Management of degenerative lumbar spinal stenosis: an evidence-based review

Covaro, A A; Vilà-Canet, Gemma; Frutos, Ana García de; Ubierna, M. T.; Ciccolo, Francesco; Cáceres, Enric

doi:10.1302/2058-5241.1.000030

Cited by 39 publications

(28 citation statements)

References 72 publications

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“…This disorder is commonly correlated with the complex heterogeneous condition of spine degeneration 2 . The clinical approach to managing degenerative spinal pain can be highly variable 3 . Treatments are aimed towards pain relief and return to an acceptable level of function.…”

Section: Introductionmentioning

confidence: 99%

“…Over the past 3 decades, epidural corticosteroid injections have become a standard part of the multimodal pain management algorithm for the treatment of low back pain, whether as a result of chronic spinal deformities or conditions associated with acute radicular pain. They are also frequently used in the treatment of chronic degenerative spine pain 3 . Despite the widespread use of epidural corticosteroid injections as a modality for chronic degenerative spine pain, its effectiveness remains controversial 3,4 …”

Section: Introductionmentioning

confidence: 99%

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A Randomized Double‐Blind Controlled Pilot Study Comparing Leucocyte‐Rich Platelet‐Rich Plasma and Corticosteroid in Caudal Epidural Injection for Complex Chronic Degenerative Spinal Pain

Ruiz‐Lopez¹,

Tsai

2020

Pain Practice

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Objectives: To compare the efficacy and safety between leucocyte-rich platelet-rich plasma (LR-PRP) and corticosteroid in fluoroscopically guided caudal epidural injection for patients with complex chronic lumbar spinal pain. Study Design: A prospective randomized controlled doubleblinded study. Methods: Fifty eligible patients with complex chronic degenerative spinal pain were randomly assigned with a 1:1 allocation ratio to receive caudal epidural injection of corticosteroid (triamcinolone acetonide, 60 mg) or LR-PRP (isolated from 60 mL autologous blood) under fluoroscopic guidance. Levels of low back pain, quality of life, and complications (or adverse effects) were evaluated at 1, 3, and 6 months after treatment. Pain levels and quality of life were assessed using the VAS and Short Form 36-Item Health Survey (SF-36), respectively. Results: No significant difference was shown at baseline between the 2 groups. Compared with the pretreatment values, there were significant reductions in the VAS score in both groups. A significantly lower VAS score at 1-month follow-up was detected in patients who received corticosteroid injection. However, the scores were lower in the LR-PRP group at 3-and 6-month follow-up. SF-36 responses at 6 months showed significant improvement in all domains in the LR-PRP group. There were no complications or adverse effects related to treatment at 6-month follow-up in either group. Conclusions: Both autologous LR-PRP and corticosteroid for caudal epidural injections under fluoroscopic guidance are equally safe and therapeutically effective in patients with complex chronic lumbar spinal pain. However, LR-PRP is superior to corticosteroid for a longer pain-relieving effect and improvement in quality of life. &

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Randomized Double‐Blind Controlled Pilot Study Comparing Leucocyte‐Rich Platelet‐Rich Plasma and Corticosteroid in Caudal Epidural Injection for Complex Chronic Degenerative Spinal Pain

Ruiz‐Lopez¹,

Tsai

2020

Pain Practice

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“…1 Lumbar decompression has demonstrated efficacy over conservative management for the treatment of radicular symptoms in trials; however, results of large-scale systematic reviews are neutral. [2][3][4][5][6][7][8][9][10] There are a multitude of surgical decompression strategies to decompress neural structures with no convincing evidence to support one technique over another. [11][12][13][14][15][16] These may be augmented by instrumentation to achieve vertebral fusion, correction of deformity, or structural imbalance.…”

Section: Introductionmentioning

confidence: 99%

“…43 This affords the surgeon a common language with which to communicate the purpose and indications supporting surgery, as well as the likelihood of improvement. 3,44 The aim of this study was to review a large dataset from our extensive and growing spinal surgery database to evaluate outcomes of simple decompression surgery from the patient's perspective.…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases

Sunderland

Foster

Dheerendra

et al. 2020

Global Spine Journal

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Study Design: Retrospective case series. Objective: Despite numerous advances in the technology and techniques available to spinal surgeons, lumbar decompression remains the mainstay of degenerative lumbar spine surgery. It has proven efficacy in trials, but only limited evidence of advantage over conservative management in large scale systematic reviews. We collated data from a large surgically managed cohort to evaluate the patient-reported outcomes. Methods: We performed a retrospective analysis of a prospectively populated database. Patient demographics, surgical details, and patient outcomes (Spine Tango core outcome measures index [COMI]-Low Back) were collected for 2699 lumbar decompression surgeries.Results: Lumbar decompression was shown to be successful at improving leg pain (mean improvement in visual analogue scale [VAS] at 3 months ¼ 4) and to a lesser extent, back pain (mean improvement in VAS at 3 months ¼ 2.61). Mean improvement in COMI score was 3.15 for all-comers. Minimal clinically important improvement (MCID) in COMI score (À2 points) was achieved in 73% of patients by 2-year follow-up. Primary surgery was more effective than redo surgery: odds ratio 0.547 (95% CI 0.408-0.733, P < .001). The benefits across all outcomes were maintained for the 2-year follow-up period. Patients can be classified according to their outcome as "early responders"; achieving MCID by 3 months (61% primary vs 41% redo), "late responders"; achieving MCID by 2 years (15% vs 20%) or nonresponders (24% vs 39%).Conclusions: Lumbar decompression is effective in improving quality of life in appropriately selected patients. Patient-reported outcome measures collected routinely and collated within a registry are a powerful tool for assessing the efficacy of lumbar spine interventions and allow accurate counseling of patients perioperatively.

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“…Of these subtypes, Chang defined the central and paracentral herniations as intracanalicular LDH, and extraforaminal herniation was defined as far-lateral LDH (2). While intracanalicular combining foraminal and/or extraforaminal LDH (ICFE-LDH) at one segment is a special and complicated type of LDH (3). Patients with ICFE-LDH often suffer multiple and unbearable radiculopathy since compressions on exiting and traversing nerve roots simultaneously (4), and it is easily to be missed in diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The modified transforaminal endoscopic technique in treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniations

Zhang¹,

Pan²,

Yu³

et al. 2018

Quant. Imaging Med. Surg

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Background: To develop a modified transforaminal endoscopic spine system (TESSYS ®) technique for treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniation (ICFE-LDH), and evaluate the technical efficacy and safety. Methods: Twenty-three patients with ICFE-LDH underwent the modified TESSYS technique were enrolled. Magnetic resonance imaging (MRI) was used to verify the reduction of herniated disc. Pre-and post-operative neurological functions were compared by visual analogue scale (VAS) score, Oswestry disability index (ODI) and the modified MacNab criteria. The technical safety was evaluated by surgical complications. Results: MRI demonstrated reductions of disc herniations in 22 patients (95.7%) after surgeries. The VAS scores were significantly improved at 1 year follow-up (low back: P=0.001, lower limbs: P<0.001), as well as ODI scores (P<0.001). 22 patients had achieved excellent and good recovery postoperatively according to the modified MacNab criteria. One patient (4.3%) underwent a reoperation due to postoperative recurrence of disc herniation. Another patient complained postoperative causalgia in 8 weeks, the symptom alleviated after conservative treatment at 1 year follow-up (VAS: back, 3, lower limbs, 0; ODI: 20%). The incidence rate of surgical complication was 8.7%. Conclusions: The modified TESSYS technique is a minimally-invasive, effective and safe surgery for treating ICFE-LDHs in selected patients.

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Management of degenerative lumbar spinal stenosis: an evidence-based review

Cited by 39 publications

References 72 publications

A Randomized Double‐Blind Controlled Pilot Study Comparing Leucocyte‐Rich Platelet‐Rich Plasma and Corticosteroid in Caudal Epidural Injection for Complex Chronic Degenerative Spinal Pain

A Randomized Double‐Blind Controlled Pilot Study Comparing Leucocyte‐Rich Platelet‐Rich Plasma and Corticosteroid in Caudal Epidural Injection for Complex Chronic Degenerative Spinal Pain

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases

The modified transforaminal endoscopic technique in treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniations

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