Radiographic Predictors of Residual Low Back Pain After Laminectomy for Lumbar Spinal Canal Stenosis

Xia, Yingpeng; Ishii, Ken; Matsumoto, Morio; Nakamura, Masaya; Toyama, Yoshiaki; Chiba, Kazuhiro

doi:10.1097/bsd.0b013e318074dded

Cited by 15 publications

(7 citation statements)

References 23 publications

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“…Of 18 studies, three failed to produce the data needed for the meta-synthesis [27][28][29]. Thus, the quantitative meta-analysis was performed on 15 studies [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. LSS had been used as an inclusion criterion in 15 studies.…”

Section: Resultsmentioning

confidence: 99%

Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

et al. 2021

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Purpose Positive spinal sagittal alignment is known to correlate with pain and disability. The association between lumbar spinal stenosis and spinal sagittal alignment is less known, as is the effect of lumbar decompressive surgery on the change in that alignment. The objective was to study the evidence on the effect of lumbar decompressive surgery on sagittal spinopelvic alignment. Methods The Cochrane Controlled Trials Register (CENTRAL), Medline, Embase, Scopus and Web of Science databases were searched in October 2019, unrestricted by date of publication. The study selection was performed by two independent reviewers. The risk of systematic bias was assessed according to the NIH Quality Assessment Tool. The data were extracted using a pre-defined standardized form. Results The search resulted in 807 records. Of these, 18 were considered relevant for the qualitative analysis and 15 for the meta-synthesis. The sample size varied from 21 to 89 and the average age was around 70 years. Decompression was mostly performed on one or two levels and the surgical techniques varied widely. The pooled effect sizes were most statistically significant but small. For lumbar lordosis, the effect size was 3.0 (95% CI 2.2 to 3.7) degrees. Respectively, for pelvic tilt and sagittal vertical axis, the effect sizes were − 1.6 (95% CI .2.6 to − 0.5) degrees and − 9.6 (95% CI − 16.0 to − 3.3) mm. Conclusions It appears that decompression may have a small, statistically significant but probably clinically insignificant effect on lumbar lordosis, sagittal vertical axis and pelvic tilt.

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Section: Resultsmentioning

confidence: 99%

Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

et al. 2021

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“…Wide decompression leads to a greater incidence of postoperative instability, progressive stenosis, and recurrence of LBP or leg symptoms [25-27]. Biomechanical studies have also reported a positive correlation between the extent of decompression and instability [24].…”

Section: Discussionmentioning

confidence: 99%

Does the Surgical Timing and Decompression Alone or Fusion Surgery in Lumbar Stenosis Influence Outcome in Cauda Equina Syndrome?

et al. 2019

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Study Design A retrospective comparative analysis of 64 patients with cauda equina syndrome (CES), who underwent either decompression alone (NF) or fusion (F) surgery. Purpose We compared the outcomes and timing effects. Overview of Literature CES can cause loss of autonomic control of vesicular function and lower limb neurological deficits. Prompt diagnosis and emergency surgery markedly improve outcome. Although decompression only is a mainstream technique, there is guarded recovery of vesicular dysfunction. Decompression ventrally in a narrow window requires manipulation of neural tissue in an already jeopardised critical canal and may accentuate irreversible damages. In F surgery, the adequate exposure leads to a lower neural manipulation. Methods Until January 2008, we treated CES with decompression (laminectomy and/or discectomy). However, from that month forward, all our single-level CES patients have received a fusion operation. In this study, characteristic categorical variables and outcomes were analysed. Results In a retrospective analysis of 64 patients, NF (n=37) and F (n=27) who received treatment, we found that both groups improved significantly on follow-up in all objective parameters. Although, the comparison of clinical and functional outcome data between the two groups was statistically insignificant, the average value of objective outcome such as vesicular function, low back pain (LBP), and complications was better for patients in F group compared with NF group. However, the patient satisfaction for the F group was also lower, in view of their residual symptoms and disabilities. Contrary to common perceptions, we found that the timing of surgery does not influence the recovery rate for either approach. Conclusions Although both the techniques appear to be equally effective, the fusion approach overall showed a definite edge over non-fusion, with respect to reduced incidence of iatrogenic dural tears, LBP, and overall outcome, even despite the lower patient satisfaction.

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“…In addition, since many authors reported long term deterioration of surgical outcomes, relatively shorter term outcome reports may have some demerit in acceptance as generalized scientific data 2,9,35,44,52,62) . The overall successful outcomes of surgical treatments for lumbar spinal stenosis, based on retrospective studies with more than 4-year follow up, were 23.8-91% according to various outcome assessment tools (Table 2) 1,11,12,14,21,22,25,26,34,36,[50][51][52]56,61) . In 1997, Airaksinen et al studied 438 patients with lumbar spinal stenosis and average 4.6-year follow up period after surgery and noted a good to excellent outcome in 62% of the patients 1) .…”

Section: Long-term Surgical Outcomesmentioning

confidence: 99%

“…Another studies did not find associated spondyolisthesis in lumbar spinal stenosis as a prognostic factor 25,56) . Some authors postulated decreasing preoperative lumbar lordosis angle and lumbar range of motion, more than 10 degrees of sagittal rotation angle, more than 50 degrees of facet angle, disc height over 6.5 mm, and motion at the spondylolisthetic level more than 1.25 mm as unfavorable prognostic factors 10,28,61) .…”

Section: Radiologic Factorsmentioning

confidence: 99%

“…However, most researchers have reported repeated surgeries in their studies regardless of surgical modalities ( Table 7). The reoperation rates were varied from 3.7% to 23% in retrospective studies 3,4,12,14,21,25,36,43,50,56,61) , from 6.2% to 35% in prospective studies 9,10,18,19,32) , and from 4 to 13% in randomized trials 1,44,47,49,59) . According to population based studies, cumulative reoperation rates were ranged 2-7.2% within one year, 5-9.4% within 2 years, 8-14.2% within 5 years, and 11-22.9% within 10 years postoperatively (Table 8) 16,30,39,45) .…”

Section: Repeated Surgerymentioning

confidence: 99%

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