Minimally Invasive Lumbar Decompression and Interspinous Process Device for the Management of Symptomatic Lumbar Spinal Stenosis: a Literature Review

Merkow, Justin; Varhabhatla, Narayana; Manchikanti, Laxmaiah; Kaye, Alan D.; Urman, Richard D.; Yong, R. Jason

doi:10.1007/s11916-020-0845-2

Cited by 8 publications

(4 citation statements)

References 73 publications

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“…In a subset of patients with central spinal stenosis who failed conventional ESI, evidence-based reviews have reported modest benefit for MILD and interspinous spacers based on mostly low-quality studies. 176…”

Section: Minimally Invasive Surgeriesmentioning

confidence: 99%

“…Minimally invasive lumbar decompression (MILD) is a procedure used to widen the spinal canal in individuals with ligamentum flavum hypertrophy, while interspinous spacers purport to unload intervertebral discs and widen the spinal canal and foramina. In a subset of patients with central spinal stenosis who failed conventional ESI, evidence‐based reviews have reported modest benefit for MILD and interspinous spacers based on mostly low‐quality studies 176 …”

Section: Treatment Optionsmentioning

confidence: 99%

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1. Lumbosacral radicular pain

Peene,

Cohen,

Kallewaard

et al. 2023

Pain Practice

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IntroductionPatients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%.MethodsThe literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized.ResultsAlthough a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s).In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short‐term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well‐selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers.ConclusionsThe diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.

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Section: Minimally Invasive Surgeriesmentioning

confidence: 99%

Section: Treatment Optionsmentioning

confidence: 99%

1. Lumbosacral radicular pain

Peene,

Cohen,

Kallewaard

et al. 2023

Pain Practice

View full text Add to dashboard Cite

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“…In comparision, the majority of spinal endoscopies are percutaneous posterior procedures with neglible blood loss, minimal muscle dissection, and hardly any postoperative wound pain. These posterior transforaminal or interlaminar decompression procedures seem preferred by most endoscopic spine surgeons for greater versatility, simplicity, and lower risks to the vital structures in the spine [49][50][51][52][53][54][55][56][57][58].…”

Section: Discussionmentioning

confidence: 99%

Anesthesia For Endoscopic Spine Surgery Of The Spine In An Ambulatory Surgery Center

Abrão¹,

Dowling

León

et al. 2020

GJAPM

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Background: Providing adequate anesthesia that caters to rapid turn-over in an outpatient ambulatory surgery center setting is sometimes as much of an art as it is a science. Outpatient spine surgery is characterized by shorter simplified versions of their inpatient counterparts carried out in a hospital setting. Objective:The monitored anesthesia care (MAC) and deep sedation with a laryngeal mask airway (LMA) in the prone position have received little attention in the anesthesia and spine surgery literature. The authors reviewed their clinical outcomes with the outpatient endoscopic spinal surgery in conjunction with these two types of anesthesias. Methods:We performed an analysis of perioperative anesthesia and clinical outcomes in 184 patients who underwent lumbar endoscopic spinal surgery in two outpatient ambulatory surgery centers. The 184 patients consisted of 90 (48.9%) women and 94 (51.1%) men with an average age of 54.3 ± 15.4 years. The average follow-up of 43.27 months. The primary clinical outcome measures were the modified Macnab criteria. Chi-square testing was employed to analyze statistically significant associations between the type of anesthesia, preoperative diagnosis, the surgical level(s), and surgeon requirements for MAC versus balanced general anesthesia.Results: At the final follow-up, the majority of patients had Excellent (93/184; 50.5%) and Good (74/184; 40.2%) Macnab outcomes regardless of treatment and anesthesia. There was minimal blood loss in all patients, and there were no complications such as dural tears, or hematomas. There were also no wound problems such as bleeding, or leaking of endoscopic irrigation fluid from the wound. Of the 184 study patients, 40 patients (21.7%) had a postoperative irritation of the dorsal root ganglion (DRG). The mean anesthesia time was 37 ± 9 minutes in patients under balanced general anesthesia. with LMA and 48 ± 12 minutes in MAC patients. All of the 184 patients were discharged under one hour from the PACU after an uneventful wakeup. Only six patients (3.26%) had postoperative nausea.Conclusions: Monitored anesthesia care with sedation in an ambulatory surgery center in the prone position is best suited for endoscopic spinal decompressions. Intubation of the patient with general anesthesia is generally not required. Most patients can be managed with a nasal cannula, face mask, or a balanced general anesthesia with a laryngeal mask airway (LMA).

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“…Similar clinical results were also demonstrated by Marsh et al [ 28 ] What’s more, a prospective, randomized, multicenter study with 2-year follow-up also demonstrated that a higher percentage of patients in the IPD treatment group achieved ODI success with improvement > 15 points, however, the results were not statistical difference. [ 17 ] Although traditional decompression surgery, as a “golden standard,” was effective to treat LSS, [ 39 , 40 ] our meta-analysis demonstrated that traditional decompression surgery was not inferior to IPD treatment in terms of ODI.…”

Section: Discussmentioning

confidence: 95%

Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis

Zhu,

Xiao

2024

Medicine

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Study Design: Systematic review and meta-analysis. Background: Interspinous process devices (IPD) were used as a treatment in selected patients with lumbar spinal stenosis (LSS). However, the use of IPD was still debated that it had significantly higher reoperation rates compared to traditional decompression. Therefore, the purpose of the meta-analysis was to evaluate the effectiveness and safety of IPD treatment in comparison to traditional treatment. Methods: The databases were searched of PubMed, Embase and the Cochrane, Chinese National Knowledge Infrastructure, Chongqing VIP Database and Wan Fang Database up to January 2024. Relevant studies were identified by using specific eligibility criteria and data was extracted and analyzed based on primary and secondary endpoints. Results: A total of 13 studies were included (5 RCTs and 8 retrospective studies). There was no significant difference of Oswestey Disability Index (ODI) score in the last follow-up (MD = −3.81, 95% CI: −8.91–1.28, P = .14). There was significant difference of Visual Analog Scale (VAS) back pain scoring in the last follow-up (MD = −1.59, 95% CI: −3.09–−0.09, P = .04), but there existed no significant difference of leg pain in the last follow-up (MD = −2.35, 95% CI: −6.15–1.45, P = .23). What’s more, operation time, bleeding loss, total complications and reoperation rate had no significant difference. However, IPD had higher device problems (odds ratio [OR] = 9.00, 95% CI: 2.39–33.91, P = .001) and lesser dural tears (OR = 0.32, 95% CI: 0.15–0.67, P = .002) compared to traditional decompression. Conclusion: Although IPD had lower back pain score and lower dural tears compared with traditional decompression, current evidence indicated no superiority for patient-reported outcomes for IPD compared with alone decompression treatment. However, these findings needed to be verified in further by multicenter, double-blind and large sample RCTs.

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Minimally Invasive Lumbar Decompression and Interspinous Process Device for the Management of Symptomatic Lumbar Spinal Stenosis: a Literature Review

Cited by 8 publications

References 73 publications

1. Lumbosacral radicular pain

1. Lumbosacral radicular pain

Anesthesia For Endoscopic Spine Surgery Of The Spine In An Ambulatory Surgery Center

Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis

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