RESUMEN
BACKGROUND: Posterolateral decompression and fusion with internal fixation is a commonly used surgical approach for treating degenerative lumbar spinal stenosis (DLSS). This study aims to evaluate the impact of preserving a portion of the unilateral facet joint during decompression on surgical outcomes and long-term recovery in patients. METHODS: This study analyzed 73 patients with DLSS accompanied by bilateral lower limb neurological symptoms who underwent single-level L4/5 posterolateral decompression and fusion surgery from January 2022 to March 2023. Patients were categorized into two groups based on the type of surgery received: Group A comprised 31 patients who underwent neural decompression without facet joint preservation, while Group B consisted of 42 patients who underwent neural decompression with preservation of partial facet joints on one side. Regular follow-up evaluations were conducted, including clinical and radiological assessments immediately postoperatively, and at 3 and 12 months thereafter. Key patient information was documented through retrospective chart reviews. RESULTS: Most patients in both groups experienced favorable surgical outcomes. However, four cases encountered complications. Notably, during follow-up, Group B demonstrated superior 1-year postoperative interbody fusion outcomes (P < 0.05), along with a trend towards less interbody cage subsidence and slower postoperative intervertebral disc height loss. Additionally, Group B showed significantly reduced postoperative hospital stay (P < 0.05). CONCLUSION: Under strict adherence to surgical indications, the posterior lateral lumbar fusion surgery, which preserves partial facet joint unilaterally during neural decompression, can offer greater benefits to patients.
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Descompresión Quirúrgica , Vértebras Lumbares , Fusión Vertebral , Estenosis Espinal , Articulación Cigapofisaria , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Fusión Vertebral/métodos , Masculino , Femenino , Estudios Retrospectivos , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano , Persona de Mediana Edad , Descompresión Quirúrgica/métodos , Articulación Cigapofisaria/cirugía , Articulación Cigapofisaria/diagnóstico por imagen , Resultado del Tratamiento , Extremidad Inferior/cirugía , Estudios de SeguimientoRESUMEN
Lumbar stenosis (LS) often leads to debilitating symptoms due to nerve compression in the spinal canal. As this condition becomes increasingly prevalent among the elderly, innovative surgical techniques are crucial. This letter examines a recent advancement introduced by Marco Aurélio Moscatelli et al., who have developed an ipsilateral interlaminar endoscopic approach for decompression at the L5-S1 level. Their study, involving 30 patients with degenerative stenosis, reports significant improvements in quality-of-life metrics, including the Oswestry Disability Index (ODI) and visual analog scales (VAS) for pain. The new approach not only overcomes anatomical challenges specific to the L5-S1 region but also offers enhanced visualization and extensive decompression without destabilizing the spine. This letter highlights the promising results of this technique, the utility of the FAPDIS algorithm in guiding surgical choices, and the broader implications for minimally invasive lumbar surgery. The findings underscore a potential shift towards more effective and safer interventions for lumbar stenosis, paving the way for better patient outcomes in spinal decompression.
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Descompresión Quirúrgica , Vértebras Lumbares , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Vértebras Lumbares/cirugía , Descompresión Quirúrgica/métodos , Resultado del Tratamiento , Endoscopía/métodos , Región Lumbosacra/cirugía , Calidad de Vida , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
PURPOSE: The objective of this systematic review and metaanalysis is to compare the efficacy and safety of decompression alone versus decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. METHODS: A comprehensive search of the PubMed, Embase, Cochrane Library, and Ovid Medline databases was conducted to find randomized control trials (RCTs) or cohort studies that compared decompression alone and decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. Operation time; reoperation; postoperative complications; postoperative Oswestry disability index(ODI) scores and scores related to back and leg pain were collected from eligible studies for meta-analysis. RESULTS: We included 3 randomized controlled trials and 9 cohort studies with 6182 patients. The decompression alone group showed less operative time(P < 0.001) and intraoperative blood loss(p = 0.000), and no significant difference in postoperative complications was observed in randomized controlled trials(p = 0.428) or cohort studies(p = 0.731). There was no significant difference between the other two groups in reoperation(P = 0.071), postoperative ODI scores and scores related to back and leg pain. CONCLUSIONS: In this study, we found that the decompression alone group performed better in terms of operation time and intraoperative blood loss, and there was no significant difference between the two surgical methods in rate of reoperation and postoperative complications, ODI, low back pain and leg pain. Therefore, we come to the conclusion that decompression alone is not inferior to decompression and fusion in patients with single-level lumbar spinal stenosis with spondylolisthesis.
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Descompresión Quirúrgica , Vértebras Lumbares , Fusión Vertebral , Estenosis Espinal , Espondilolistesis , Humanos , Estenosis Espinal/cirugía , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/efectos adversos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Espondilolistesis/cirugía , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Tempo Operativo , ReoperaciónRESUMEN
BACKGROUND: Unilateral laminotomy for bilateral decompression (ULBD) has yielded positive results in the treatment of lumbar spinal stenosis (LSS). Unilateral biportal ULBD (UB-ULBD) and percutaneous endoscopic ULBD (PE-ULBD) are gaining popularity because of the progress that has been made in minimally invasive surgery (MIS). The objective of this study was to evaluate and compare the radiographic and clinical results of UB-ULBD and PE-ULBD. METHODS: This study retrospectively enrolled patients who underwent ULBD surgery for LSS. The patients were categorized into two groups on the basis of the surgical method: the UB-ULBD group and the PE-ULBD group. Data on the general demographic data, surgical details, clinical efficacy, radiography and complications were compared between the two groups were compared. The minimum follow-up duration was 12 months. RESULTS: A total of 113 LSS patients who had undergone ULBD at our institution were included, of whom 61 patients underwent UB-ULBD surgery and 52 underwent PE-ULBD surgery. The UB-ULBD group had a significantly shorter operation time (P < 0.05). The facet was significantly better preserved in the UB-ULBD group than in the PE-ULBD group, and the angle of ipsilateral facet joint resection in the UE-ULBD group was significantly smaller (P < 0.05). The ODI score, VAS score and modified Macnab criteria improved postoperatively in both groups. The UB-ULBD group had a 95.08% rate of excellent or good patient outcomes, whereas the PE-ULBD group had a 92.30% rate. CONCLUSION: Both UB-ULBD and PE-ULBD can provide favourable clinical outcomes when used to treat LSS. UB-ULBD is beneficial because of its shorter operation time, smaller angle of ipsilateral facet joint resection and better facet preservation, making it a viable and safe option for treating LSS while ensuring spinal stability.
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Descompresión Quirúrgica , Endoscopía , Laminectomía , Vértebras Lumbares , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Femenino , Masculino , Estudios Retrospectivos , Descompresión Quirúrgica/métodos , Laminectomía/métodos , Persona de Mediana Edad , Anciano , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Resultado del Tratamiento , Endoscopía/métodos , Estudios de Seguimiento , Tempo OperativoRESUMEN
BACKGROUND: To analyze the characteristics of an unnamed interlaminar ligaments(ILL) through magnetic resonance image (MRI), endoscopy and pathological examination. METHOD: A retrospective study was conducted to analyze the clinical data of patients who underwent posterior endoscopic surgery for lumbar disc herniation or lumbar spinal stenosis from January 2021 to February 2022 at our medical center. The height, width and cross-sectional thickness of the ligament was analyzed using T2 weighted MRI. Meanwhile, the morphological and pathological characteristics were also compared with those of the ligamentum flavum to highlight the differences between above mentioned ligaments. RESULT: Forty-three patients were included in this study, including 27 males and 16 females, with an average age of 46.6 ± 12.1y. There were 20 cases of lumbar disc herniation and 23 cases of lumbar spinal stenosis. The width, length, thickness of the ILL, the thickness of LF and surgical time in the lumbar disc group were 17.7 ± 3.5 mm, 4.3 ± 1.3 mm, 18.3 ± 3.5 mm, 5.3 ± 1.9 mm, 53.2 ± 14.5 min, respectively. In the lumbar spinal stenosis group, the corresponding parameters were 16.0 ± 3.1 mm, 4.1 ± 1.6 mm, 17.6 ± 4.8 mm, 6.3 ± 0.8 mm, 61.8 ± 12.4 min, respectively. The intergroup difference in thickness of the ligamentum flavum was statistically significant (P = 0.02). The difference in surgical time was also established(P = 0.04). Endoscopic differences were identified as to the location of the anchor points and appearances among the two ligaments. Significant differences in the density and direction of fibrous structures were also observed under biopsy. Under endoscopy, significant difference as to the grade of ILL thickness was established when compared regarding disease spectrum (P = 0.09.) CONCLUSION: The interlaminar ligament is a structure that has not yet been officially named, which has significant structural differences from those of the ligamentum flavum. For posterior endoscopic procedure, its clinical significance lies in its ability to serve as the endpoint of soft tissue channel establishment. The thickness of the ligamentum flavum in MRI and the thickness of ILL under endoscopy vary according to the disease spectrum.
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Endoscopía , Desplazamiento del Disco Intervertebral , Ligamento Amarillo , Vértebras Lumbares , Imagen por Resonancia Magnética , Estenosis Espinal , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Imagen por Resonancia Magnética/métodos , Endoscopía/métodos , Adulto , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/patología , Estenosis Espinal/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Ligamento Amarillo/diagnóstico por imagen , Ligamento Amarillo/patología , Ligamentos/diagnóstico por imagen , Ligamentos/patología , AncianoRESUMEN
BACKGROUND: To evaluate the treatment outcomes of lateral interbody bone graft surgery and posterior percutaneous screws for lumbar spinal stenosis Methods: This is a cross-sectional descriptive study. There were 27 patients with 30 segments of surgery diagnosed with lumbar spinal stenosis that were surgically treated with the XLIF method. Clinical outcomes measured included VAS scores for lower back pain and leg pain, ODI, and JOA scores. Magnetic resonance imaging of the lumbar spine after surgery was used to evaluate indirect decompression. X-ray or CT scan to evaluate bone fusion after 6 months of surgery. Differences were determined by independent T-test. RESULTS: There were 27 patients with 30 segments of surgery. They were 12 males and 15 females with an average age of 58.81±8.1. There was significant improvement in VAS for lower back pain from 7.11±1.31 to 3.67±1.3, VAS for leg pain from 6.81±2.19 to 1.59±1.89, ODI from 26.41±8.95 to 13.69±8.34, and JOA score from 7.63±2.87 to 13.5±1.73. A-P diameter increased 134%, lateral diameter increased 120%, lateral recess depth increased 166%, disc height increased 126%, foraminal height increased 124%, spinal canal area increased 30%. The p-values were all <0.001. The average hospital stay was 6.79±3.01 days. Complications included 1 pedicle screw malformation, 1 ALL avulsion fracture, 1 abdominal herniation, 1 venous damage, 1 failure. CONCLUSION: XLIF surgery presents a favorable option for patients with lumbar spinal stenosis. This is a minimally invasive surgical method that reduces pain, reduces bleeding, and is effective in indirectly decompressing the spinal canal both clinal and imaging.
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Vértebras Lumbares , Fusión Vertebral , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Masculino , Femenino , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Fusión Vertebral/métodos , Estudios Transversales , Imagen por Resonancia Magnética , Descompresión Quirúrgica/métodos , Dolor de la Región Lumbar/cirugía , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/etiología , Trasplante Óseo/métodos , Tomografía Computarizada por Rayos X , Tornillos ÓseosRESUMEN
BACKGROUND: The L5-S1 interlaminar access described in 2006 by Ruetten et al. represented a paradigm shift and a new perspective on endoscopic spinal approaches. Since then, the spinal community has shown that both the traditional ipsilateral and novel contralateral interlaminar approaches to the L5-S1 foramen are good alternatives to transforaminal access. This study aimed to provide a technical description and brief case series analysis of a new endoscopic foraminal and extraforaminal approach for pathologies at the lumbar L5-S1 level using a new ipsilateral interlaminar approach. METHODS: Thirty patients with degenerative stenotic conditions at the L5-S1 disc level underwent the modified interlaminar approach. The surgical time, blood loss, occurrence of complications, and clinical outcomes were recorded. The data were compiled in Excel and analyzed using R software version 4.2. All continuous variables are presented as the mean, median, minimum, and maximal ranges. For categorical variables, data are described as counts and percentages. RESULTS: Thirty patients were included in the study. The cohort showed significant improvements in all quality-of-life scores (ODI, visual analog scale of back pain, and visual analog scale of leg pain). Five cases of postoperative numbness and three cases of postoperative dysesthesia have been reported. No case of durotomy or leg weakness has been reported. CONCLUSIONS: The fundamental change proposed by this procedure, the new ipsilateral approach, presents potential advantages to surgeons by overcoming anatomical challenges at the L5-S1 level and by providing surgeon-friendly visualization and access. This approach allows for extensive foraminal and extraforaminal decompression, including the removal of hernias and osteophytosis, without causing neural retraction of the L5-S1 roots while maintaining the stability of the operated level.
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Descompresión Quirúrgica , Vértebras Lumbares , Humanos , Femenino , Masculino , Descompresión Quirúrgica/métodos , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Anciano , Adulto , Sacro/cirugía , Endoscopía/métodos , Estenosis Espinal/cirugía , Resultado del Tratamiento , Neuroendoscopía/métodosRESUMEN
OBJECTIVE: To assess whether decompression alone is non-inferior to decompression with instrumented fusion five years after primary surgery in patients with degenerative lumbar spondylolisthesis. DESIGN: Five year follow-up of a randomised, multicentre, non-inferiority trial (Nordsten-DS). SETTING: 16 public orthopaedic and neurosurgical clinics in Norway. PARTICIPANTS: Patients aged 18-80 years with symptomatic lumbar spinal stenosis and a spondylolisthesis of 3 mm or more at the stenotic level. INTERVENTIONS: Decompression surgery alone and decompression with additional instrumented fusion (1:1). MAIN OUTCOME MEASURES: The primary outcome was a 30% or more reduction in Oswestry disability index from baseline to five year follow-up. The predefined non-inferiority margin was a -15 percentage point difference in the proportion of patients who met the primary outcome. Secondary outcomes included the mean change in Oswestry disability index, Zurich claudication questionnaire, numeric rating scale for leg and back pain, and EuroQol Group 5-Dimension (EQ-5D-3L) questionnaire. RESULTS: From 12 February 2014 to 18 December 2017, 267 participants were randomly assigned to decompression alone (n=134) and decompression with instrumented fusion (n=133). Of these, 230 (88%) responded to the five year questionnaire: 121 in the decompression group and 109 in the fusion group. Mean age at baseline was 66.2 years (SD 7.6), and 69% were women. In the modified intention-to-treat analysis with multiple imputation of missing data, 84 (63%) of 133 people in the decompression alone group and 81 (63%) of 129 people in the fusion group had a at least a 30% reduction in Oswestry disability index, a difference of 0.4 percentage points. (95% confidence interval (CI) -11.2 to 11.9). The respective results of the per protocol analysis were 65 (65%) of 100 in the decompression alone group and 59 (66%) of 89 in the fusion group, a difference of -1.3 percentage points (95% CI -14.5 to 12.2). Both 95% CIs were higher than the predefined non-inferiority margin of -15%. The mean change in Oswestry disability index from baseline to five years was -17.8 in both groups (mean difference 0.02 (95% CI -3.8 to 3.9)). Results of the other secondary outcomes were in the same direction as the primary outcome. From two to five year follow-up, a new lumbar operation occurred in six (5%) of 123 people in the decompression group and 11 (10%) of 113 people in the fusion group, with a total from baseline to five years of 21 (16%) of 129 people and 23 (18%) of 125, respectively. CONCLUSIONS: In participants with degenerative spondylolisthesis, decompression alone was non-inferior to decompression with instrumented fusion five years after primary surgery. Proportions of subsequent surgeries at the index level or an adjacent lumbar level were no different between the groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT02051374.
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Descompresión Quirúrgica , Evaluación de la Discapacidad , Vértebras Lumbares , Fusión Vertebral , Espondilolistesis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Descompresión Quirúrgica/métodos , Estudios de Seguimiento , Vértebras Lumbares/cirugía , Noruega , Fusión Vertebral/métodos , Estenosis Espinal/cirugía , Espondilolistesis/cirugía , Resultado del TratamientoRESUMEN
In adult patients affected by degenerative disc disease with lumbar instability and chronic low back pain, spine surgery with lumbar fixation aims to reduce segmental instability and pain. Different techniques have been developed, but the optimal surgical technique remains controversial. No studies have compared the clinical and radiological outcomes between stand-alone pedicle screw fixation (SAPF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). This was a retrospective study. All patients who underwent surgery for single-level L4-L5 or L5-S1 lumbar stenosis, associated with minor lumbar instability and treated with SAPF or MI-TLIF techniques were included in the study. Data were collected preoperatively and at 24 monts follow-up. Clinical primary outcomes were Oswestry Disability Index (ODI) and Numerical Rating Scale (NRS). Secondary outcomes were patient satisfaction, walking ability and self reported back and leg pain. In addition, perioperative data and complications were recorded. Segmental lordosis (L4-L5 and L5-S1) and overall lumbar lordosis (L1-S1) were measured on lumbar X-Rays preoperatively and at least 24 months postoperatively. 277 patients were firstly identified. Baseline data and a minimum of two-year follow-up were available for 62 patients. After the propensity score matching, 44 patients (22 patients in the SAPF group and 22 patients in the MI-TLIF group) were matched. At 24 months follow-up, no difference between the two groups of patients in NRS (p = 0.11) and ODI scores (p = 0.21) were observed. Patients' satisfaction at follow-up was also not significantly different between the two groups. In both groups, a significant improvement in the walked distance was observed after surgery (p = 0.05) while no difference was observed regarding the type of surgery performed (p = 1.00). No differences were found in the pre- and post-operative median lumbar lordosis (p = 0.91 and p = 0.67) and the same findings were observed for lumbar segmental lordosis (p = 0.65 and p = 0.41 respectively). Significant improvements in ODI and NRS-scores were recorded after 24 months follow-up with both SAPF and MI-TLIF. No significant differences in postoperative PROMs and patients' satisfaction were observed between the groups. The results of our study indicate no superiority of either surgical technique concerning pain and functional outcomes after 24 months.
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Vértebras Lumbares , Procedimientos Quirúrgicos Mínimamente Invasivos , Tornillos Pediculares , Fusión Vertebral , Humanos , Masculino , Femenino , Fusión Vertebral/métodos , Fusión Vertebral/instrumentación , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Estudios Retrospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento , Degeneración del Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/diagnóstico por imagen , Anciano , Adulto , Puntaje de Propensión , Estudios de Cohortes , Estudios de Seguimiento , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagenRESUMEN
Conventional open laminectomy has long been considered one of the important surgical options for lumbar central stenosis owing to its positive outcomes. However, newer approaches have emerged as alternatives, including full-endoscopic and biportal endoscopic laminectomy. Therefore, a comparison of the outcomes that are associated with each of these surgical methods is warranted. This prospective multicenter trial, initiated in February 2019, compared the outcomes of three lumbar central stenosis surgical approaches: open laminectomy (OPEN), uniportal endoscopy (UNIPORT), and biportal endoscopy (BIPORT). Among 115 participants from seven centers, one-year follow-ups assessed laboratory, radiological, and clinical outcomes. Despite all groups showing adequate decompression and clinical improvement, the OPEN group exhibited less improvement in Visual analog scale (VAS) for back pain scores (p < 0.05) and significant postoperative increases in most laboratory markers. Furthermore, the OPEN group experienced a significant decrease in multifidus muscle cross-sectional area compared to endoscopic groups (p < 0.001). Each surgical techniques produced similar clinical outcomes and dural space expansion. However, endoscopic surgery was associated with better muscle preservation and better relief of back pain. Endoscopic surgery is a reasonable alternative to conventional laminectomy for treating lumbar central stenosis.This trial was registered on CRIS (Clinical Research Information Service, KCT0004355).
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Descompresión Quirúrgica , Endoscopía , Laminectomía , Vértebras Lumbares , Estenosis Espinal , Humanos , Laminectomía/métodos , Estenosis Espinal/cirugía , Masculino , Descompresión Quirúrgica/métodos , Femenino , Vértebras Lumbares/cirugía , Endoscopía/métodos , Estudios Prospectivos , Anciano , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Patients surgically treated for lumbar spinal stenosis or cervical radiculopathy report improvement in approximately two out of three cases. Advancements in Machine Learning and the utility of large datasets have enabled the development of prognostic prediction models within spine surgery. This trial investigates if the use of the postoperative outcome prediction model, the Dialogue Support, can alter patient-reported outcome and satisfaction compared to current practice. METHODS: This is a prospective, multicenter clinical trial. Patients referred to a spine clinic with cervical radiculopathy or lumbar spinal stenosis will be screened for eligibility. Participants will be assessed at baseline upon recruitment and at 12 months follow-up. The Dialogue Support will be used on all participants, and they will thereafter be placed into either a surgical or a non-surgical treatment arm, depending on the decision made between patient and surgeon. The surgical treatment group will be studied separately based on diagnosis of either cervical radiculopathy or lumbar spinal stenosis. Both the surgical and the non-surgical group will be compared to a retrospective matched control group retrieved from the Swespine register, on which the Dialogue Support has not been used. The primary outcome measure is global assessment regarding leg/arm pain in the surgical treatment group. Secondary outcome measures include patient satisfaction, Oswestry Disability Index (ODI), EQ-5D, and Numeric Rating Scales (NRS) for pain. In the non-surgical treatment group primary outcome measures are EQ-5D and mortality, as part of a selection bias analysis. DISCUSSION: The findings of this study may provide evidence on whether the use of an advanced digital decision tool can alter patient-reported outcomes after surgery. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov on April 17th, 2023, NCT05817747. PROTOCOL VERSION: 1. TRIAL DESIGN: Clinical multicenter trial.
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Macrodatos , Vértebras Lumbares , Medición de Resultados Informados por el Paciente , Radiculopatía , Estenosis Espinal , Humanos , Estudios Prospectivos , Estenosis Espinal/cirugía , Vértebras Lumbares/cirugía , Radiculopatía/cirugía , Resultado del Tratamiento , Satisfacción del Paciente , Vértebras Cervicales/cirugía , Estudios Multicéntricos como Asunto , Masculino , Femenino , Dimensión del DolorRESUMEN
BACKGROUND: Morphometric analysis of the psoas major muscle has shown utility in predicting postoperative morbidity in various surgical fields, but its usefulness in predicting complications in elderly patients undergoing multilevel lumbar fusion surgery has not been studied. The study aimed to investigate if psoas major parameters are independent risk factors of early postoperative complication among elderly patients. METHODS: Patients who underwent multilevel lumbar fusion for degenerative lumbar spinal stenosis (DLSS) were included. The psoas major was measured at the lumbar 3/4 intervertebral disc level in three ways on computed tomography image: psoas muscle mass index, mean muscle attenuation, and morphologic change of the psoas major. Early complications were graded using the Clavien-Dindo classification system and the Comprehensive complication index (CCI). A CCI ≥ 26.2 indicated severe complications. Logistic regression was performed to identify independent risk factors. RESULTS: This retrospective study reviewed 108 patients (mean age 70.9 years, female to male ratio 1.8:1). Complications were observed in 72.2% of patients, with allogeneic blood transfusion being the most frequent (66.7%), followed by wound infection, acute heart failure (2.8% each). Severe complications occurred in 13.9% of patients. After multivariable regression analysis, those in the lowest psoas muscle attenuation tertile had higher odds of experiencing early postoperative complications (OR: 3.327, 95% CI 1.134-9.763, p = 0.029) and severe complications (OR: 6.964, 95% CI 1.928-25.160, p = 0.003). CONCLUSION: The psoas muscle attenuation can be used as a predictor of early postoperative complications in elderly patients undergoing multilevel lumbar fusion surgery for DLSS.
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Vértebras Lumbares , Complicaciones Posoperatorias , Músculos Psoas , Fusión Vertebral , Estenosis Espinal , Humanos , Masculino , Femenino , Anciano , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Músculos Psoas/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Anciano de 80 o más Años , Tomografía Computarizada por Rayos X , Persona de Mediana EdadRESUMEN
BACKGROUND: Tandem spinal stenosis (TSS) is a condition characterized by the narrowing of the spinal canal in multiple segments of the spine. Predominantly observed in the cervical and lumbar regions, TSS also manifests in the conjunction of the cervical and thoracic spine. The simultaneous occurrence of cervical and thoracic spinal stenosis engenders intricate symptoms, potentially leading to missed and delayed diagnosis. Furthermore, the presence of tandem cervical and thoracic stenosis (TCTS) introduces a notable impact on the decision-making calculus of surgeons when contemplating either one-staged or two-staged surgery. Currently, there is no agreed-upon strategy for surgical intervention of TCTS in the literature. METHODS: Medical databases in English (Pubmed, Web of Science, Embase, the Cochrane Database of Systematic Reviews) and Chinese (CNKI, Wanfang Data, VIP CMJD) were searched using Medical Subject Heading queries for the terms "tandem cervical and thoracic stenosis", "cervical stenosis AND thoracic stenosis", "tandem spinal stenosis" and "concomitant spinal stenosis" from January 1980 to March 2023. We included studies involving adult individuals with TCTS. Articles exclusively focused on disorders within a single spine region or devoid of any mention of spinal disorders were excluded. RESULTS: Initially, a total of 1625 literatures underwent consideration for inclusion in the study. Following the elimination of the duplicates through the utilization of EndNote, and a meticulous screening process involving scrutiny of abstracts and full-texts, 23 clinical studies met the predefined inclusion criteria. Of these, 2 studies solely focused on missed diagnosis, 19 studies exclusively discussed surgical strategy for TCTS, and 2 articles evaluated both surgical strategy and missed diagnosis. CONCLUSION: Our study revealed a missed diagnosis rate of 7.2% in TCTS, with the thoracic stenosis emerging as the predominant area susceptible to oversight. Therefore, the meticulous identification of TCTS assumes paramount significance as the inaugural step in its effective management. While both one-staged and two-staged surgeries have exhibited efficacy in addressing TCTS, the selection of the optimal surgical plan should be contingent upon the individualized circumstances of the patients.
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Vértebras Cervicales , Estenosis Espinal , Vértebras Torácicas , Humanos , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico , Descompresión Quirúrgica/métodosRESUMEN
Remarkable innovations in spinal endoscopic surgery have broadened its applications over the past 20 years. Full-endoscopic fusions have been widely reported, and several full-endoscopic approaches for interbody fusion have been published. In general, full-endoscopic lumbar interbody fusion (LIF) is called Endo-LIF, and facet-preserving Endo-LIF through the transforaminal route is called trans-Kambin's triangle LIF, which has a relatively longer history than facet-sacrificing Endo-LIF via the posterolateral route. Both approaches can reduce intraoperative and postoperative bleeding. However, there is a higher risk of subsidence and exit nerve root injury. There is no direct decompression in either of the interbody fusions, and additional decompression is required if there is severe lumbar bony canal stenosis. However, the posterior interlaminar approach, which is a well-known standard in full-endoscopic spine surgery, has rarely been applied in the field of endoscopic lumbar fusion surgery. Full-endoscopic posterior LIF (FE-PLIF) via an interlaminar approach can accomplish direct decompression of bony canal stenosis and safe interbody fusion. FE-PLIF via an interlaminar approach demonstrated a longer operation time, less blood loss, and shorter hospitalization duration than minimally invasive transforaminal LIF. FE-PLIF, which can accomplish direct decompression for bony spinal canal stenosis, is superior to other Endo-LIFs. However, FE-PLIF requires technical dexterity to improve efficiency and reduce technical complexity.
Asunto(s)
Vértebras Lumbares , Fusión Vertebral , Humanos , Fusión Vertebral/métodos , Vértebras Lumbares/cirugía , Estenosis Espinal/cirugía , Neuroendoscopía/métodos , Descompresión Quirúrgica/métodos , Endoscopía/métodosRESUMEN
RATIONALE: Dysphagia after anterior cervical discectomy and fusion (ACDF) is a common postoperative complication. However, information regarding rehabilitation strategies for postoperative dysphagia is limited. Herein, we report a compensatory strategy for treating dysphagia after ACDF. PATIENT CONCERNS: A 65-year-old Asian male presented with left arm pain and weakness for more than 1 month. Magnetic resonance imaging of the cervical spine revealed degenerative disc lesions and spinal stenosis at the C3 to C7 levels. The patient underwent ACDF at the C3 to C5 levels and artificial disc replacement at the C5 to C7 levels by right side approach. After surgery, the patient complained of difficulty swallowing. A video fluoroscopic swallowing study (VFSS) detected swallowing dysfunction in the pharyngeal phase, revealing an asymmetric pharyngeal residue in the anterior-posterior view. DIAGNOSIS: The patient was diagnosed with dysphagia after ACDF. INTERVENTIONS: Based on the VFSS findings, the patient underwent swallowing rehabilitation therapy and compensatory techniques, such as head rotation to the weak right side and head tilting to the robust left side. OUTCOMES: After 2 months of rehabilitation with compensatory techniques, food moved smoothly towards the robust side, and the subjective symptoms of dysphagia improved. LESSONS: Consequently, swallowing function post-ACDF surgery must be assessed; if unilateral dysphagia is detected, compensatory techniques may prove beneficial. This case study showed that, based on the objective findings of the VFSS, an effective swallowing compensation strategy can be established and applied to patients with postoperative dysphagia.
Asunto(s)
Vértebras Cervicales , Trastornos de Deglución , Discectomía , Complicaciones Posoperatorias , Fusión Vertebral , Humanos , Masculino , Trastornos de Deglución/etiología , Trastornos de Deglución/rehabilitación , Anciano , Vértebras Cervicales/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Discectomía/efectos adversos , Discectomía/métodos , Complicaciones Posoperatorias/etiología , Estenosis Espinal/cirugíaRESUMEN
Objective: To investigate the short-term effectiveness of unilateral biportal endoscopy (UBE) in treatment of lumbar lateral saphenous fossa combined with intervertebral foramina stenosis via contralateral sublaminar approach. Methods: A clinical data of 15 patients with lumbar lateral saphenous fossa combined with intervertebral foramina stenosis, who were admitted between September 2021 and December 2023 and met selective criteria, was retrospectively analyzed. There were 5 males and 10 females with an average age of 70.3 years (range, 46-83 years). Surgical segment was L 4, 5 in 12 cases and L 5, S 1 in 3 cases. The disease duration was 12-30 months (mean, 18.7 months). All patients were treated by UBE via contralateral sublaminar approach. The operation time, intraoperative blood loss, postoperative hospital stay, and the occurrence of complications were recorded. The visual analogue scale (VAS) score was used to evaluate the degree of lower back and leg pain before and after operation; the Japanese Orthopaedic Association (JOA) score and the Oswestry disability index (ODI) were used to evaluate the lumbar function; and the clinical outcome was evaluated using the MacNab criteria at 6 months after operation. Postoperative MRI and CT were taken to observe whether the lateral saphenous fossa and intervertebral foramen stenosis were removed or not, and the cross-sectional area of the spinal canal (CSA-SC), cross-sectional area of the intervertebral foramen (CSA-IVF), and cross-sectional area of the facet joint (CSA-FJ) were measured. Results: The operation time was 55-200 minutes (mean, 127.5 minutes); the intraoperative blood loss was 10-50 mL (mean, 27.3 mL); the length of postoperative hospital stay was 3-12 days (mean, 6.8 days). All patients were followed up 6-12 months (mean, 8.9 months). At 1 day, 1 month, 3 months, and 6 months after operation, the VAS scores of low back and leg pain and ODI scores after operation were significantly lower than preoperative scores and showed a gradual decrease with time; the JOA scores showed a gradual increase with time; the differences in the above indexes between different time points were significant ( P<0.05). The clinical outcome was rated as excellent in 10 cases, good in 4 cases, and poor in 1 case according to the MacNab criteria at 6 months after operation, with an excellent and good rate of 93.33%. Imaging review showed that the compression on the lateral saphenous fossa and intervertebral foramina had been significantly relieved, and the affected articular process joint was preserved to the maximum extent; the CSA-SC and CSA-IVF at 3 days after operation significantly increased compared to the preoperative values ( P<0.05), and the CSA-FJ significantly reduced ( P<0.05). Conclusion: The UBE via contralateral sublaminar approach can effectively reduce pressure in the lateral saphenous fossa and the intervertebral foramina of the same segment while preserving the bilateral articular process joints. The short-term effectiveness is good and it is expected to avoid fusion surgery caused by iatrogenic instability of the lumbar spine. However, further follow-up is needed to clarify the mid- and long-term effectiveness.
Asunto(s)
Endoscopía , Vértebras Lumbares , Estenosis Espinal , Humanos , Masculino , Femenino , Estenosis Espinal/cirugía , Persona de Mediana Edad , Anciano , Vértebras Lumbares/cirugía , Endoscopía/métodos , Resultado del Tratamiento , Anciano de 80 o más Años , Descompresión Quirúrgica/métodos , Dimensión del Dolor , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/cirugíaRESUMEN
STUDY DESIGN: A systematic review and Bayesian network meta-analysis (NMA). OBJECTIVE: To compare the effectiveness and safety of different posterior decompression techniques for LSS. Lumbar spinal stenosis (LSS) is one of the most common degenerative spinal diseases that result in claudication, back and leg pain, and disability. Currently, posterior decompression techniques are widely used as an effective treatment for LSS. METHODS: An electronic literature search was performed using the EMBASE, Web of Science, PubMed, and Cochrane Library databases. Two authors independently performed data extraction and quality assessment. A Bayesian random effects model was constructed to incorporate the estimates of direct and indirect treatment comparisons and rank the interventions in order. RESULTS: In all, 14 eligible studies comprising 1,260 patients with LSS were included. Five interventions were identified, namely, spinal processes osteotomy (SPO), conventional laminotomy/laminectomy (CL), unilateral laminotomy/laminectomy (UL), bilateral laminotomy/ laminectomy (BL), and spinous process-splitting laminotomy/laminectomy (SPSL). Among these, SPO was the most promising surgical option for decreasing back and leg pain and for lowering the Oswestry Disability Index (ODI). SSPL had the shortest operation time, while SPSL was associated with maximum blood loss. SPO and UL were superior to other posterior decompression techniques concerning lesser blood loss and shorter length of hospital stay, respectively. Patients who underwent BL had the lowest postoperative complication rates. CONCLUSION: Overall, SPO was found to be a good surgical choice for patients with LSS.