Surgery For Spinal Stenosis Research Articles

Clinical outcome following decompression and short or long instrumented fusion in lumbar degenerative spinal stenosis. A prospective case-control analysis

ObjectivesThere is limited data on the direct clinical comparison between short and long fusion following surgery for lumbar spinal stenosis. The hypothesis that regardless their baseline characteristics and morbidity, clinical outcome is similar in patients with lumbar stenosis treated with decompression plus posterior instrumented fusion in one or two versus three to five levels was tested. MethodsSubjects were divided into Group A and Group B corresponding to stenotic pathology and instrumented fusion in one or two levels and three to five levels, respectively. Primary outcome measures at one year were the change in SF-36 physical component (PCS) and Oswestry Disability Index (ODI). Secondary outcome measures included the EuroQol-5D (EQ-5D), the Visual Analog Scale (VAS), the mental component (MCS) of SF-36 scale and the Zung Self-Rating Depression Scale. ResultsSeventy seven (77) patients were included (Group A, n = 42; Group B, n = 35). Patients in Group B were older, surgery lasted longer and intraoperative blood loss was greater than patients in Group A (p < 0.05). A significant clinical improvement was noted in both Groups on all scales (p < 0.01). Clinical outcome at one year was equally favorable in both Groups (p > 0.05). The evaluation of depression for Group A showed a significant improvement at one year (p = 0.02) compared to the preoperative status. ConclusionsOlder individuals are more likely to have multilevel stenosis and more co-morbidities and they were associated with longer instrumentation. However, complications are similar and clinical outcome is equally favorable compared to short instrumented fusion for fewer levels of disease.

Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study

PurposeThe aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain.MethodsThe NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight.ResultsThe percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score.ConclusionIn this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings.Trial registrationwww.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

Improving effect of microendoscopic decompression surgery on low back pain in patients with lumbar spinal stenosis and predictive factors of postoperative residual low back pain: a single-center retrospective study

BackgroundAlthough there are reports on the effectiveness of microendoscopic laminotomy using a spinal endoscope as decompression surgery for lumbar spinal stenosis, predicting the improvement of low back pain (LBP) still poses a challenge, and no clear index has been established. This study aimed to investigate whether microendoscopic laminotomy for lumbar spinal stenosis improves low back pain and determine the preoperative predictors of residual LBP.MethodsIn this single-center retrospective study, we examined 202 consecutive patients who underwent microendoscopic laminotomy for lumbar spinal stenosis with a preoperative visual analog scale (VAS) score for LBP of ≥40 mm. The lumbar spine Japanese Orthopaedic Association (JOA), and VAS scores for LBP, leg pain (LP), and leg numbness (LN) were examined before and at 1 year after surgery. Patients with a 1-year postoperative LBP-VAS of ≥25 mm composed the residual LBP group. The preoperative predictive factors associated with postoperative residual LBP were analyzed.ResultsJOA scores improved from 14.1 preoperatively to 20.2 postoperatively (p < 0.001), LBP-VAS improved from 66.7 to 29.7 mm (p < 0.001), LP-VAS improved from 63.8 to 31.2 mm (p < 0.001), and LN-VAS improved from 63.3 to 34.2 mm (p < 0.001). Ninety-eight patients (48.5%) had a postoperative LBP-VAS of ≥25 mm. Multiple logistic regression analysis revealed that Modic type 1 change (odds ratio [OR], 5.61; 95% confidence interval [CI], 1.68–18.68; p = 0.005), preoperative VAS for LBP ≥ 70 mm (OR, 2.19; 95% CI, 1.17–4.08; p = 0.014), and female sex (OR, 1.98; 95% CI, 1.09–3.89; p = 0.047) were preoperative predictors of residual LBP.ConclusionMicroendoscopic decompression surgery had an ameliorating effect on LBP in lumbar spinal stenosis. Modic type 1 change, preoperative VAS for LBP, and female sex were predictors of postoperative residual LBP, which may be a useful index for surgical procedure selection.

Minimally Invasive versus Open Thoracolumbar Surgery for Lumbar Spinal Stenosis in Patients with Diabetes: A CSORN Study

Introduction: This study was aimed at comparing outcomes of minimally invasive (MIS) versus OPEN surgery for lumbar spinal stenosis (LSS) in patients with diabetes.&#x0D; Methodology: This retrospective cohort study included patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database. Outcomes of MIS and OPEN approaches were compared for two cohorts: (i) patients with diabetes who underwent decompression alone (N = 116; MIS, n = 58, OPEN, n = 58) and (ii) patients with diabetes who underwent decompression with fusion (N = 108; MIS, n = 54, OPEN, n = 54). Mixed measures analyses of covariance compared modified Oswestry Disability Index (mODI) and back and leg pain at one-year post operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at one year were compared.&#x0D; Result: MIS approaches had less blood loss (decompression alone difference 99.66 mL, p = 0.002; with fusion difference 244.23, p &lt; 0.001) and shorter LOS (decompression alone difference 1.15 days, p = 0.008; with fusion difference 1.23 days, p = 0.026). MIS compared to OPEN decompression with fusion had less patients experience an adverse event (difference, 13 patients, p = 0.007). The MIS decompression with fusion group had lower one-year mODI (difference, 14.25, p &lt; 0.001) and back pain (difference, 1.64, p = 0.002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at one year for mODI (MIS 75.9% vs OPEN 53.7%, p = 0.028) and back pain (MIS 85.2% vs OPEN 70.4%, p = 0.017).&#x0D; Conclusion: MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.

Surgery versus nonsurgery for lumbar spinal stenosis: an in-depth analysis of the 2016 Cochrane analysis, the studies included for analysis, and Cochrane methodology.

Lumbar spinal stenosis is a common degenerative condition among the elderly population and a leading cause of morbidity in this age group. A recent Cochrane analysis reviewed the evidence for surgical versus nonsurgical treatment from 5 prospective, randomized controlled studies and concluded that "No clear benefits were observed with surgery versus non-surgical treatment." This is despite the fact that all 5 of the reports analyzed concluded that surgery provided superior outcome compared to nonsurgical therapy. This report analyzes, in detail, the Cochrane analysis of Zaina et al., each of the 5 studies included in the Zaina analysis, and the Cochrane methodology itself. Unlike the ultimate in objectivity sought after by the creators of the Cochrane tool, what is revealed is a remarkably subjective methodology fraught with the potential for bias.

Should Posterior Midline Structures Be Preserved in Decompression Surgery for Lumbar Spinal Stenosis?: A Systematic Review and Meta-analysis.

This was a systematic review and meta-analysis study. The purpose of this study is to evaluate the available evidence on the preservation of posterior midline structures in decompression surgery for lumbar spinal stenosis (LSS). The gold-standard treatment for LSS refractory to conservative management is facet-preserving laminectomy. The question remains whether the midline structures should be preserved in decompression surgery for LSS. We performed a systematic review of the Medline, PubMed, Embase, and Cochrane databases in search of published reports comparing midline structure preservation (MSP) and conventional laminectomy (CL) for LSS. The population was divided into 2 groups: (1) MSP group (intervention) and (2) CL group (control). The various outcome parameters including blood loss, operation time, hospital stay, back and leg pain, functional scores including Oswestry Disability Index (ODI) score, Japanese Orthopedic Association score, and 36-Item Short Form Survey (SF-36) scores, satisfaction, and instability rates were analyzed. Data were extracted and aggregated for meta-analysis. Of the published reports, 16 met our inclusion criteria with an aggregated 540 in the intervention and 538 in the control groups, respectively. The aggregated data demonstrated patients undergoing MSP had significantly decreased back pain Visual Analog Scale compared with CL, regardless of time after surgery ( P =0.007). The MSP group also showed a significantly lower Oswestry Disability Index score and SF-36 Mental Component Summary score ( P =0.005 and 0.03, respectively) and longer 6-month walking distance ( P &lt;0.00001). The patient satisfaction rate was significantly higher in the MSP group ( P =0.02), and the instability rate was significantly lower in the MSP group compared with the CL group ( P &lt;0.0001). At 3 days after surgery, MSP significantly decreased the level of creatinine phosphokinase ( P &lt;0.00001). Regarding intraoperative blood loss, hospital stay, leg pain Visual Analog Scale score, Japanese Orthopedic Association score, and SF-36 Physical Component Summary score, there were no significant differences between the 2 groups. However, MSP showed significantly higher operation time ( P =0.04). We concluded despite heterogenous and limited data, this study suggests that preservation of midline structure leads to less severe back pain, better functional recovery, and satisfaction rate. Meanwhile, it decreases creatinine phosphokinase level and instability rate. Level III-therapeutic.

Long-Term Pain Characteristics and Management Following Minimally Invasive Spinal Decompression and Open Laminectomy and Fusion for Spinal Stenosis.

Background and Objectives: To compare the long-term pain characteristics and its chronic management following minimally invasive spinal (MIS) decompression and open laminectomy with fusion for lumbar stenosis. Materials and Methods: The study cohort included patients with a minimum 5-year postoperative follow-up after undergoing either MIS decompression or laminectomy with fusion for spinal claudication. The primary outcome of interest was chronic back and leg pain intensity. Secondary outcome measures included pain frequency during the day, chronic use of non-opioid analgesics, narcotic medications, medical cannabinoids, and continuous interventional pain treatments. Results: A total of 95 patients with lumbar spinal stenosis underwent one- or two-level surgery for lumbar spinal stenosis between April 2009 and July 2013. Of these, 50 patients underwent MIS decompression and 45 patients underwent open laminectomy with instrumented fusion. In the fusion group, a higher percentage of patients experienced moderate-to-severe back pain with 48% compared to 21.8% of patients in the MIS decompression group (p < 0.01). In contrast, we found no significant difference in the reported leg pain in both groups. In the fusion group, 20% of the patients described their back and leg pain as persistent throughout the day compared to only 2.2% in the MIS decompression group (p < 0.05). A trend toward higher chronic dependence on analgesic medication and repetitive pain clinic treatments was found in the fusion group. Conclusions: MIS decompression for the treatment of degenerative spinal stenosis resulted in decreased long-term back pain and similar leg pain outcomes compared to open laminectomy and instrumented fusion surgery.

Association between Redundant Nerve Root and Clinical Outcome after Fusion for Lumbar Spinal Stenosis

Objective: This study aimed to determine the association between redundant nerve root and clinical outcome after fusion for lumbar spinal stenosis by comparing outcomes in patients with or without redundant nerve root.Methods: A total of 163 patients who underwent spinal fusion surgery between January 1, 2014, and December 31, 2018, were enrolled. Patients were divided into two groups: with a redundant nerve root (R group) and without a redundant nerve root (N group). The clinical outcome of the two groups was compared using VAS and claudication distance.Results: A total of 46 patients had a redundant nerve root, while the remaining 117 did not. Symptom duration was significantly different between the two groups (R=41.0±25.0, N=24.1±12.2, p&lt;0.001). Changes in the VAS score for lower extremity pain between the two groups at 1 year after surgery showed that patients without a redundant nerve root had significantly better outcomes than those with a redundant nerve root (R: 4.2±1.3 vs. N: 5.5±1.4; p&lt;0.001). Conclusion: Redundant nerve root on MRI is associated with clinical outcome after fusion for lumbar spinal stenosis. Patients with a redundant nerve root had poor outcomes after fusion surgery for lumbar spinal stenosis than those without a redundant nerve root.

339 The Glasgow Lumbar Spinal Stenosis Scale: An Individualised Measurement Formula for the Radiological Assessment of Lumbar Spinal Stenosis

Abstract Background Lumbar spinal stenosis (LSS) is a common spinal problem. Currently there is no universally accepted quantitative approach to the radiological measurement of LSS. Quantitative descriptions do exist, but these are unidimensional and do not consider normal variation in anatomy. We propose a universal and individualised measurement system for the quantitative radiological assessment of lumbar spinal stenosis. Method A retrospective case series of patients who had undergone surgery for symptomatic lumbar spinal stenosis over a 3-year period. Pre-operative T2 weighted lumbar spine MRI were analysed. Each patient had the degree of lumbar canal stenosis quantified using our approach. Results Our novel formula for the quantitative radiological assessment of LSS is two dimensional, repeatable, and presented as a percentage, to correct for the individual patient. The surface area of the canal at the level of stenosis is measured (mm2). The adjacent 2 levels are then measured and averaged. The calculation becomes (A-S/A) x 100 = R, where S is the canal surface area at the stenosed level, A is the average canal surface area of the two levels adjacent to the level of interest and R is the relative degree of lumbar spinal canal stenosis expressed as a percentage. Conclusions This novel quantitative measurement formula for the radiological assessment of lumbar canal spinal stenosis is quick and simple to calculate and most importantly adjusts for the individual patient’s normal or degenerative anatomy. This new measurement tool will need validation against specific clinical and operative criteria in the future.

Trans-Sacral Epiduroscopic Ho:YAG Laser Ablation of the Ligamentum Flavum in a Live Pig.

Introduction For the aging population, surgery for lumbar spinal canal stenosis (LSCS) requires minimally invasive procedures. Recently, trans-sacral epiduroscopic laser decompression for lumbar disc herniation has been reported with good results. In this study, we devised a new method to perform trans-sacral epiduroscopic laser ablation of the ligamentum flavum (LF), known to be the major cause of LSCS. Using a live pig, this study aims to evaluate the efficacy, safety, and drawbacks of this procedure. Methods Using an epiduroscope, we observed intra-spinal canal structures and then examined the feasibility and problems of a decompression procedure to ablate the LF using holmium:YAG (Ho:YAG) laser. The pig was observed for behavioral changes and neurological deficits after the procedure. Histological analysis was performed to evaluate the amount of tissue ablation and damage to surrounding tissues. Results Although it was possible to partially ablate the LF using the Ho:YAG laser under epiduroscopy, it was difficult to maintain a clear field of view, and freely decompressing the target lesion has been a challenge. After the first two experiments, the pig neither showed abnormal behavior nor any signs of pain or paresis. However, in the third experiment, the pig died during the operation. On autopsy, no thermal or mechanical injury was noted around the ablated site, including the dura mater and nerve root. Histological analysis showed that the LF and lamina were deeply ablated as the laser power increased, and no damage was noted on surrounding tissues beyond a depth of 500 μm. Conclusions Although Ho:YAG laser could ablate the ligamentum and bone tissues without causing damage to surrounding tissues, it was difficult to completely decompress the LF under epiduroscopy. This method is a potentially highly invasive procedure that requires caution in its clinical application and needs further improvement in terms of the instruments and techniques used.

Reoperations After Decompression With or Without Fusion for L3-4 Spinal Stenosis With Degenerative Spondylolisthesis: A Study of 372 Patients in Swespine, the National Swedish Spine Register.

Register study with prospectively collected data. The aim was to investigate reoperation rates at the index level and the adjacent levels after surgery for lumbar L3-4 spinal stenosis with concomitant degenerative spondylolisthesis (DS). There are different opinions on how to surgically address lumbar spinal stenosis with DS. The potential benefit of fusion surgery should be weighed against the risks of future reoperations because of adjacent segment degeneration. Data on the reoperation rate at adjacent segments after single level L3-4 fusion surgery are limited. A total of 372 patients, who underwent surgery for lumbar L3-4 spinal stenosis with DS (slip >3 mm) between 2007 and 2012, were followed between 2007 and 2017 to identify reoperations at the index level and adjacent levels. The reoperation rate for decompression and fusion was compared with the reoperation rate for decompression only. Patient-reported outcome measures before and 1 year after surgery were evaluated. The reoperation rate at the index level (L3-4) was 3.5% for decompression and fusion and 5.6% for decompression only. At the cranial adjacent level (L2-3), the corresponding numbers were 6.6% and 4.2%, respectively, and the caudal adjacent level (L4-5), the corresponding numbers were 3.1% and 4.9%, respectively. The effect sizes of change were larger for decompression and fusion compared with decompression only. The effect sizes of change were similar for leg pain and back pain. We could not identify any differences in reoperation rates at the cranial or caudal adjacent segment after decompression and fusion compared with decompression only for L3-4 spinal stenosis with DS. The improvement in back pain is similar to the improvement in leg pain after surgery for L3-4 spinal stenosis with DS.

Facet Joint Opening on Computed Tomography Is a Predictor of Poor Clinical Outcomes After Minimally Invasive Decompression Surgery for Lumbar Spinal Stenosis.

Retrospective longitudinal cohort study. To investigate the impact of facet joint opening (FJO) on clinical outcomes after minimally invasive decompression surgery for lumbar spinal stenosis. Although FJOs have previously been identified as indicators of segmental spinal instability, their impact on clinical outcomes after decompression alone surgery has yet to be investigated. This study included 296 patients from a single institution who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥5 years. Our analysis focused on identifying FJOs at the index decompression level (d-FJO) and at multiple levels (m-FJO) (i.e., ≥3 levels within the lumbar segment) using preoperative computed tomography. Clinical outcomes including reoperations, improvement ratio for Japanese Orthopaedic Association score, and achievement of a minimal clinically important difference in visual analogue scale scores for low back pain or leg pain at 5 years were compared between patients with and without d-FJO or m-FJO. There were 129 (44%) and 62 (21%) patients with d-FJO (more common with lateral olisthesis) and m-FJO (less common with spondylolisthesis), respectively. Reoperations were more common in patients with d-FJO than in those without (16% vs. 5%). On Cox proportional hazards analysis, d-FJO was identified as a predictor for revision at the index decompression level (hazard ratio 4.04, P = 0.03), whereas m-FJO was a predictor for revision at other lumbar levels (hazard ratio 3.71, P = 0.03). Patients with m-FJO had slightly lower rates of achieving minimal clinically important difference in visual analogue scale scores for low back pain (34% vs. 52%, P = 0.03) and poorer improvement ratio for Japanese Orthopaedic Association scores (74% vs. 80%, P = 0.03) than those without. FJO at both index decompression level and multiple level were predictors of poor outcomes; patients with FJOs require careful surgical planning or special follow-up.Level of Evidence: 3.

Patients Undergoing 3-Level-or-Greater Decompression-Only Surgery for Lumbar Spinal Stenosis Have Similar Outcomes to Those Undergoing Single-Level Surgery at 2 Years.

Stability following multilevel decompressive laminectomy without fusion has been debated using in vitro biomechanical and radiographic models. However, there is a lack of information regarding clinical outcomes for these patients. The aim of the present study was to determine the association between clinical outcomes and number of levels decompressed via laminectomy for treatment of lumbar spinal stenosis. We performed a retrospective cohort analysis of patients who underwent a primary lumbar laminectomy between 2009 and 2015 by senior orthopedic spine surgeons for lumbar spinal stenosis. Patients were divided into 2 groups based on the number of decompression levels: single level or 3 or more levels. Patient-reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey scores, and Veterans Rand 12-Item Health Mental and Physical Survey scores. Overall, 138 consecutive patients were assessed, of which 106 underwent a single-level and 32 underwent a 3-or-more-level laminectomy. Average follow-up was 24.2 months. There were no significant differences in the preoperative VAS back, VAS leg, or ODI scores between the single-level laminectomy and 3-or-more-level laminectomy groups. Both groups of patients experienced significant improvements in these clinical outcomes postoperatively with no clinically significant difference in the degree of improvement. Reoperation rates were low and similar between the 2 groups. Patients undergoing decompression of 3 or more levels present with similar postoperative outcomes to those who undergo a single-level decompression for lumbar spinal stenosis. Under specific clinical and radiographic criteria, a multilevel decompression of 3 or more levels may be a safe and effective procedure with acceptable outcomes at 2 years after surgery. 3.

Alleviating Paravertebral Muscle Spasm after Radiofrequency Ablation Treatment of Hypersensitive Basivertebral and Sinuvertebral Nerves for Chronic Discogenic Back Pain

Paraspinal muscle spasm caused by pain from a lumbar degenerative disc is frequently investigated in patients with low back pain. Radiofrequency ablation (RFA) surgery could alleviate paraspinal muscle spasms. We performed RFA surgery on the high-intensity zone (HIZ) and hypersensitive sinuvertebral and basivertebral nerves to evaluate its outcome. The paravertebral muscle cross-sectional area (CSA) was measured on magnetic resonance imaging (MRI) before and after surgery to evaluate the effect of RFA surgery on the paravertebral muscle. Prospective cohort study. A single spine surgery center. A comparative study was performed on 2 different uniportal spinal endoscopic surgery groups; 23 patients who underwent RFA surgery for chronic discogenic back pain and 45 patients who underwent posterior decompression surgery for lumbar spinal stenosis with 12 months of follow-up. Paravertebral muscle cross-sectional area, Schiza grade, Modic type, and HIZ size were measured on pre- and post-operative MRI. An endoscopic video review was performed to evaluate the presence of intraoperative twitching and grade the degree of epidural neovascularization and adhesion. Visual analog scale VAS, modified Oswestry Disability Index, ODI and MacNab's criteria were evaluated for outcome measures. Intraoperative endoscopic video evaluation showed neovascularization and adhesion adjacent to the disc and pedicle. In the RFA surgery group, there were 7 patients (30.43%) with grade 2 and 16 (69.57%) with grade 3 neovascularization; intraoperative twitching was observed in 19 out of 23 patients (82.61%). After performing an RFA on the sinuvertebral and basivertebral nerves for the treatment of discogenic back pain, the results showed significant improvement in pain and disability scores. The mean CSA of the paraspinal muscle in the RFA surgery group was significantly increased after surgery at the L4-L5 and L5-S1 levels (L4-L5: 3901 ± 1096.7 mm² to 4167 ± 1052.1 mm², P = 0.000; L5-S1: 3059 ± 968.5 mm² to 3323 ± 1046.2 mm², P = 0.000) compared to preoperative CSA. This study was limited by its small sample size. Hypersensitive sinuvertebral and basivertebral nerves are strongly associated with epidural neovascularization with adhesion and the pathological pain pathway in degenerative disc disease. Epidural neovascularization with adhesion reflects aberrant neurological connections, which are associated with reflex inhibitory mechanisms of the multifidus muscle, which induces spasm. RFA treatment of the region of epidural neovascularization with adhesion effectively treated chronic discogenic back pain and could induce paraspinal muscle spasm release.

Impact of leg numbness on patient satisfaction following decompression surgery for lumbar spinal stenosis

Decompression surgery is the most common surgical treatment for lumbar spinal stenosis (LSS). Relatively low satisfaction rate was reported. Patients often complaint of residual numbness despite significant pain relief. We hypothesized that numbness had a significant impact on patient satisfaction, but had not been evaluated, which is associated with low satisfaction rate. This study aimed to examine how much numbness is associated with patient satisfaction.We retrospectively reviewed prospectively collected data from consecutive patients who underwent decompression without fusion for LSS. We evaluated the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness preoperatively and at the final follow-up visit. Improvement was evaluated using minimum clinically important differences (MCIDs). Patient satisfaction was evaluated using the question, “How satisfied are you with the overall result of your back operation?”. There are four possible answers consisting of “very satisfied (4-point)”, “somewhat satisfied (3-point)”, “somewhat dissatisfied (2-point)”, or “very dissatisfied (1-point)”. Spearman correlation was used to evaluate the association between patient satisfaction and reaching MCIDs.A total of 116 patients were included. All three components had correlation with patient satisfaction with the correlation efficient of 0.30 in LBP, 0.22 in leg pain, and 0.33 in numbness. Numbness had greatest correlation efficient value.We showed that numbness has a greater impact than leg/back pain on patient satisfaction in patients undergoing decompression for LSS. We suggest not only LBP and leg pain but also numbness should be evaluated pre- and postoperatively.

Use of vacuum systems for early implant-associated infection after decompression and stabilization surgery for lumbar spinal stenosis

Objective. To analyze the results of treatment of patients with implant-associated surgical site infection after decompression and stabilization surgery performed for lumbar spinal stenosis.Material and Methods. Results of treatment of 43 patients with early (up to 90 days after the operation) suppuration of the surgical wound after decompression and stabilization operations for lumbar spinal stenosis were analyzed.Results. A total of 4033 operations for lumbar spinal stenosis with implantation of stabilization systems were performed from 2015 to 2019. There were 43 (1.06 %) cases of early suppuration of the surgical wound with the installed instrumentation. Out of them seven (16.27 %) cases were superficial and 36 (83.78 %) – deep. In all cases, the wound revision, surgical debridement and installation of a vacuum assisted closure (VAC-dressing) were performed. The treatment of superficial suppuration was accompanied by a single installation of a VAC-dressing before wound closure, and in deep suppuration from 2 to 8 (on average 4.10 ± 1.73) VAC-dressings were changed. Wound healing was achieved in all patients within 14–55 (average 29.10 ± 10.06) days. Timely diagnosis of the complication and application of negative pressure therapy allowed arresting the inflammatory process and preserving the implants in all patients with a follow-up period of 12 months.Conclusion. In the case of development of early suppuration of the surgical wound, the patient needs an urgent sanitizing operation. Negative pressure treatment with VAC-dressings is an effective and safe way to relieve this complication. This method combined with etiotropic antibiotic therapy makes it possible to quickly cleanse and heal the wound while preserving the implanted instrumentation.

Obese people benefit from lumbar spinal stenosis surgery as much as people of normal weight

BackgroundLumbar spinal stenosis (LSS) is a common degenerative condition of the spine that causes back pain radiating to the lower extremity. Surgical treatment is indicated to treat progressive radical symptoms. Obesity has been associated with inferior results in the domains of quality of life (QoL) following an LSS operation, but the research findings have been limited. This paper aims to identify whether obesity affects QoL due to back pain among patients who underwent an operation for LSS.MethodsThis study is based on a series of patients operated on for LSS between 2012 and 2018. Operated patients who returned for follow-up forms within the first or second years were included. A total of 359 patients were selected, 163 males (45%) and 196 females (55%). The mean age was 68.9 years. The EuroQol five-dimension scale (EQ-5D) questionnaire was chosen to measure QoL and the Oswestry Disability Index (ODI) for functional disability.ResultsQoL, as measured by EQ-5D, was preoperatively lower in those patients with a BMI ≥ 30. One year after the operation, all groups had a similar trend of improved QoL. At the second year, the results in all groups levelled off even though there was no statistical difference in clinical outcomes (p = 0.92).The ODI was preoperatively statistically higher in patients with a BMI ≥ 30 (p < 0.001). Two years after the surgery, all groups had improved ODI scores, but there was no statistical difference in ODI between the BMI groups (p = 0.54).ConclusionSurgical intervention for debilitating or longstanding symptoms of LSS should be considered as a treatment option for suitable patients in spite of an elevated BMI.

Minimally Invasive vs. Open Surgery for Lumbar Spinal Stenosis in Patients with Diabetes - A Canadian Spine Outcomes and Research Network Study.

Retrospective cohort. To compare outcomes of minimally invasive surgery (MIS) vs open surgery (OPEN) for lumbar spinal stenosis (LSS) in patients with diabetes. Patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database were included. MIS vs OPEN outcomes were compared for 2 cohorts: (1) patients with diabetes who underwent decompression alone (N = 116; MIS n = 58 and OPEN n = 58), (2) patients with diabetes who underwent decompression with fusion (N = 108; MIS n = 54 and OPEN n = 54). Modified Oswestry Disability Index (mODI) and back and leg pain were compared at baseline, 6-18weeks, and 1-year post-operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at 1-year was compared. MIS approaches had less blood loss (decompression alone difference 100mL, P = .002; with fusion difference 244mL, P < .001) and shorter length of stay (LOS) (decompression alone difference 1.2days, P = .008; with fusion difference 1.2days, P = .026). MIS compared to OPEN decompression with fusion had less patients experiencing adverse events (AEs) (difference 13 patients, P = .007). The MIS decompression with fusion group had lower 1-year mODI (difference 14.5, 95% CI [7.5, 21.0], P < .001) and back pain (difference 1.6, 95% CI [.6, 2.7], P = .002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at 1-year for mODI (MIS 75.9% vs OPEN 53.7%, P = .028) and back pain (MIS 85.2% vs OPEN 70.4%, P = .017). MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.

Early Warning Value of ASL-MRI to Estimate Premorbid Variations in Patients With Early Postoperative Cognitive Dysfunctions.

Background: Postoperative cognitive dysfunction (POCD) is a general complication following cardiac and major non-cardiac surgery amongst the elderly, yet its causes and mechanisms are still unknown. The present study aimed to detect whether regional cerebral blood flow (CBF) is altered in the brain before surgery in POCD patients compared with non-POCD (NPOCD) patients, thus, CBF variation may potentially predict the occurrence of early POCD.Methods: Fifty patients scheduled for spinal stenosis surgery were enrolled in the study. All study participants completed a battery of neuropsychological tests (NPTs) by a well-trained neuropsychologist before the surgery and 1 week after the surgery. POCD was defined when the preoperative to postoperative difference of at least two of the NPTs’ |Z|-scores with reference to a control group exceeded 1.96. Pulsed arterial spin-labeling (ASL) MRI was scanned at least 1 day before surgery. The ASLtbx toolkit and SPM12 were applied to preprocess and correct the images, which were then normalized to the MNI brain template space to obtain standardized cerebral perfusion images.Results: POCD was identified in 11 out of 50 patients (22%). The CBF of the right superior temporal lobe, right and left middle cingulate gyrus, and the right hippocampus, and parahippocampal gyrus in POCD group was lower than that in NPOCD group (P < 0.001). The CBF of the pars triangularis of inferior frontal gyrus in POCD group was higher than that in NPOCD group (P < 0.001).Conclusions: These preliminary findings suggest that CBF premorbid alterations may happen in cognitively intact elderly patients that develop early POCD. Alterations of preoperative CBF might be a bio-marker for early POCD that can be detected by noninvasive MRI scans.

P22. Recurrent CSF leak following repair of incidental durotomy in lumbar spinal stenosis surgery

P22. Recurrent CSF leak following repair of incidental durotomy in lumbar spinal stenosis surgery