We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences. The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded.Aims
Methods
A clinical retrospective study was conducted. Results of isolated decompression for degenerative lumbar stenosis was compared with the outcome in patients who underwent decompression-stabilisation. From January 1992 to December 2002, 127 patients (average age 65.5) with lumbar degenerative stenosis surgically treated were studied. In all patients the Roy-Camille technique was used for decompression; in 41 patients decompression and posterior stabilisation procedures were carried out. Average follow-up was 6 years (range 2–11 years). The outcomes, evaluated according to Lassale classification, were satisfactory in 81% of the decompressed group while improved to 88% in the stabilised–decompressed group. Three patients of the first group required stabilisation for intractable low back pain (one patient) and lumboradicular symptoms (two patients), while problems related to the device (one hardware failure) and two instances of adjacent segmental instability were seen in the second group.
To compare the efficacy of decompression alone (DA) with i) decompression and fusion (DF) and ii) interspinous process device (IPD) in the treatment of lumbar stenosis with degenerative spondylolisthesis. Outcomes of interest were both patient-reported measures of postoperative pain and function, as well as the perioperative measures of blood loss, operation duration, hospital stay, and reoperation. Data were obtained from electronic searches of five online databases. Included studies were limited to randomised-controlled trials (RCTs) which compared DA with DF or IPD using patient-reported outcomes such as the Oswestry Disability Index (ODI) and Zurich Claudication Questionnaire (ZCQ), or perioperative data. Patient-reported data were reported as part of the systematic review, while meta-analyses were conducted for perioperative outcomes in MATLAB using the DerSimonian and Laird random-effects model. Forest plots were generated for visual interpretation, while heterogeneity was assessed using the Aims
Methods
Symptomatic lumbar spinal stenosis is a common entity and increasing in prevalence. Limited evidence is available regarding patient reported outcomes comparing primary vs revision surgery for those undergoing lumbar decompression, with or without fusion. Evidence available suggest a lower rate of improvement in the revision group. The aim of this study was to assess patient reported outcomes in patients undergoing revision decompression, with or without fusion, when compared to primary surgery. Patient data was collected from the Canadian Spine Outcomes Research Network (CSORN) database. Patients undergoing lumbar decompression without or without fusion were included. Patients under 18, undergoing discectomy, greater than two level decompressions, concomitant cervical or thoracic spine surgery were excluded. Demographic data, smoking status, narcotic use, number of comorbidities as well as individual comorbidities were included in our propensity scores. Patients undergoing primary vs revision decompression were matched in a four:one ratio according to their scores, whilst a separate matched cohort was created for those undergoing primary vs revision decompression and fusion. Continuous data was compared using a two-tailed t-test, whilst categorical variables were assessed using chi-square test. A total of 555 patients were included, with 444 primary patients matched to 111 revision surgery patients, of which 373 (67%) did not have fusion. Patients undergoing primary decompression with fusion compared to revision patients were more likely to answer yes to “feel better after surgery” (87.8% vs 73.8%, p=0.023), “undergo surgery again” (90.1% vs 76.2%, P=0.021) and “improvement in mental health” (47.7% vs 28.6%, p=0.03) at six months. There was no difference in either of these outcomes at 12 or 24 months. There was no difference between the groups ODI, EQ-5D, SF 12 scores at any time point. Patients undergoing primary vs revision decompression alone showed no difference in PROMs at any time point. In a matched cohort, there appears to be no difference in improvement in PROMS between patients undergoing primary vs revision decompression, with or without fusion, at two year follow-up. This would suggest similar outcomes can be obtained in revision cases.
The purpose of the study was to evaluate if use of the ArthroCare Radiofrequency Ablation Wand caused excess heating and collateral damage to the surrounding tissues during Arthroscopic Subacromial
Lumbar spinal stenosis (LSS) is a common spinal disorder mostly caused by the arthritic process. In cases with refractory complaints or significant neurologic deficit, decompressive surgery with or without instrumented fusion may be indicated. We aimed to investigate the surgical outcome of multi-level LSS in the patient with stable spine treated by simple decompression versus decompression and instrumented fusion. Methods: We retrospectively studied 51 patients (25 male, 26 female) with stable multi-level (>2 levels) LSS who were treated by decompressive surgery alone (group A, 31 cases) and decompression and instrumented fusion (group B, 20 cases) and followed them for more than two years. The patients’ disability and pain were assessed with Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), respectively. At the last follow-up visit, patient satisfaction with surgery was also scored. Results: The two groups were homogeneous in terms of age, sex, severity of disability and pain. Surgery could significantly improve pain and disability in both groups. Preoperative ODI in group A and B were 51.0±23.7 and 54.5±22.9, respectively, however at the last follow-up visit these parameters improved to 23.1±21.1 and 36.6±21.4 showing a statistical significance. Mean patient satisfaction with surgical intervention was also higher in the simple decompression group, but this difference was not significant. Conclusion: In surgical treatment of the patients with multi-level but stable LSS, simple decompression versus decompression and instrumented fusion could achieve more disability improvement for more than two years of follow-up.Objective
Spinal stenosis is a condition resulting in the compression of the neural elements due to narrowing of the spinal canal. Anatomical factors including enlargement of the facet joints, thickening of the ligaments, and bulging or collapse of the intervertebral discs contribute to the compression.
The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis).Aims
Methods
Introduction.
Study Design. A prospective cohort study was carried out looking at the functional outcome and post-procedure translational segmental instability after multi-level lumbar decompression using a Hinge osteotomy technique. Objective. The Hinge osteotomy technique involves unilateral subperiosteal muscle dissection with osteotomy of the base of the spinous processes thereby preserving the integrity of the posterior elements. The objective of this study was to demonstrate the results of this technique clinically and radiologically. Methods. Between February 2005 and February 2007, 120 patients (51 male and 69 female) diagnosed with degenerative and/or congenital lumbar stenosis with a mean age of 64 years, underwent central and bilateral canal decompression using the hinge osteotomy technique. A mean of 2 segments (range 2-4) was decompressed. All patients were followed up for a minimum of three years. Five outcome measures were used: visual analogue scale for leg pain, Likert scale for functional status, symptom specific well-being score, general well-being score, and ODI score. The outcome measures were recorded pre-operatively and at 6 months and 3 years post-operatively. Successful surgical outcome was defined as an improvement in at least four out of five outcome measures. Results. 108 patients (90%) had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (p< 0.001) when measured at the 6-month post-operative mark as compared to pre-operatively, with further marginal significant improvement (p< 0.05) at 3 years post-surgery. There was no evidence of progressive lumbar segmental instability at 3 years post-operatively. Conclusion.
We carried out a prospective study looking at the functional outcome and post-procedure segmental instability after lumbar decompression using a flip osteotomy technique that involved unilateral subperiosteal muscle dissection with hinging of the spinous processes thereby preserving the integrity of the posterior elements for unilateral or bilateral lumbar spine decompression. Between February 2007 and February 2008, 51 patients (29 male and 22 female) diagnosed with degenerative and congenital lumbar stenosis with an average age of 60, underwent central and lateral canal decompression using the flip osteotomy technique. An average of two segments (range 1-3 segments) was decompressed. Patients with a history of previous spinal surgery, spinal fusion, existing degenerative spondylolisthesis or cauda equina syndrome were excluded. All patients were followed up for a mean of 1.5 years. Five outcome measures were used – visual analogue scale for pain, Likert scale for functional status, symptom specific well-being score, general well-being score, number of days incapacitated in last 4 weeks. The outcomes measures were recorded pre-operatively, 6 weeks and one year post-operatively. Successful surgical outcome was defined as an improvement in at least four out of five outcome measures. 90% (46 patients) of patients had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (p<0.005) at the 6-week post-operative mark as compared to pre-operatively, with marginal improvement at one year post-surgery. There was no evidence of progressive lumbar segmental instability at one year post-operatively using our flip osteotomy technique.
To determine if the surface area of partial thickness (<
50%), Bursal side tears of the cuff influence outcome following Subacromial
Introduction and Aims: To determine if the surface area of partial thickness (<
50%), Bursal side tears of the cuff influence outcome following Subacromial
The use of interspinous distraction devices should remain the subject of audit and research. They are a relatively new addition to the armamentarium of surgical treatment of lumbar spinal stenosis. The reported results are variable and there are a number of different devices available. It is recognised that there is an early failure rate with interspinous distraction devices. This is a report of the clinical results after conversion to segmental lumbar decompression following a failure of interspinous distraction procedure. 18 patients had removal of device and conversion to a standard lumbar decompression at an average of 13 months after the index procedure. There were 7 females and 11 males. The average age was 68 years (range 49-85). The two youngest patients had a decompression and instrumented fusion, the others had decompression alone. Prior to the Index procedure of stand alone interspinous distraction device the average Oswestry Disability Index (ODI) was 42 and Visual Analogue Score (VAS) leg 7.2. Prior to revision the average ODI was 42 and VAS leg 6.7. Complications: One intra operative myocardial infarction, one incidental durotomy and one post operative infection (pseudomonas isolated). At a mean of 9 months follow up the average ODI was 23 and VAS leg 2.1. The VAS back was 1.9. The walking distance was subjectively reported as 246 yards pre op and 1100 yards post procedure. There was a clinically significant improvement in all patients. A failed interspinous distraction device can be satisfactorily salvaged with a segmental lumbar decompression.
The Patient Evaluation Measure (PEM) was designed at the Derby consensus meeting in 1995. It was validated for Carpal Tunnel Syndrome (CTS) in 2005 (Hobby et al) and was preferable to the DASH score for CTS assessment. We aimed to audit CTS treated by surgical decompression in our unit using the PEM, and to compare our results with the published literature. Thirty consecutive patients undergoing carpal tunnel decompression were questioned about one hand. Patients completed a preoperative PEM and a postoperative PEM at 3 months. Mean PEM scores improved from 41.3 to 23.9 (P<
0.001). Individual questions showed statistically significant improvements in mean scores: Feeling in the hand, Cold intolerance, Pain, Dexterity, Movement and Hand in general (all P<
0.001): Work (P<
0.005): ADL (P<
0.01): Movements, Grip and Appearance (P<
0.05). Our results are similar to previously published series, both overall, and for individual questions in the PEM. Results for Carpal Tunnel
To assess the incision used for routine primary Carpal Tunnel
Sub-Acromial
Tibialis posterior tendon (TPT) dysfunction is a disorder of unknown aetiology. Trauma, inflammatory processes, anatomical abnormalities and iatrogenic factors have all been implicated as causative mechanisms. The condition presents with pain and swelling around the medial malleolus. The pain is characteristically worse on exercise and relieved by elevation. The disorder has been classified by Johnson and Strom (1989); stage I is characterized by pain around the medial malleolus and mild weakness of single heel raising. Without treatment the condition may progress to a fixed valgus deformity along with pes planus. Aim. To assess the outcome of surgical decompression of stage I TPT dysfunction. Method. Ten cases were identified, operated on by a single surgeon over a three-year period. The patients were assessed in a dedicated clinic by administration of a questionnaire and by clinical examination. Results. Nine patients with an average age of 30 years (13–51) agreed to participate in the study. Six of the nine patients recalled a sporting injury to the ankle prior to onset of symptoms. Eight of these of patients underwent a course of physiotherapy prior to surgery. After decompression all patients reported reduction of pain as measured using a visual analogue scale, with five patients reporting complete resolution of pain. Patients experienced relief of pain on average four weeks (1.5–6) after surgery. All patients were able to return to work and normal leisure activities after appropriate rehabilitation. Conclusions.
Aim. To assess the safety of Zero Profile Interbody fusion (Zero P) device in Anterior Cervical
The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI). Patients with tSCI requiring surgical spinal decompression presenting to 17 centres in Europe were recruited. Depending on the timing of decompression, patients were divided into early (≤ 12 hours after injury) and late (> 12 hours and < 14 days after injury) groups. The American Spinal Injury Association neurological (ASIA) examination was performed at baseline (after injury but before decompression) and at 12 months. The primary endpoint was the change in Lower Extremity Motor Score (LEMS) from baseline to 12 months.Aims
Methods