Surgical options for lumbar spinal stenosis

Machado, Gustavo C; Ferreira, Paulo H.; Yoo, Rafael Ij; Harris, Ian; Pinheiro, Marina B.; Koes, Bart W.; Tulder, Maurits W. van; Rzewuska, Magdalena; Maher, Christopher G.; Ferreira, Manuela L

doi:10.1002/14651858.cd012421

Cited by 99 publications

(103 citation statements)

References 144 publications

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“…e results of scientific and research studies are consistent in the conclusion that nonsteroidal anti-inflammatory drugs combined with muscle relaxants are effective methods of treating LBP [34][35][36][37]. Most literature sources indicate that staying in the reclined position has no effect on acute pain [38][39][40][41][42][43]. It has been repeatedly noted that the following factors play a role in the prevention of acute pain with mild aetiology: (i) Education of people with LBP in methods to avoid overloading (ii) Moderate physical activity, using decompression movements in a position without pain or a significantly reduced pain, relaxing and stabilizing structures (iii) Return to normal activity [34,35,37,39] However, given the fact that, in most cases (i.e., 70% of people with LBP) complaints are caused by the dysfunction of myofascial structures, the most important scientific research issue should be the systematization of manual therapy (MT) procedures.…”

Section: Introductionmentioning

confidence: 75%

Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics

Bitenc-Jasiejko

Konior²,

Lietz–Kijak

2020

Pain Research and Management

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Introduction. Lower back pain (LBP) is almost a problem of civilizations. Quite often, it is a consequence of many years of disturbed distribution of tension within the human body caused by local conditions (injuries, hernias, stenoses, spondylolisthesis, cancer, etc.), global factors (postural defects, structural integration disorders, lifestyle, type of activity, etc.), or systemic diseases (connective tissue, inflammation, tumours, abdominal aneurysm, and kidney diseases, including urolithiasis, endometriosis, and prostatitis). Therefore, LBP rehabilitation requires the use of integrated therapeutic methods, combining the competences of interdisciplinary teams, both in the process of diagnosis and treatment. Aim of the Study. Given the above, the authors of the article conducted meta-analysis of the literature in terms of integrated therapeutic methods, indicating the techniques focused on a holistic approach to the patient. The aim of the article is to provide the reader with comprehensive knowledge about treating LBP using noninterventional methods. Material and Methods. An extensive search for the materials was conducted online using PubMed, the Cochrane database, and Embase. The most common noninterventional methods have been described, as well as the most relevantly updated and previously referenced treatment of LBP. The authors also proposed noninvasive (measurable) diagnostic procedures for the functional assessment of the musculoskeletal system, including initial, systematic, and cross-sectional control. All figures and images have been prepared by the authors and are their property. Results. This review article goes beyond combining a detailed description of each procedure with full references, as well as a comprehensive discussion of this very complex and troublesome problem. Conclusions. Lower back pain is a serious health problem, and this review article will help educate physicians and physiotherapists dealing with LBP in the options of evidence-based treatment. Ultimately, the article introduces and postulates the need to systematize therapeutic procedures in LBP therapy, with a long-term perspective.

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Section: Introductionmentioning

confidence: 75%

Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics

Bitenc-Jasiejko

Konior²,

Lietz–Kijak

2020

Pain Research and Management

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“…Clinical and radiological investigation to rule out instability contralateral approach corridor Clinical findings with concordant imaging are key in patient selection. Anteroposterior, lateral, lumbar flexion, and extension roentgenogram should be obtained to rule out anteroposterior and lateral spinal instability [1,8].…”

Section: Description Of the Techniquementioning

confidence: 99%

How I do it? Uniportal full endoscopic contralateral approach for lumbar foraminal stenosis with double crush syndrome

Kim

Jang³

2019

Acta Neurochir

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Background Evolution of endoscopic surgery provides equivalent results to open surgery with advantages of minimal invasive surgery. The literature on technique Uniportal Full endoscopic contralateral approach is scarce. Methods The endoscopic contralateral approach technique applies for patients presenting with double crush syndrome with foraminal and extraforminal stenosis. The key steps focus on contralateral ventral overriding superior articular process decompression, foraminal and extraforaminal discectomy, and lateral vertebral syndesmophyte decompression leading to enlargement of the contralateral foramen and extraforamen size. Conclusion The Uniportal Full endoscopic contralateral approach is a good alternative to open surgery or minimally invasive microscopic surgery through direct endoscopic visualization of the entire route of exiting nerve with no neural retraction allowing both lateral recess and foraminal and extraforaminal decompression all in one approach.

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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%

“…17 There has been much attention paid to the question of decompression alone versus decompression plus fusion for the management of lumbar stenosis, particularly in the presence of degenerative spondylolisthesis. 10,[18][19][20][21][22][23][24] There is often a disconnect between the radiological severity of stenosis, and the severity of clinical symptoms. Consequently, a patient with severe narrowing and significant neural effacement may be asymptomatic or may present only with minor symptoms and vice versa.…”

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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Surgical options for lumbar spinal stenosis

Cited by 99 publications

References 144 publications

Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics

Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics

How I do it? Uniportal full endoscopic contralateral approach for lumbar foraminal stenosis with double crush syndrome

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

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