222 patients, included in the analysis, 108 underwent DLD and 114 underwent SLD. There was no difference in change scores for any of the investigated patient-reported outcomes between the groups after 2 years. However, the DLD group had longer duration of surgery and longer length of hospital stay. There was no difference in reoperation rates or perioperative complications. ConclusionThis study, alongside the NORDSTEN-LSS trial on patients with adjacent moderate stenosis as well as an index stenosis, showed no superior clinical effectiveness for dual-level surgery compared with single-level surgery.

Congenital Stenosis of the Spine—A Cross-Sectional Study of 1019 Whole-Spine Computed Tomography Scans to Determine Prevalence and Association Among Multilevel, Tandem, and Triple Region Stenosis

BackgoundPatients with Congenital stenosis of the spine (CSS) present with clinical symptoms at an early age, and with fewer degenerative hypertrophic changes than the more common degenerative cohort. Literature is lacking in the true prevalence of CSS affecting the three segments of the spine in isolation as well as in tandem in the Indian sub-continent. MethodsAnteroposterior spinal canal diameter in axial plane CT at the mid-vertebral level was measured in asymptomatic patients with whole spine CT. Spinal canal stenosis was defined as a diameter of less than 12 mm for the cervical region, less than 12 mm for the thoracic region, and less than 13 mm for the lumbar region. Single-level and multilevel stenosis as well as tandem and triple-region stenosis were evaluated. ResultsThe results show the prevalence of CSS as 16.6%, 11.5%, and 20.1% involving the cervical, thoracic, and lumbar spine respectively. Single-level stenosis affected 90.6%, 94%, and 79.8% of the patients with cervical, thoracic, and lumbar CSS respectively. Tandem stenosis affected 10.4% of the population (n=104), with cervicolumbar stenosis being the most prevalent (n=51, 5%). The presence of CSS in any one segment of the spine was significantly associated with the presence of stenosis at one of the other segments (p<0.05). Triple-region stenosis was seen in 0.3%(n=3) patients. ConclusionThe prevalence of cervical, thoracic, lumbar and tandem stenosis from our study is established at 16.6%, 11.5%, 20.1%, and 10.4%. Additionally, our study demonstrates the association between stenosis of the different regions of the spine.

Lumbar fusion through the anterolateral mini-approach: comparison of anterior interbody (OLIF-AF) and percutaneous pedicle (OLIF-PF) fixations in the surgical treatment of single-level stenosis

Objective. To perform comparative analysis of the clinical efficacy and safety of indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach (OLIF) with anterolateral (OLIF-AF) and posterior percutaneous (OLIF-PF) screw fixations in the surgical treatment of single-segment lumbar stenosis.Material and Methods. A retrospective comparative analysis of treatment of 88 patients aged 29 to 72 years with single-level lumbar stenosis was carried out. Posterior instrumental fixation (OLIF-PF) was performed in 60 cases, and anterolateral (OLIF-AF) – in 28.Results. The compared groups did not statistically significantly differ from each other in terms of age, gender, body mass index, clinical picture and duration of symptoms before surgery, assessment of neurological status according to the Zurich Claudication Questionnaire (ZCQ), preoperative diagnosis, localization of stenosis, pain assessment in the back and leg before surgery according to a digital rating scale, physical status (ASA), health assessment (SF-12, ODI), follow-up period, as well as smoking and the presence of comorbidities (p &gt; 0.05). In the OLIF-AF group, compared to the OLIF-PF group, a statistically significant advantage was found in terms of blood loss, duration of surgery and anesthesia, the level of radiological exposure, duration of patient’s hospitalization and hospital stay in the postoperative period, as well as the duration of antibiotic prophylaxis and intraoperative volume of infusions (p &lt; 0.05). Despite earlier discharge and less use of local anesthesia (35.7 % vs 73.3 %; p = 0.001), patients in the OLIF-AF group had statistically significantly lower level of back pain on the day of discharge (3.0 vs 3.5; p = 0.034) and were less likely to need opioids (3.6 % vs 31.7 %; p = 0.003). With regard to complications and adverse events, there were no statistically significant differences during dynamic follow-up period from 3 to 50 months in both groups (17.9 % vs 28.3 %; p = 0.290), including depending on the timing of complications (early or late). In addition, no statistically significant differences were found for neurological, infectious, gastrointestinal, urological, or implant-related complications (p &gt; 0.05).Conclusions. Indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach in combination with OLIF-AF is an effective and safe technique for the surgical treatment of single-segment lumbar stenosis. This method allows to reduce the invasiveness of surgery and severity of the pain syndrome and to create conditions for enhanced recovery after surgery. Further multicenter randomized trials are needed to comprehensively evaluate long-term outcomes.

When does CT myelography add value beyond MRI for lumbar degenerative disease?

Background ContextIn patients with lumbar spinal stenosis, it is crucial for clinicians to identify all symptomatic levels. Prior studies have demonstrated that CT myelography has a greater sensitivity in revealing stenosis (94.4%) compared to MRI (75.9%). However, this is an invasive test that should be used judiciously. No study has identified subgroups of patients that do or do not benefit from this additional invasive testing. PurposeThe objective of this study was to identify subgroups of patients with lumbar stenosis for whom CT myelogram could be expected to provide additional information following an MRI scan. Study DesignRetrospective chart review. Patient SampleConsecutive series of patients with lumbar degenerative disease seen at a single multisurgeon tertiary spine center. Outcome measuresDegree of stenosis on MRI or CT myelo. MethodsMedical records were reviewed to collect standard demographic and surgical data and patient diagnoses. MRI and CT myelo obtained within 6 months of each other in patients >45 years old with a diagnosis of central stenosis, spondylolisthesis or degenerative scoliosis were reviewed. Each lumbar level was recorded as mild, moderate, or severe based on the radiologist's report. Fisher exact test was performed with change in recorded severity of stenosis from MRI to CT myelo as the primary outcome of interest. ResultsOf 269 patients, 207 (80%) had at least one level of moderate or severe central stenosis on MRI and 62 had mild or no stenosis on MRI. Of the 207, 139 (67%) had multilevel stenosis and 68 (33%) had single level stenosis. CT myelo identified a greater proportion of additional stenotic levels in patients with multilevel stenosis (80/139, 58%) compared to patients with single-level stenosis (27/68, 40%, p=.018). In 62 patients with a clinical diagnosis of lumbar stenosis but no moderate to severe stenosis on MRI, CT myelogram identified three additional stenotic levels (3/65, 5%, p=.836). ConclusionSCT myelography is not as useful in providing additional information in patients with no stenosis or single level stenosis as compared to patients with multilevel stenosis.

144. Recognizing patients in whom CT-myelography detects additional level of stenosis compared to MRI

<h3>BACKGROUND CONTEXT</h3> In patients with lumbar spinal stenosis, it is crucial for clinicians to identify all symptomatic levels. Prior studies have demonstrated that CT-myelography has a greater sensitivity in revealing stenosis (94.4%) compared to MRI (75.9%). CT-myelograms demonstrate weight-bearing changes as opposed to single position and single time point changes on MRI. However, CT-myelography is invasive, requiring injection of contrast dye into the thecal sac. <h3>PURPOSE</h3> The purpose of this study is to identify patients in whom additional levels of stenosis are likely to be recognized by a CT-myelogram following an MRI scan. <h3>STUDY DESIGN/SETTING</h3> Retrospective observational cohort at a single multi-surgeon spine center. <h3>PATIENT SAMPLE</h3> Patients ≥45 years old who had an MRI followed by a CT-myelogram within 6 months with a diagnosis of stenosis, spondylolisthesis, or degenerative scoliosis. <h3>OUTCOME MEASURES</h3> Additional levels of moderate to severe stenosis identified on CT-myelogram vs MRI. <h3>METHODS</h3> Medical records were reviewed to collect standard demographic and surgical data and to note if patients were deemed to have single-level or multi-level stenosis clinically. MRIs and CT-Myelograms obtained within six months of each other were reviewed and each lumbar level was recorded as mild, moderate, or severe based on the radiologist's report. Fisher's exact test was performed with change in recorded level of stenosis from MRI to CT-Myelogram as the primary outcome of interest. <h3>Results</h3> Of 207 patients, 139 (67%) had clinically reported multilevel stenosis and 68 (33%) had single-level stenosis. CT-Myelogram identified a greater proportion of additional stenotic levels in patients with clinically reported multilevel stenosis (80/139, 58%) compared to patients with single-level stenosis (27/68, 40%, p=0.018). When classifying patients based on MRI findings of stenosis instead of clinical diagnosis, 90 (43%) patients had multi-level stenosis, and 117 (56%) had single-level stenosis. In patients with radiologist-reported multilevel stenosis, CT-myelogram also identified a greater proportion of additional stenotic levels (55/90, 61%) compared to patients with radiologist-reported single level stenosis (52/117, 44%, p=0.025). <h3>Conclusions</h3> CT myelography is significantly more likely to provide valuable additional information in patients with multilevel stenosis as compared to patients with single level stenosis. This finding was consistent regardless of whether the distinction of single-level or multilevel stenosis was determined by clinical diagnosis or based solely off the MRI report. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Functional outcome of lumbar spine disorders treated with laminectomy

Patients with multiple levels of stenosis had somewhat less severe pain at baseline on the SF-36 bodily pain scale compared to one and two levels. Patients with single level stenosis were less likely to present with neurogenic claudication (p

"A decade with micro-tubular decompression": Peri-operative complications and surgical outcomes in single and multilevel lumbar canal stenosis.

We present tenyears experience with micro-tubular decompression (MTD) performed for single and multilevel lumbar canal stenosis (LCS) assessing the peri-operative complications and mid-term surgical outcome. The aims of this study were to review the incidence of peri-operative complications and classification of complications and define risk factors to prevent it while negotiating the learning curve. A retrospective review of prospectively collected data over a period of tenyears involving 625 patients who underwent single/multilevel lumbar MTD. Peri-operative clinical-radiological parameters, post-operative complications, clinical outcome (VAS and ODI), and satisfactory outcomes in the form of Wang and Bohlmann's criteria were evaluated. The peri-operative complications were divided into five broad categories based on their time of occurrence, severity, and system affected. The comparison between the patients with and without complications was done to evaluate the causative risk factors. The overall incidence of the peri-operative complication was 12.96% over tenyears with higher rate (29.8%) during the initial threeyears of practice and lower rate (8.78%) in the last seven years. The most common peri-operative complications were urinary tract infections (UTI). The risk factors for complications with MTD revealed in statistical analysis were presence of one or more comorbidities, L4-L5 single-level stenosis, bilateral stenosis with ipsilateral and bilateral decompression done through unilateral approach, and multilevel MTD done through single incision for multilevel LCS. More than 95% patients operated with MTD showed excellent to good outcome as per the Wang and Bohlmann's criteria at the final follow-up. This study represents 12.96% overall incidence of peri-operative complications with higher rate (29.8%) during the initial threeyears of practice and lower rate (8.78%) in the last sevenyears with MTD for single/multilevel LCS with. MTD is an effective procedure with substantial clinical benefits in the form of excellent to good clinico-radiological outcomes at twoyear follow-up. However, there is a learning curve associated with the adoption of the technique. The described classification for peri-operative complications is helpful to record, to evaluate, and to understand the aetiology and risk factors based on its duration of occurrence in the peri-operative period.

Outcome of decompressive operative procedure in the treatment of degenerative lumbar spinal canal stenosis: experience of managing consecutive 25 cases

Background: Lumbar spinal canal stenosis (LSCS) is a common medical disorder due to degenerative changesin the middle age and older individual. In this condition, narrowing of lumbar spinal canal and nerve rootcanal leads to painful, debilitating compression of spinal nerves and blood vessels. Decompressive surgery inlumbar spinal canal stenosis is one of modern methods of treatment.The objective of this study was to evaluate the outcome of decompressive operative management in degenerativelumbar spinal canal stenosis.&#x0D; Methods: Thiswas a prospective interventional study carried out at National Institute of Traumatology andOrthopaedic Rehabilitation (NITOR) and City Hospital, Lalmatia, Dhaka from October 2012 to December2014.Total number of patients were 25 who underwent decompressive surgical procedures. Each of patientswas evaluated by the visual analogue scale (VAS) for pain, disability by using Oswestry disability index (ODI)and ModifiedMacnab Criteria (MMC)for assessment of improvement.&#x0D; Results: This was a prospective interventional study carried out at National Institute Of Traumatology and OrthopaedicRehabilitation (NITOR) and City hospital, Lalmatia, Dhaka from October 2012 to December 2014. Out of 25patients, 19 patients(76%)were male and 6 patients (24%) were female, age ranged from 38-65 years with the meanage 48.50 ± 8.65 years. Sixteen (64%) patients were manual worker and 9 patients (36%) were sedentary worker.Sixteen (64%) patients had multilevel stenosis and 9 patients (36%) had single level stenosis. The mean follow upduration was 1.5 years (range: 1-3 years). Mean estimated blood loss was 150ml (range : 100-200ml), meansurgery time was 130mutes (range: 80-180min) and average hospital stay was 7 days (range: 4-10 days). Only 1patient (4%) had discitis, 1 patient (4%) had superficial wound infection and 1 patient (4%) had dural tear. AsMMC, 21 (84%) patients was poor before operation and after operation at 12 months follow up 8 patients (32%)had excellent, 12 patients (48%) had good, 4 patients (16%) had fair and 1 patient (4%) had poor functionaloutcome. Mean (SD) ODI were 75.40 (± 5.01) before operation and reduced to 8.36 (± 13.54) after operation at 3rd(12 month) follow up. Mean (SD) VAS was 7.12 (± 0.86) before operation and reduced to 1.46 (± 1.31) afteroperation at 3rd (12 month) follow up. Twenty (80%) patients had satisfactory functional outcome.&#x0D; Conclusion: Decompressive operation is an effective, safe and acceptable method of treatment in degenerativelumbar spinal canal stenosis (LSCS).&#x0D; Birdem Med J 2020; 10(2): 103-107

Wednesday, September 26, 2018 10:35 AM – 12:00 PM Understanding Lumbar Stenosis/Spondylolisthesis: 14. Stability-preserving multilevel versus single-level decompression-only surgery for lumbar spinal stenosis: demographic patterns and outcomes

BACKGROUND CONTEXT There has been debate on the stability, and thus clinical outcomes, of multilevel lumbar decompression-only surgeries compared to those undergoing a single-level procedure. In patients with single-level stenosis, laminectomy has long been considered the standard of surgical care, with generally favorable outcomes. However, there has been considerable debate regarding the optimal surgical approach for patients with multi-level spinal stenosis. While the addition of a posterior lumbar fusion has been supported for a number of patient populations (degenerative spondylolisthesis, degenerative scoliosis, pars defects with disc disease, symptomatic baseline instability), the merits of fusion in patients with only multi-level stenosis is still debated. PURPOSE The goal of this study was to compare patient outcomes following a multi-level versus a single-level stability-preserving decompression-only surgery for lumbar spinal stenosis. STUDY DESIGN/SETTING Retrospective cohort series. PATIENT SAMPLE We performed a retrospective cohort analysis of patients who underwent a primary lumbar laminectomy between 2009 and 2015 by one of two senior orthopedic spine surgeons for lumbar spinal stenosis. Patients were excluded from analysis if they had any previous lumbar surgery, an unstable spondylolisthesis, were under 18 years of age at the time of surgery, or had postoperative follow-up less than 3 months. Patients were divided into three groups based on the number of decompression levels: single-level, two-level, or three or more levels. OUTCOME MEASURES Patient reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and the Veterans Rand 12-Item Health Mental and Physical Survey (VR-12) scores. METHODS Baseline patient characteristics were compared using chi-squared analysis and independent sample t tests for categorical and continuous data, respectively. Bivariate and multivariate regressions were subsequently used to compare clinical outcomes between procedure groups. Multivariate analyses controlled for differences in baseline patient characteristics. RESULTS Overall, 212 consecutive patients who fulfilled our inclusion criteria were assessed. Average follow-up was 24.14 months (range 3-78 months). There were 106 patients who underwent a single-level, 74 patients underwent a two-level, and 32 patients underwent a three- or more level laminectomy. The multi-level decompression patients were significantly older (3+ levels 67.9±8.7 years, 2-level 56.4±14.7 years, single-level 48.7±16.4 years; p CONCLUSIONS Patients undergoing decompression of three or more levels present with similar postoperative outcomes to those who undergo a single-level decompression for lumbar spinal stenosis. Despite concerns for instability following a multi-level decompression, re-operation rates are low and not significantly different when comparing the number of levels that underwent a stability-preserving lumbar decompression. Under specific clinical and radiographic criteria, a multi-level decompression of three or more levels appears to be a safe and effective procedure with acceptable outcomes at 2 years after surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Multilevel cervical laminectomy and fusion with posterior cervical cages.

Context:Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of significant spinal stenosis. Three-level anterior decompression and fusion are associated with higher nonunion rates and prolonged dysphagia. Posterior multilevel laminectomies with foraminotomies jeopardize the bone stock required for stable fixation with lateral mass screws (LMSs).Aims:This is the first case series of multilevel laminectomy and fusion for CSM instrumented with posterior cervical cages.Settings and Design:Three patients presented with a history of worsening neck pain, numbness in bilateral upper extremities and gait disturbance, and examination findings consistent with myeloradiculopathy. Cervical magnetic resonance imaging demonstrated multilevel spondylosis resulting in moderate to severe bilateral foraminal stenosis at three cervical levels.Materials and Methods:The patients underwent a multilevel posterior cervical laminectomy and instrumented fusion with intervertebral cages placed between bilateral facet joints over three levels. Oswestry disability index and visual analog scores were collected preoperatively and at each follow-up. Pre- and post-operative images were analyzed for changes in cervical alignment and presence of arthrodesis.Results:Postoperatively, all patients showed marked improvement in neurological symptoms and neck pain. They had full resolution of radicular symptoms by 6 weeks postoperatively. At 12-month follow-up, they demonstrated solid arthrodesis on X-rays and computed tomography scan.Conclusions:Posterior cervical cages may be an alternative option to LMSs in multilevel cervical laminectomy and fusion for cervical spondylotic myeloradiculopathy.

Interspinous Distraction in Lumbar Spinal Stenosis

Prospective neurophysiological study. To identify and quantify the neurophysiological effects of interspinous distraction during spine surgery for lumbar spinal stenosis (LSS). Interspinous devices have been introduced as an alternative treatment of LSS in selected patients aiming at obtaining indirect decompression. Nevertheless, there is no data on the immediate neurophysiological effect of distraction. Thirty patients with LSS undergoing decompression (14 at single level, 16 at multiple levels) were enrolled, resulting in a total of 48 levels to be analyzed. Before decompression, calibrated incremental distraction simulating interspinous device implantation of 8, 10, 12, 14, and 16 mm was performed. Intraoperative motor evoked potentials were acquired before any distraction, during distraction at each incremental value and after bilateral decompression. We evaluated relative changes of motor evoked potentials normalized to hand muscles and related them to the number of affected levels, LSS radiological severity based on the A to D grading, lordosis, and disc height. For single-level disease, 8-mm distraction and open decompression yielded similar improvement in motor evoked potentials not only in levels with morphological grades A or B, but also in levels with morphological grades C or D (i.e., severe or extreme stenosis) (P = 0.32). In contrast, distraction superior to 8 mm was less effective (P ≤ 0.05). In multiple-level stenosis, decompression was significantly more effective than any degree of distraction (P < 0.001). No correlation of those results to disc height or lordosis was observed. Using χ trend test to analyze the effect of distraction, a linear trend favoring moderate over severe stenotic morphology was observed (P = 0.0349). Interspinous distraction of 8 mm is sufficient to replicate electrophysiological improvements obtained during full decompression even in severe single-level stenosis but not in multilevel disease. Interspinous distraction has therefore an immediately measurable neurophysiological effect. 4.

Clinical Outcomes and Predictive Factors Relating to Prognosis of Conservative and Surgical Treatments for Cervical Spondylotic Amyotrophy

Retrospective clinical analyses of patients with cervical spondylotic amyotrophy (CSA). To report the clinical outcomes and predictive factors relating to the prognosis in conservative and surgical treatments for CSA. CSA is a clinical entity characterized by muscle atrophy in the upper extremity without marked sensory disturbance or spastic tetraparesis. The indications for, and outcomes of conservative and surgical treatments for CSA have not been clearly enunciated. Ninety patients with CSA were enrolled in this study. All of them initially received continuous cervical traction for 2 to 3 weeks as inpatients. If this conservative treatment was ineffective, surgical intervention was carried out after informed consent was obtained. We investigated the outcome of conservative treatment, the predictive factors relating to the prognosis of the conservative treatment, and the outcome of surgery after initial conservative treatment failed. After initial conservative treatment, 42 patients (46.7%) showed excellent or good outcome, 29 patients underwent surgery, and 19 patients declined surgery. Consequently, 61 patients were conservatively followed up. At final follow-up, 40% of the patients still showed excellent or good neurologic status by conservative treatment, and this group was characterized by age <50 years, duration of symptoms <6 months, single-level stenosis, foraminal stenosis, and a good response to traction therapy. Additional 5 patients underwent surgery during follow-up because of deterioration of symptom, and 34 patients consequently underwent surgery at the final follow-up. Of 34, 28 (82%) patients who underwent surgery obtained neurologic improvement. The present study has demonstrated the outcome of conservative and of surgical treatments for CSA, together with the predictive factors relating to the prognosis. Conservative treatment should be initially tried on CSA patients, especially those with predictive factors relating to a better prognosis. However, if conservative treatment failed, surgical intervention was successful.

Correlation between disability and MRI findings in lumbar spinal stenosis

Background and purpose MRI is the modality of choice when diagnosing spinal stenosis but it also shows that stenosis is prevalent in asymptomatic subjects over 60. The relationship between preoperative health-related quality of life, functional status, leg and back pain, and the objectively measured dural sac area in single and multilevel stenosis is unknown. We assessed this relationship in a prospective study.Patients and methods The cohort included 109 consecutive patients with central spinal stenosis operated on with decompressive laminectomy or laminotomy. Preoperatively, all patients completed the questionnaires for EQ-5D, SF-36, Oswestry disability index (ODI), estimated walking distance and leg and back pain (VAS). The cross-sectional area of the dural sac was measured at relevant disc levels in mm2, and spondylolisthesis was measured in mm. For comparison, the area of the most narrow level, the number of levels with dural sac area < 70 mm2, and spondylolisthesis were studied.Results Before surgery, patients with central spinal stenosis had low HRLQoL and functional status, and high pain levels. Patients with multilevel stenosis had better general health (p = 0.04) and less leg and back pain despite having smaller dural sac area than patients with single-level stenosis. There was a poor correlation between walking distance, ODI, the SF-36, EQ-5D, and leg and back pain levels on the one hand and dural sac area on the other. Women more often had multilevel spinal stenosis (p = 0.05) and spondylolisthesis (p < 0.001). Spondylolisthetic patients more often had small dural sac area (p = 0.04) and multilevel stenosis (p = 0.06).Interpretation Our findings indicate that HRQoL, function, and pain measured preoperatively correlate with morphological changes on MRI to a limited extent.

Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression

Surgical decompression is the recommended treatment in patients with moderate to severe degenerative lumbar spinal stenosis (DLSS) in whom symptoms do not respond to conservative therapy. Multilevel disease, poor patient health, and advanced age are generally considered predictors of a poor outcome after surgery, essentially because of a surgical technique that has always been considered invasive and prone to causing postoperative instability. The authors present a minimally invasive surgical technique performed using a unilateral approach for lumbar decompression. A retrospective study was conducted of data obtained in a consecutive series of 473 patients treated with unilateral microdecompression for DLSS over a 5-year period (2000-2004). Clinical outcome was measured using the Prolo Economic and Functional Scale and the visual analog scale (VAS). Radiological follow-up included dynamic x-ray films of the lumbar spine and, in some cases, computed tomography scans. Follow-up was completed in 374 (79.1%) of 473 patients--183 men and 191 women. A total of 520 levels were decompressed: 285 patients (76.2%) presented with single-level stenosis, 86 (22.9%) with two-level stenosis, and three (0.9%) with three-level stenosis. Three hundred twenty-nine patients (87.9%) experienced a clinical benefit, which was defined as neurological improvement in VAS and Prolo Scale scores. Only three patients (0.8%) reported suffering segmental instability at a treated level, but none required surgical stabilization, and all were successfully treated conservatively. Evaluation of the results indicates that unilateral microdecompression of the lumbar spine offers a significant improvement for patients with DLSS, with a lower rate of complications.

Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression

Object Surgical decompression is the recommended treatment in patients with moderate to severe degenerative lumbar spinal stenosis (DLSS) in whom symptoms do not respond to conservative therapy. Multilevel disease, poor patient health, and advanced age are generally considered predictors of a poor outcome after surgery, essentially because of a surgical technique that has always been considered invasive and prone to causing postoperative instability. The authors present a minimally invasive surgical technique performed using a unilateral approach for lumbar decompression. Methods A retrospective study was conducted of data obtained in a consecutive series of 473 patients treated with unilateral microdecompression for DLSS over a 5-year period (2000–2004). Clinical outcome was measured using the Prolo Economic and Functional Scale and the visual analog scale (VAS). Radiological follow-up included dynamic x-ray films of the lumbar spine and, in some cases, computed tomography scans. Results Follow-up was completed in 374 (79.1%) of 473 patients—183 men and 191 women. A total of 520 levels were decompressed: 285 patients (76.2%) presented with single-level stenosis, 86 (22.9%) with two-level stenosis, and three (0.9%) with three-level stenosis. Three hundred twenty-nine patients (87.9%) experienced a clinical benefit, which was defined as neurological improvement in VAS and Prolo Scale scores. Only three patients (0.8%) reported suffering segmental instability at a treated level, but none required surgical stabilization, and all were successfully treated conservatively. Conclusions Evaluation of the results indicates that unilateral microdecompression of the lumbar spine offers a significant improvement for patients with DLSS, with a lower rate of complications.

A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication.

The relationship between objective measurements and subjective symptoms of patients with spinal stenosis and the degree of narrowing of the spinal canal is not clear. The purpose of this study was to evaluate patients undergoing surgery for lumbar spinal stenosis and intermittent neurogenic claudication with functional testing, quantitative imaging, and patient self-assessment. Sixty-two patients with lumbar spinal stenosis and neurogenic claudication were prospectively enrolled in the study. All underwent preoperative magnetic resonance imaging and/or computed tomography myelography, and all were treated with decompressive surgery and were followed for a minimum of two years. The evaluation included treadmill and bicycle exercise tests as well as patient self-assessment with use of the Oswestry Disability Index and a visual analog pain scale preoperatively and postoperatively. Preoperatively fifty-eight (94%) of the patients had a positive result (provocation of symptoms) on the treadmill test and twenty-seven (44%) had a positive result on the bicycle test, whereas postoperatively six and twelve, respectively, had positive results. The mean preoperative scores on the Oswestry Disability Index and visual analog pain scale were 58.4 and 7.1, respectively. Postoperatively, these scores decreased to 21.1 and 2.3, respectively, and both decreases were significant (p < 0.05). Forty-seven (76%) of the patients were seen to have central stenosis on the preoperative imaging studies; forty-one of them had a cross-sectional area of the dural tube of <100 mm (2) at at least one level and twelve had a cross-sectional area of <100 mm (2) at at least two levels. A positive treadmill test was consistent with a diagnosis of spinal stenosis and neurogenic claudication in >90% of the patients preoperatively. Following surgical decompression of the lumbar spinal stenosis, more functional improvement was demonstrated by the treadmill test than by the bicycle test. The scores on the Oswestry Disability Index and visual analog pain scale also improved postoperatively. The severity of central canal narrowing at a single level does not appear to limit the postoperative improvement in either functional ability or patient self-assessment. Patients with multilevel central stenosis were, on the average, older and walked a shorter distance preoperatively and postoperatively, although the improvement in their postoperative self-assessment scores was similar to that of patients with single-level stenosis.