Is minimally invasive surgery superior to open surgery for treatment of lumbar spinal stenosis? A systematic review

Ng, Karen Ka Man

doi:10.1177/2309499017716254

Cited by 13 publications

(4 citation statements)

References 16 publications

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“…By now, this minimally invasive approach is not considered the gold standard technology because of its rather steep "learning curve" and a significant risk of technical complications [23]. In addition, the available data is still insufficient to compare the open decompression and the minimally invasive technique used in the treatment of stenosis of the lumbar spine [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Pedicle-Lengthening Osteotomy for the Treatment of Lumbar Spinal Stenosis: the Surgical Technique (Pilot Clinical Study)

Mlyavykh¹,

Bokov²,

Yashin³

et al. 2018

Sovrem Tehnol Med

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Stenosis of the lumbar spine is a common degenerative disease; its progression leads to a significant restriction in daily activities and quality of life. This pilot study presents a novel minimally invasive technology for surgical correction of lumbar stenosis; the technique involves a widening of the spinal canal and intravertebral foramen by percutaneous bilateral osteotomy of the vertebral pedicles and their subsequent lengthening. Materials and Methods. Twenty patients with symptomatic lumbar stenosis were included in this prospective study (11 of them with stable anterolisthesis grade I). The patients underwent percutaneous osteotomy with lengthening of the vertebral pedicles at one or two levels. X-ray results were obtained from either standard radiography or computed tomography of the lumbar spine. The baseline patients' condition and the clinical outcomes of the surgical treatment were assessed using a number of validated examination tests, including the Oswestry Disability Index (ODI), the Zurich Claudication Questionnaire (ZCQ), the 10-mm visual-analogue pain scale (VAS), the SF-12 nonspecific quality of life questionnaire (version 2) with the physical (PCS) and mental (MCS) component summary scores. The minimal period of postoperative follow-up was 78 months (6.5 years). Results. In all cases of surgical interventions, the percutaneous osteotomy proceeded without complications and with a minimal blood loss. As compared with the preoperative period, the patients' quality of life (according to ODI) significantly improved from 48 to 15.5 points over 12 months (p=0.0002) and 5 years (p=0.0004), and up to 20 points in 6 and more years (p=0.0001). The SF-12 test also showed a statistically significant improvement in the quality of life throughout the observation period, with the exception of the MCS score taken soon (6 weeks) after the surgery. The pain syndrome (according to VAS) significantly diminished both in the back and in the lower extremityfrom the preoperative 5.8 and 7.4 points to 2.25 and 0.05 points after 5 years (p=0.0004). However, after 6 years or more, the pain syndrome again increased to 3.2 and 2.4 points, respectively, but remained significantly better than that in the preoperative period (p=0.04 and p=0.0006, respectively). According to the ZCQ questionnaire, the patients' condition improved from 2.0 points (6 weeks after surgery) to 1.5 points at 12 months (p=0.01) and to 1.67 after 5 years (p=0.011). However, after 6 years or more, the value of ZCQ increased to 1.83 points, which did not significantly differ from the preoperative level (p=0.14). Conclusion. Percutaneous bilateral osteotomy of the vertebral pedicles followed by their lengthening in patients with symptomatic lumbar spinal stenosis (including stable spondylolisthesis grade I) is a promising innovative technology. This minimally invasive treatment is beneficial primarily for elderly patients and those suffering from comorbidity. The results of this pilot study followed up for more than 6 years indicate a good immediate and...

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Section: Discussionmentioning

confidence: 99%

Pedicle-Lengthening Osteotomy for the Treatment of Lumbar Spinal Stenosis: the Surgical Technique (Pilot Clinical Study)

Mlyavykh¹,

Bokov²,

Yashin³

et al. 2018

Sovrem Tehnol Med

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“…Open surgery is an effective method for the treatment; however, injuries to muscles and paravertebral ligaments due to large incisions during surgery may induce increased postoperative back pain and muscle atrophy [10,11]. One study showed that most open vertebral fusion procedures have longer hospital stays and may require more time for muscle recovery after surgery than minimally invasive fusion procedures [12].…”

Section: Limitations Of Conservative Treatment Versus Conventional Su...mentioning

confidence: 99%

A comparative study on the clinical efficacy of UBETlif and Mis-Tlif in the treatment of degenerative Lumbar Stenosis with Instability

Zhou,

Zhang,

Liang

et al. 2023

Preprint

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Purpose To compare the clinical efficacy of unilateral biportal endoscopic technique transforaminal lumbar interbody fusion (UBE-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treating degenerative lumbar stenosis with instability. Methods A retrospective study was performed on 64 patients with degenerative lumbar stenosis with instability admitted between January 2018 and December 2021 and divided into UBE-TLIF and MIS-TLIF groups. Comparison of data; surgical index; postoperative complications; the visual analogue scale (VAS) score for back pain and leg pain, Oswestry disability index (ODI), and MOS 36-Item Short-Form health survey (SF-36) were used to evaluate the function before surgery, 1 and 3 months after surgery, and at the last follow-up; and adult spinal deformity (ASD) at the last follow-up. Results All patients successfully completed the surgery, with a follow-up time of 6 to 16 months. There were no statistical differences in general data between groups. Reagarding surgical indicators: the UBE-TLIF group had more advantages in terms of intraoperative blood loss, surgical incision length, and postoperative hospital stay, although the operation time was longer. Regarding clinical efficacy evaluation indicators: the VAS, ODI, and SF-36 in both groups significantly improved at each time point after surgery, there was no difference in other time points. Compared with the MIS-TLIF group, there was no significant difference in the VAS or SF-36. The ODI of the UBE-TLIF group was better than the MIS-TLIF group 1 month after surgery, with no statistical difference at other time points. ASD incidence in both groups was 3.125%, the difference was not statistically significant. Conclusion Compared with MIS-TLIF, UBE-TLIF achieved a similar interbody fusion effect in the treatment of degenerative lumbar instability with spinal stenosis, optimised surgical indicators, and reduced postoperative stress response.

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“…A review of various conservative versus surgical treatment comparison studies published up to February 2015 found that surgery was associated with high complication and reoperation rates, whereas on the other hand, no side effects were reported for any of the conservative treatment options [17]. Even minimally invasive surgery for LSS did not significantly reduce operating time, length of hospital stay, or reoperation rates, nor did it offer better pain relief in outcome scores such as the visual analog scale (VAS), the 36-Item Short-Form Survey, and Japanese Orthopaedic Association scores [12]. However, a ten-year follow-up study of one hundred LSS patients who underwent either conservative therapy or surgical treatment found many with the former to have unsatisfactory outcomes that later became favorable after a subsequent switch to surgery, and there was no evidence of surgical treatment having worse outcomes in LSS patients with moderate to severe symptoms [18].…”

Section: Introductionmentioning

confidence: 98%

“…Treatment options for LSS are categorized as conservative and surgical; conservative therapies include pain medication, epidural injections, rehabilitation such as manual therapy with a hands-on physical therapist, aerobic training, and exercise intervention to treat patients with mild to moderate symptoms [7,11], and surgical intervention is considered if LSS symptoms do not improve with conservative therapies [12]. Surgeries aim to decompress the entrapped neural element or provide decompression through lumber fusion; for example, a split-spinous process for laminotomies and discectomies to correct LSS can minimize muscular trauma, maintain spinal stability, and easily re-enable movement, shorten the duration of hospital stays, reduce postoperative back pain, and provide satisfactory neurological and functional outcomes [13].…”

Section: Introductionmentioning

confidence: 99%

Choice between Surgery and Conservative Treatment for Patients with Lumbar Spinal Stenosis: Predicting Results through Data Mining Technology

et al. 2020

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Currently, patients with lumbar spinal stenosis (LSS) have two treatment options: nonoperative conservative treatment and surgical treatment. Because surgery is invasive, patients often prefer conservative treatment as their first choice to avoid risks from surgery. However, the effectiveness of nonoperative conservative treatment for patients with LSS may be lower than expected because of individual differences. Rules to determine whether patients with LSS should undergo surgical treatment merits exploration. In addition, without a decision-making system to assist patients undergoing conservative treatment to decide whether to undergo surgical treatment, medical professionals may encounter difficulty in providing the best treatment advice. This study collected medical record data and magnetic resonance imaging diagnostic data from patients with LSS, analyzed and consolidated the data through data mining techniques, identified crucial factors and rules affecting the final outcome the patients with LSS who opted for conservative treatment and ultimately underwent surgical treatment, and, finally, established an effective prediction model. This study applied logistic regression (LGR) and decision tree algorithms to extract the crucial features and combined them with back propagation neural networks (BPNN) and support vector machines (SVM) to establish the prediction model. The crucial features obtained are as follows: reduction of the intervertebral disc height, age, blood pressure difference, leg pain, gender, etc. Among the models predicting whether patients with LSS ultimately underwent surgical treatment, the model combining LGR and the decision tree for feature selection with a BPNN has a testing accuracy rate of 94.87%, sensitivity of 0.9, specificity of 1, and area under the receiver operating characteristic curve of 0.952. Adopting these data mining techniques to predict whether patients with LSS who opted for conservative treatment ultimately underwent surgical treatment may assist medical professionals in reaching a treatment decision and provide clearer treatment. This may effectively mitigate disease progression, aid the goals of precision medicine, and ultimately enhance the quality of health care.

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Is minimally invasive surgery superior to open surgery for treatment of lumbar spinal stenosis? A systematic review

Cited by 13 publications

References 16 publications

Pedicle-Lengthening Osteotomy for the Treatment of Lumbar Spinal Stenosis: the Surgical Technique (Pilot Clinical Study)

Pedicle-Lengthening Osteotomy for the Treatment of Lumbar Spinal Stenosis: the Surgical Technique (Pilot Clinical Study)

A comparative study on the clinical efficacy of UBETlif and Mis-Tlif in the treatment of degenerative Lumbar Stenosis with Instability

Choice between Surgery and Conservative Treatment for Patients with Lumbar Spinal Stenosis: Predicting Results through Data Mining Technology

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