A novel method for treatment of lumbar spinal stenosis in high-risk surgical candidates: pilot study experience with percutaneous remodeling of ligamentum flavum and lamina.
Adult; Female; Humans; Male; Middle Aged; Aged; Pilot Projects; Follow-Up Studies; Risk Factors; Prospective Studies; Pain Measurement; Equipment Design; Comorbidity; Disability Evaluation; Conscious Sedation; Fluoroscopy; Ligamentum Flavum/*surgery; Lumbar Vertebrae/*surgery; Minimally Invasive Surgical Procedures/*instrumentation; Postoperative Complications/diagnosis/*prevention & control; Spinal Stenosis/*surgery; Anesthesia; Human; Pilot Studies; Middle Age; 80 and over; Local; Ligaments; Decompression; Surgical/*instrumentation; 80 and Over; Spinal Stenosis – Surgery; Postoperative Complications – Diagnosis; Articular – Surgery; Lumbar Vertebrae – Surgery; Minimally Invasive Procedures – Equipment and Supplies; Postoperative Complications – Prevention and Control; Surgical – Equipment and Supplies
OBJECT: treatment of lumbar spinal stenosis (LSS) in chronically ill or debilitated patients is challenging. The percutaneous remodeling of ligamentum flavum and lamina (PRLL) technique is a novel method for decompression of the hypertrophic ligamentum flavum component of LSS that is performed using a fluoroscopically guided percutaneous approach, local anesthesia, and minimal sedation. METHODS: fourteen patients deemed to be at high risk for complications related to open spine surgery and general anesthesia were treated using the PRLL technique. Prospectively collected visual analog scale (VAS) and Oswestry Disability Index (ODI) data were analyzed at the most recent follow-up. The average follow-up duration was 23.5 weeks. RESULTS: a statistically significant improvement in VAS scores was observed, with a reduction in pain of 53% compared with preoperative levels. In contrast, the ODI scores failed to improve. CONCLUSIONS: this pilot series points to a potential new therapeutic option for LSS in high-risk surgical patients.
Chopko Bohdan Wolodymyr
Journal of neurosurgery. Spine
2011
2011-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3171/2010.9.SPINE091012" target="_blank" rel="noreferrer noopener">10.3171/2010.9.SPINE091012</a>
Spinous process osteotomies to facilitate lumbar decompressive surgery.
80 and over; Aged; Decompression; Female; Humans; Laminectomy/adverse effects/methods; Low Back Pain; Lumbar Vertebrae/*surgery; Magnetic Resonance Imaging; Male; Middle Aged; Osteotomy/adverse effects/instrumentation/*methods; Pain Measurement; Prospective Studies; Spinal Stenosis/*surgery; Surgical/adverse effects/instrumentation/*methods; Treatment Outcome
STUDY DESIGN: A technique for lumbar decompression using spinous process osteotomies is described, and the outcomes are studied prospectively. OBJECTIVE: To describe a technique that affords a wide exposure for decompression while minimizing damage to surrounding tissues, and to analyze the outcomes formally using the technique. SUMMARY OF BACKGROUND DATA: Commonly used techniques of lumbar decompression, which include bilateral takedown of paraspinal musculature and aggressive bony resection, can result in significant iatrogenic sequelae, whereas minimally invasive techniques often provide inadequate visualization and/or decompression. METHOD: Unilateral limited takedown of the multifidus is undertaken, followed by spinous process osteotomies at the involved levels. The spinous processes with the attached interspinous/supraspinous ligaments are then retracted. A complete "trumpeted" decompression is then undertaken. Fifty consecutive patients undergoing the procedure were analyzed prospectively and at follow-up by an independent observer using a validated functional outcome measure, a visual analog pain scale, and a patient satisfaction score. RESULTS: Functional outcome scores improved on average by 47%, pain levels were reduced by 66%, and high satisfaction rates were reported by 83% of patients. CONCLUSIONS: The technique affords excellent visualization and a wide area available for Kerrison use and angulation while minimizing destruction to tissues not directly involved in the pathologic process, including the paraspinal musculature as well as the interspinous/supraspinous ligament complex and facets. Additionally, it minimizes dead space and improves the cosmetic result.
Weiner B K; Fraser R D; Peterson M
Spine
1999
1999-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00007632-199901010-00015" target="_blank" rel="noreferrer noopener">10.1097/00007632-199901010-00015</a>
Adjacent segment degeneration after lumbar spinal fusion: risk factors and implications for clinical practice.
Humans; Intervertebral Disc Degeneration/*surgery; Lumbar Vertebrae/*surgery; Risk Factors; Spinal Fusion
Schoenfeld Andrew J
The spine journal : official journal of the North American Spine Society
2011
2011-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.spinee.2010.10.022" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2010.10.022</a>