[Minimally invasive decompression techniques for spinal cord stenosis]

Comparison of Functional and Radiological Outcomes of Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion Techniques in the Treatment of Lumbar Spinal Stenosis

BACKGROUND

This study aimed to compare posterolateral fusion with transforaminal lumbar interbody fusion (PLF + TLIF) and PLF only in terms of revision surgery rates and complications, as well as functional and radiological outcomes in lumbar spinal stenosis (LSS) patients.

METHODS

Seventy-one patients (37 patients in the PLF + TLIF group and 34 patients in the PLF only group) who underwent surgery due to LSS between January 2013 and December 2016 were retrospectively investigated. Functional evaluation was performed by using the McGill-Melzack Pain Questionnaire (MPQ), Roland Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI) scales pre-and postoperatively. Radiological evaluation was made by examining adjacent vertebrae, posterior ligamentous complex (PLC) morphology, and sagittal balance on magnetic resonance imaging (MRI).

RESULTS

Postoperative MPQ, RMDQ, and ODI scores were significantly better in the PLF + TLIF group (p < 0.001, p < 0.001, and p = 0.001, respectively). The complication rate was significantly higher in the PLF only group (p = 0.026). In the PLF + TLIF group, postoperative functional scores showed significant improvement in terms of the instrumented segment and level of interbody fusion. Postoperative functional scores showed significant improvement in PLF + TLIF patients with no complications, no revision surgery, no postoperative MRI findings, and neutral sagittal balance compared to the preoperative functional scores (p < 0.001).

CONCLUSION

PLF + TLIF is significantly superior in terms of functional scores and complications, despite the statistical similarity in terms of postoperative MRI findings and sagittal balance between the groups. Surgeons should prefer PLF + TLIF for the surgical treatment of LSS for better results.

Comparison of the short-term effects of lumbar endoscopic and microscopic tubular unilateral laminotomy with bilateral decompression in the treatment of elderly patients with lumbar spinal stenosis

Objective

To compare the clinical efficacy of lumbar endoscopic Delta large channel and microscopic tubular Quadrant channel unilateral laminotomy with bilateral decompression in the treatment of elderly patients with lumbar spinal stenosis.

Methods

A total of 40 patients aged above 75 years with lumbar spinal stenosis admitted from June 2019 to August 2021 were reviewed, in which the observation group was treated with the Delta large channel technique and the control group was treated with Quadrant channel open decompression. The general data, duration of illness, operation time, intraoperative bleeding, VAS score preoperatively, 3 days postoperatively, 3 months postoperatively and 6 months postoperatively, and ODI index of the two groups were recorded in the two groups.

Results

The observation group had significantly shorter operation time (59.93 ± 10.46 min vs 77.66 ± 12.44 min, P < 0.001) and less intraoperative bleeding (21.06 ± 4.59 mL vs 51.00 ± 10.02 mL, P < 0.001) than the control group. There were no significant differences between the two groups in the duration of illness (11.85 ± 5.08 years vs 13.80 ± 7.40 years, P = 0.337), VAS score preoperatively (6.05 ± 1.19 vs 6.40 ± 1.47, P = 0.412), 3 days postoperatively (1.90 ± 0.85 vs 2.00 ± 1.08, P = 0.746), 3 months postoperatively (1.10 ± 0.31 vs 1.20 ± 0.41, P = 0.389) and 6 months postoperatively (1.25 ± 0.44 vs 1.30 ± 0.57, P = 0.759), and ODI index preoperatively (0.78 ± 0.07 vs 0.74 ± 0.07, P = 0.09), 3 months postoperatively (0.28 ± 0.06 vs 0.30 ± 0.05, P = 0.189) and 6 months postoperatively (0.21 ± 0.07 vs 0.22 ± 0.04, P = 0.444) (P > 0.05). The ODI index 3 days postoperatively in the observation group was significantly lower than that in the control group (0.33 ± 0.06 vs 0.37 ± 0.05, P = 0.022).

Conclusion

Both surgical methods had good clinical outcomes for the treatment of lumbar spinal stenosis. However, Delta large channel endoscopy had a clearer vision, less trauma and lower incidence of early postoperative back pain than that of Quadrant channel open decompression.

Decompression Using Minimally Invasive Surgery for Lumbar Spinal Stenosis Associated with Degenerative Spondylolisthesis: A Review

Lumbar spinal stenosis (LSS), which often occurs concurrently with degenerative spondylolisthesis (DS), is a common disease in the elderly population, affecting the quality of life of aged people significantly. Notwithstanding the frequently good effect of conservative therapy on LSS, a minority of the patients ultimately require surgery. Surgery for LSS aims to decompress the narrowed spinal canals with preservation of spinal stability. Traditional open surgery, either pure decompression or decompression with fusion, was considered effective for the treatment of LSS with or without DS. However, the long-term clinical outcomes of traditional open surgery are still unclear. Moreover, the disadvantages of conventional open surgery are extensive, examples including tissue injuries or secondary instability, with limited outcomes and significant reoperation rates. With the development and improvement of surgical tools, various minimally invasive spine surgery (MISS) methods, including indirect decompression techniques of interspinous process devices (IPDs) and direct decompression techniques such as microscopic spine surgery or endoscopic spine surgery (ESS), have been updated with enhancement. IPDs, such as Superion devices, were reported to behave with comparable physical function, disability, and symptoms outcomes to laminectomy decompression. As an emerging technique of MISS, ESS has beneficial hallmarks including minimal tissue injuries, reduced complication rates, and shortened recovery periods, thus gaining popularity in recent years. ESS can be classified in terms of endoscopic hallmarks and approaches. Predictably, with the continuous development and gradual maturity, MISS is expected to replace traditional open surgery widely in the surgical treatment of LSS associated with DS in the future.