Far Lateral Tubular Decompression: A Case Series Studying One and Two Year Outcomes with Predictors of Failure

Knio, Ziyad O.; Hsu, Wesley; Marquez-Lara, Alejandro; Luo, T. David; Angelo, John M St; Medda, Suman; O’Gara, Tadhg

doi:10.7759/cureus.5133

Cited by 3 publications

(8 citation statements)

References 12 publications

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“…LTM techniques utilized were the unilateral laminotomy (UL) to address central and ipsilateral lateral recess stenosis, the unilateral laminotomy for bilateral decompression (ULBD) to address central pathology, bilateral lateral recess pathology and contralateral foraminal stenosis, and the far lateral “transpedicular” decompression (FLD) to address ipsilateral foraminal stenosis. All procedures were performed by a single surgeon using previously described techniques 6,7,17,18…”

Section: Methodsmentioning

confidence: 99%

“…For the FLD, "scotty dog view" fluoroscopy was used to approach the neuroforamen from an oblique approach, sometimes up to 9 cm off midline, as previously described. 7 This oblique approach permitted decompression of the foramen medial to the pedicle with minimal resection of the pars interarticularis. Oblique fluoroscopy was used to dock the METRx tubular retractor (Medtronic, Dublin, Ireland) to the superior articular process.…”

Section: Study Population and Surgical Proceduresmentioning

confidence: 99%

“…Case series' patients understood that the LTM was limited and prone to recurrence of stenotic pathology and therefore further surgical interventions maybe needed in the future. [6][7][8][9][10] Failure was defined as any subsequent surgery at the same level as the index surgery level or levels and included revision to fusion, open laminectomy, or subsequent LTM at the same level. This current paper is an analysis of the overall case series' five-year failure rate, missing data, complications, and patientreported outcome (PRO) differences between patients who fail versus those who do not.…”

mentioning

confidence: 99%

“…Given the mixed literature supporting any one specific surgical treatment for most lumbar pathologies,5 the senior author initiated a case series, which defaulted to the least invasive option. Case series’ patients understood that the LTM was limited and prone to recurrence of stenotic pathology and therefore further surgical interventions maybe needed in the future 6–10. Failure was defined as any subsequent surgery at the same level as the index surgery level or levels and included revision to fusion, open laminectomy, or subsequent LTM at the same level.…”

mentioning

confidence: 99%

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Patient-Reported Outcomes and Reoperation Rates Following Lumbar Tubular Microdecompression: Six-year Follow-Up

Bullock

Sangio

Beck

et al. 2022

Spine

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Study Design. Prospective cohort study Objective. To report reoperation rates after lumbar tubular microdecompression (LTM) and to compare patient-reported outcomes (PROs) six years after surgery between those who did and did not need revision at the index level. Summary of Background Data. Long-term data describing PROs and reoperation rates after LTMs are lacking. Materials and Methods. Patients with lumbar spinal stenosis underwent one or more of three LTM procedures. Demographic, PROs [Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain], and reoperation data were collected. Failure of an index LTM was defined as any revision surgery at the index level. Revision LTM at a different level was not considered failure. Failure and revision LTM incidence at a different level and cumulative incidence were prospectively collected up to six years. Mixed effects linear regressions with 95% CIs were performed to assess potential differences in ODI and reported VAS back and leg pain between patients that reported failure and those that did not. Results. A total of 418 patients were included with median follow-up of 3.0 (1.9, 4.1) years. In all, 25% had a reoperation by six years. Sixty-five (16%) failed and 35 (9%) underwent a second LTM at another level. Cumulative failure incidence was 9% within the first two years. Failure patients had a statistically higher ODI [12.1 (95% CI, 3.2, 20.1) and VAS back [2.3 (95% CI, 0.9, 3.8)] and leg pain [1.6 (95% CI, 0.2, 3.1)] throughout follow-up. The overall dural tear rate was 7.2%. Conclusions. LTM is an effective treatment for lumbar spinal stenosis with sustained six-year PROs. Most failures occur within two years postoperatively and stabilize to 4% yearly incidence by year 5. The yearly incidence of reoperation with LTM stabilizes at 3% by year 6 postoperatively. Level of Evidence. 2.

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Section: Methodsmentioning

confidence: 99%

Section: Study Population and Surgical Proceduresmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Patient-Reported Outcomes and Reoperation Rates Following Lumbar Tubular Microdecompression: Six-year Follow-Up

Bullock

Sangio

Beck

et al. 2022

Spine

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“… 6 ) This strategy has been modified further, 7 - 9 ) and endoscope-assisted tubular surgeries have also been performed instead of microsurgery. 10 ) For decompression alone, it is important to perform bone removal to a sufficient extent; however, the occurrence of secondary instability is a factor that has to be considered seriously. In view of the instability, lumbar interbody fusion (LIF) has been selected primarily for the treatment of L5/S1 LFS by many spinal surgeons.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

Fujita

Inui

Oshima

et al. 2022

Neurol. Med. Chir.(Tokyo)

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This study compared the outcomes of microendoscopy-assisted lumbar interbody fusion (ME-LIF) and uniportal full-endoscopic laminectomy (FEL) for L5 radiculopathy caused by lumbar foraminal stenosis (LFS). ME-LIF was performed using an 18- to 20-mm tubular retractor and endoscope, and FEL via the translaminar approach (TLA) was performed at the dorsal part of the foramen using a 4.1-mm working channel endoscope. Patients with LFS treated using ME-LIF (n = 39) or FEL-TLA (n = 30) were retrospectively evaluated. Patients' background and operative data were collected. The 36-item Short Form Survey (SF-36), Oswestry Disability Index (ODI), and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 2 years postoperatively. The background data of the two groups (ME-LIF and FEL-TLA) were similar. The mean operation times for ME-LIF and FEL-TLA were 110.7 and 65.2 min, respectively, and the mean length of hospital stay were 10.3 and 1.5 days, respectively. Reoperation was required for surgical site infection, and percutaneous pedicle screw malposition in three patients was treated using ME-LIF. During follow-up, second FEL-TLA and LIF were performed for recurrent L5 radiculopathy in one and three patients in the FEL-TLA group, respectively. Although the SF-36, ODI, and EQ-5D scores 2 years postoperatively improved in both groups, improvement in ODI scores was lower following FEL-TLA than following ME-LIF. FEL-TLA can be performed to treat patients with L5 radiculopathy caused by LFS. Although the ODI score improvement following FEL-TLA was unremarkable, FEL-TLA might be considered because of its better safety profile and minimal invasiveness than ME-LIF.

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Rates of Achieving Meaningful Outcomes After Undergoing Minimally-Invasive Far Lateral Tubular Decompression

Barghi,

Gowd,

Beck

et al. 2023

Preprint

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Purpose: To evaluate rates of achieving meaningful outcomes among patients undergoing far lateral tubular decompression (FLTD) for neuroforaminal stenosis. Traditional midline approaches are ineffective in treating isolated neuroforaminal stenosis. Direct decompression via a far lateral approach offers a minimally invasive, facet-sparing surgery with minimal surgical dissection. Methods: Patients who underwent FLTD between January 2014 and January 2019 for isolated foraminal stenosis were included. The study collected patient demographics, perioperative data, and pre- and postoperative patient-reported outcomes (PROs). The study calculated thresholds for achieving minimal clinically important difference (MCID) on each PRO and performed logistic regression analysis to identify predictors of achieving meaningful clinical outcomes and clinical failure. Results: 64 patients were included with a 2-year follow-up. The analysis showed improvement in each PRO over the 2-year period (p < 0.001 for all). 90.2% of patients achieved MCID for at least one PRO, with the VAS leg pain having the highest achievement rate at 79.7%. During the follow-up period, 17.2% required additional surgery. Increased severity of preoperative symptoms was associated with a greater likelihood of achieving MCID in all three PROs (p < 0.05, each). The presence of spondylolisthesis was associated with decreased odds of achieving MCID by ODI (p = 0.04). Increased operative time was associated with increased odds of achieving MCID by ODI (p = 0.03). No variables were associated with revision surgery. Conclusions: FLTD is an effective treatment option for direct decompression of foraminal and extra foraminal stenosis in well-indicated patients. Most patients achieved MCID two years from surgery, with more severe symptoms having a greater likelihood of improvement, particularly with radicular pain. Further research should be performed on patients with spondylolisthesis to prescribe treatment resulting in maximal benefit. Level of Evidence: 4

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Far Lateral Tubular Decompression: A Case Series Studying One and Two Year Outcomes with Predictors of Failure

Cited by 3 publications

References 12 publications

Patient-Reported Outcomes and Reoperation Rates Following Lumbar Tubular Microdecompression: Six-year Follow-Up

Patient-Reported Outcomes and Reoperation Rates Following Lumbar Tubular Microdecompression: Six-year Follow-Up

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

Rates of Achieving Meaningful Outcomes After Undergoing Minimally-Invasive Far Lateral Tubular Decompression

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