Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes

Abstract

There is ongoing controversy regarding the most appropriate surgical treatment for lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS): decompression alone, decompression with limited spinal fusion, or long spinal fusion for deformity correction. The coexistence of degenerative stenosis and deformity is a common scenario; Nonetheless, selecting the appropriate surgical intervention requires thorough understanding of the patients clinical symptomatology as well as radiographic parameters. Minimally invasive (MIS) decompression surgery was performed for LSS patients with DLS. The aims of this study were (1) to investigate the clinical outcomes of MIS decompression surgery in LSS patients with DLS, and (2) to identify the predictive factors for both radiographic and clinical outcomes after MIS surgery. 438 consecutive patients were enrolled in this study. Inclusion criteria was evidence of LSS and DLS with coronal curvature measuring greater than 10°. The Japanese Orthopaedic Association (JOA) score, JOA recovery rate, low back pain (LBP), and radiographic features were evaluated preoperatively and at over 2 years postoperatively. Of the 438 patients, 122 were included in final analysis, with a mean follow-up of 2.4 years. The JOA recovery rate was 47.6%. LBP was significantly improved at final follow-up. Cobb angle was maintained for 2 years postoperatively (p = 0.159). Clinical outcomes in foraminal stenosis patients were significantly related to sex, preoperative high Cobb angle and progression of scoliosis (p = 0.008). In the severe scoliosis patients, the JOA recovery was 44%, and was significantly depended on progression of scoliosis (Cobb angle: preoperation 29.6°, 2-years follow-up 36.9°) and mismatch between the pelvic incidence (PI) and the lumbar lordosis (LL) (preoperative PI-LL 35.5 ± 21.2°) (p = 0.028). This study investigated clinical outcomes of MIS decompression surgery in LSS patients with DLS. The predictive risk factors of clinical outcomes were severe scoliosis, foramina stenosis, progressive scoliosis and large mismatch of PI-LL.

WITHDRAWN: Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

“…It has obtained a good clinical result with the development of microsurgery and minimally invasive spine surgery technique. The concept of percutaneous endoscopic lumbar decompression was rst proposed by Kambin in 1973 (14), and this kind of technology has gradually matured after continuous improvement of YESS technique and TESSYS technique. On the one hand, this kind of surgery is performed through the interlaminar space or intervertebral foramen, without damaging paravertebral muscles or ligaments or affecting the stability of the spine (15).…”

Decompression Surgery versus Interspinous Devices for Lumbar Spinal Stenosis: A Systematic Review of the Literature

“…This comprehensive systematic review investigated three groups of studies that examined the clinical and functional impact of decompression surgery or placement of ISDs for lumbar spinal stenosis. Of the literature that explored the role of decompression exclusively, most studies compiled within this review involved conventional decompression surgery via open laminectomy [8,15,16,[18][19][20][21][22][23][24]27] or laminotomy [5,9,11,25], but other types of decompression surgery were explored, including minimally invasive decompression [4,[6][7][8], full-endoscopic interlaminar bilateral decompression [9], the Marmot operation [17], lumbar spinous process splitting decompression, midline decompression, modified unilateral laminotomy for bi-Author Year Fig. 4.…”

“…The average participant age was 68.7 years (range, 31-88 years). Types of decompression surgery included Marmot operation [17], minimally invasive [4][5][6][7][8][9][10][11][12], traditional laminectomy [15][16][17][18][19][20][21][22][23][24][25], unilateral laminectomy [16], open laminectomy [8], endoscopic interlaminar approach [9], endoscopic unilateral decompression [9], lumbar spinous process splitting, midline decompression, mild percutaneous decompression [26], mild interlaminar decompression, windows technique laminoforaminotomy [22], bilateral laminotomy [25], and unilateral laminotomy [16,19,25,27]. The average follow-up period for these studies was 17.6 months (range, 0-90 months).…”

“…The average follow-up period for these studies was 17.6 months (range, 0-90 months). The major findings included decreased neuropathic pain as measured by VAS [4,9,10,15,[19][20][21][22][23][24][26][27][28][29], decreased functional impairment secondary to lower back pain as measured by ODI [6][7][8][9][10][11]16,18,[21][22][23]26,27,29], and reduction in severity of lower back pain as measured by JOA score [4,5,11,19,28] (Table 1). Studies also reported complications associated with decompression such as dural tear [5,8,9,11,12,16,19,[21][22][23][24] (n=65/3,386, 2.2%), transient neuralgia [5,7,9,…”

“…While lumbar spinal stenosis can be congenital [2], the most common cause of lumbar spinal stenosis is degenerative spondylosis [3], which commonly affects the elderly population. In fact, lumbar spinal stenosis is a leading cause of disability in the elderly [4][5][6][7][8][9][10][11][12] with reported rates as high as 11.2% in the 70-80-year-old population. Moreover, lumbar spinal stenosis poses a significant socioeconomic burden to patients and was associated with $1.65 billion in Medicare costs in 2009 [13].…”