Prospective analysis of surgical outcomes in patients undergoing decompressive laminectomy and posterior instrumentation for degenerative lumbar spinal stenosis

Gelalis, Ioannis D.; Arnaoutoglou, Christina; Christoforou, Giorgos; Lykissas, Marios G.; Batsilas, Ioannis; Xenakis, Theodoros

doi:10.3944/aott.2010.2278

Cited by 22 publications

(17 citation statements)

References 26 publications

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“…There is controversy concerning the necessity of MIS procedures in order to achieve fusion and adequate decompression [2,9,15,20,28]. Because of a reduced destruction of the soft tissues, proponents of these MIS techniques claim to achieve superior clinical results with reduced postoperative pain, narcotic use, and hospital length of stay [4,5,10,12,16,23].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the severity of the central spinal stenosis, facet osteoarthritis and foraminal narrowing can significantly differ between patients [21]. Consequently, it has been suggested that the procedure should be tailored to each patient depending on imaging findings and symptoms-for example, ventral approaches in cases of high-grade spondylolisthesis or unilateral approaches in cases of unilateral symptoms [2,29]. The authors of previous studies of MIS and especially MIS-TLIF have commonly neglected the heterogeneity of the patient population by including such complex cases in the patient population without differentiating the efficacy of the surgery on these patients [5,12,18,20,23,26].…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, analysis of outcome was based on the VAS for pain and satisfaction and the ODI for disability [1,2,18,26]. Both MIS-TLIF and open surgery resulted in a significant reduction of overall pain (p \ 0.001) in the long term.…”

Section: Outcome Assessmentmentioning

confidence: 99%

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Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

Archavlis

Nievas²

2013

Eur Spine J

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Purpose The object of this study was to compare minimally invasive surgery (MIS) with open surgery in a severely affected subgroup of degenerative spondylolisthetic patients with severe stenosis (SDS) and high-grade facet osteoarthritis (FJO). Methods From January 2009 to February 2010, 49 patients with severe SDS and high-grade FJO were treated using either MIS or open TLIF. Intraoperative and diagnostic data, including perioperative complications and length of hospital stay (LOS), were collected, using retrospective chart review. Surgical short-and long-term outcomes were assessed according to the Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Results Comparing MIS and open surgery, the MIS group had lesser blood loss, significantly lesser need for transfusion (p = 0.02), more rapid improvement of postoperative back pain in the first 6 weeks of follow-up and a shorter LOS. On the other hand, we experienced in the MIS group a longer operative time. The distribution on the postoperative ODI (p = 0.841), VAS leg (p = 0.943) and back pain (p = 0.735) scores after a mean follow-up of 2 years were similar. The overall proportion of complications showed no significant difference between the groups (29 % in the MIS group vs. 28 % in the open group, p = 0.999). Conclusion Minimally invasive surgery for severe SDS leads to adequate and safe decompression of lumbar stenosis and results in a faster recovery of symptoms and disability in the early postoperative period.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

Archavlis

Nievas²

2013

Eur Spine J

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“…Some authors prefer to perform a laminectomy without fusion. It is argued that fusion after laminectomy is necessary to prevent instability and postoperative complications [13]. Some authors prefer the open interbody fusion and instrumentation in cases of spondylolisthesis with severe stenosis and spondylarthrosis [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…It is argued that fusion after laminectomy is necessary to prevent instability and postoperative complications [13]. Some authors prefer the open interbody fusion and instrumentation in cases of spondylolisthesis with severe stenosis and spondylarthrosis [13][14][15]. There is growing evidence that circumferential support through TLIF offers the advantage of avoiding the cost and morbidity of an anterior approach while providing equivalent clinical results with a lower rate of perioperative complications than PLIF [16].…”

Section: Introductionmentioning

confidence: 99%

Preliminary Results of Minimally Invasive Decompression, TLIF and Percutaneous Pedicle Screw Insertion in Stenotic Spondylolisthesis with Severe Facet Joint Osteoarthritis

Archavlis¹

2013

J Spine

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Object: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however, little data to assess whether these procedures in combination with minimally invasive transforaminal interbody fusion (MI-TLIF) and percutaneous pedicle screw insertion are effective in complex cases of stenotic degenerative spondylolisthesis with severe facet joint osteoarthritis (FJO). Methods:This study retrospectively reviewed all patients who underwent lumbar instrumentation, fusion and decompression for degenerative spondylolisthesis with severe stenosis and facet joint osteoarthritis (FJO) between June 2010 and June 2011. Blood loss, operative time and intraoperative complications were assessed in all surgically treated patients who were treated with MIS decompression, MI-TLIF and percutaneous transpedicular instrumentation. Clinical outcome was measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back pain, leg pain, and activity level. Satisfaction was assessed with VAS for satisfaction. Radiological follow-up includes x-ray films, computed tomography and in some cases magnetic tomography scan.Results: Twenty four cases with severe stenotic changes accompanied by severe FJO were treated with minimally invasive procedure. The minimum follow-up was 6 months with a mean of 8 months. The mean preoperative ODI score was 46.8, decreasing to a mean of 23 postoperatively. The mean VAS leg and back pain scores were 67.5 improving to means of 25.8. Twenty one out of 24 cases experienced a clinical benefit according to VAS for satisfaction and ODI. Complications included wound healing disturbance (4%), CSF fistula (4%) and contralateral radiculopathy due to articular bone spurs (8%). The accuracy of pedicle screws was high and only one revision surgery was performed.Conclusion: MIS for severe stenotic spondylolisthesis leads to adequate and safe decompression of lumbar stenosis and results in a highly significant reduction of symptoms and disability. MIS-TLIF and percutaneous pedicle screw insertion constitute a promising treatment alternative for patients with severe stenosis and facet joint osteoarthritis.

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Methodological Issues in Work Disability Prevention Research

Hogg‐Johnson

MacEachen

2013

Handbook of Work Disability

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Prospective analysis of surgical outcomes in patients undergoing decompressive laminectomy and posterior instrumentation for degenerative lumbar spinal stenosis

Abstract: Most patients with degenerative lumbar spinal stenosis benefit from decompressive surgery. Patients with long-standing preoperative symptoms and concomitant diseases often have poor results and are less satisfied with the postoperative outcome.

Cited by 22 publications

References 26 publications

Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

Preliminary Results of Minimally Invasive Decompression, TLIF and Percutaneous Pedicle Screw Insertion in Stenotic Spondylolisthesis with Severe Facet Joint Osteoarthritis

Methodological Issues in Work Disability Prevention Research

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