Twelve-month results of a clinical pilot study utilizing pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis

Clinical article

View More View Less
  • 1 Nizhny Novgorod Research Institute of Traumatology and Orthopaedics, Nizhny Novgorod, Russia;
  • | 2 Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland;
  • | 3 Goodman Campbell Brain & Spine, Indianapolis, Indiana; and
  • | 4 Department of Orthopaedic Surgery, Thomas Jefferson University/Rothman Institute, Philadelphia, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $376.00
USD  $612.00
Print or Print + Online Sign in

Object

Lumbar spinal stenosis (LSS) is a common condition that leads to significant disability, particularly in the elderly. Current therapeutic modalities for LSS have certain drawbacks when applied to this patient population. The object of this study was to define the 12-month postoperative outcomes and complications of pedicle-lengthening osteotomies for symptomatic LSS.

Methods

A prospective, single-treatment clinical pilot study was conducted. A cohort of 19 patients (mean age 60.9 years) with symptomatic LSS was treated by pedicle-lengthening osteotomy procedures at 1 or 2 levels. All patients had symptoms of neurogenic claudication or radiculopathy secondary to LSS and had not improved after a minimum 6-month course of nonoperative treatment. Eleven patients had a Meyerding Grade I degenerative spondylolisthesis in addition to LSS. Clinical outcomes were measured using the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), 12-Item Short-Form Health Survey (SF-12), and a visual analog scale (VAS). Procedural variables, neurological outcomes, adverse events, and radiological imaging (plain radiographs and CT scans) were collected at the 1.5-, 3-, 6-, 9-, and 12-month time points.

Results

The pedicle-lengthening osteotomies were performed through percutaneous approaches with minimal blood loss in all cases. There were no operative complications. Four adverse events occurred during the follow-up period. Clinically, significant improvement was observed in the mean values of each of the outcome scales (comparing preoperative and 12-month values): ODI scores improved from 52.3 to 28.1 (p < 0.0001); the ZCQ physical function domain improved from 2.7 to 1.8 (p = 0.0021); the SF-12 physical component scale improved from 27.0 to 37.9 (p = 0.0024); and the VAS score for leg pain while standing improved from 7.2 to 2.7 (p < 0.0001). Imaging studies, reviewed by an independent radiologist, showed no evidence of device subsidence, migration, breakage, or heterotopic ossification. Thin-slice CT documented healing of the osteotomy site in all patients at the 6-month time point and an increase in the mean cross-sectional area of the spinal canal of 115%.

Conclusions

Treatment of patients with symptomatic LSS with a pedicle-lengthening osteotomy procedure provided substantial enlargement of the area of the spinal canal and favorable clinical results for both disease-specific and non–disease-specific outcome measures at the 12-month time point. Future studies are needed to compare this technique to alternative therapies for lumbar stenosis.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $376.00
USD  $612.00
  • 1

    Amundsen T, , Weber H, , Lilleås F, , Nordal HJ, , Abdelnoor M, & Magnaes B: Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976) 20:11781186, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Amundsen T, , Weber H, , Nordal HJ, , Magnaes B, , Abdelnoor M, & Lilleâs F: Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study. Spine (Phila Pa 1976) 25:14241436, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Arnoldi CC, , Brodsky AE, , Cauchoix J, , Crock HV, , Dommisse GF, & Edgar MA, et al.: Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res 115:45, 1976

    • Search Google Scholar
    • Export Citation
  • 4

    Asgarzadie F, & Khoo LT: Minimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes. Orthop Clin North Am 38:387399, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Atlas SJ, , Keller RB, , Wu YA, , Deyo RA, & Singer DE: Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine lumbar spine study. Spine (Phila Pa 1976) 30:936943, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Bowers C, , Amini A, , Dailey AT, & Schmidt MH: Dynamic interspinous process stabilization: review of complications associated with the X-Stop device. Neurosurg Focus 28:6 E8, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Brussee P, , Hauth J, , Donk RD, , Verbeek AL, & Bartels RH: Self-rated evaluation of outcome of the implantation of interspinous process distraction (X-Stop) for neurogenic claudication. Eur Spine J 17:200203, 2008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Burdock E, , Fleiss JL, & Hardesty AS: A new view of interobserver agreement. Person Psychol 16:373384, 1963

  • 9

    Deyo RA, , Mirza SK, , Martin BI, , Kreuter W, , Goodman DC, & Jarvik JG: Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:12591265, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    ECRI Health Technology Assessment Group: Evidence Report/Technology Assessment Number 32: Treatment of Degenerative Lumbar Spinal Stenosis June 2001. (http://www.spinalstenosis.org/AHRQ%20WEB/mainpage.htm) [Accessed November 21, 2012]

    • Search Google Scholar
    • Export Citation
  • 11

    Fredman B, , Arinzon Z, , Zohar E, , Shabat S, , Jedeikin R, & Fidelman ZG, et al.: Observations on the safety and efficacy of surgical decompression for lumbar spinal stenosis in geriatric patients. Eur Spine J 11:571574, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Fu KM, , Smith JS, , Polly DW Jr, , Perra JH, , Sansur CA, & Berven SH, et al.: Morbidity and mortality in the surgical treatment of 10,329 adults with degenerative lumbar stenosis. Clinical article. J Neurosurg Spine 12:443446, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Hamasaki T, , Tanaka N, , Kim J, , Okada M, , Ochi M, & Hutton WC: Biomechanical assessment of minimally invasive decompression for lumbar spinal canal stenosis: a cadaver study. J Spinal Disord Tech 22:486491, 2009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Jansson KA, , Blomqvist P, , Granath F, & Nemeth G: Spinal stenosis surgery in Sweden 1987–1999. Eur Spine J 12:535541, 2003

  • 15

    Jansson KA, , Nemeth G, , Granath F, & Blomqvist P: Spinal stenosis re-operation rate in Sweden is 11% at 10 years–a national analysis of 9,664 operations. Eur Spine J 14:659663, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Katz JN, , Lipson SJ, , Brick GW, , Grobler LJ, , Weinstein JN, & Fossel AH, et al.: Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 20:11551160, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Katz JN, , Lipson SJ, , Chang LC, , Levine SA, , Fossel AH, & Liang MH: Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 21:9298, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Kim DH, , Tantorski M, , Shaw J, , Martha J, , Li L, & Shanti N, et al.: Occult spinous process fractures associated with interspinous process spacers. Spine (Phila Pa 1976) 36:E1080E1085, 2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Lee MJ, , Bransford RJ, , Bellabarba C, , Chapman JR, , Cohen AM, & Harrington RM, et al.: The effect of bilateral laminotomy versus laminectomy on the motion and stiffness of the human lumbar spine: a biomechanical comparison. Spine (Phila Pa 1976) 35:17891793, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Mannion RJ, , Guilfoyle MR, , Efendy J, , Nowitzke AM, , Laing RJ, & Wood MJ: Minimally invasive lumbar decompression: long-term outcome, morbidity, and the learning curve from the first 50 cases. J Spinal Disord Tech 25:4751, 2012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Podichetty VK, , Spears J, , Isaacs RE, , Booher J, & Biscup RS: Complications associated with minimally invasive decompression for lumbar spinal stenosis. J Spinal Disord Tech 19:161166, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Pratt RK, , Fairbank JC, & Virr A: The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 27:8491, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Rahimi-Movaghar V, , Rasouli MR, & Vaccaro AR: Patient outcomes vs a minimally invasive approach in lumbar spinal stenosis: which is more important?. Neurosurgery 67:E1180, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Rosen DS, , O'Toole JE, , Eichholz KM, , Hrubes M, , Huo D, & Sandhu FA, et al.: Minimally invasive lumbar spinal decompression in the elderly: outcomes of 50 patients aged 75 years and older. Neurosurgery 60:503510, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Siddiqui M, , Karadimas E, , Nicol M, , Smith FW, & Wardlaw D: Influence of X Stop on neural foramina and spinal canal area in spinal stenosis. Spine (Phila Pa 1976) 31:29582962, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Stucki G, , Daltroy L, , Liang MH, , Lipson SJ, , Fossel AH, & Katz JN: Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976) 21:796803, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Stucki G, , Liang MH, , Fossel AH, & Katz JN: Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. J Clin Epidemiol 48:13691378, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Tai CL, , Hsieh PH, , Chen WP, , Chen LH, , Chen WJ, & Lai PL: Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome— an experimental study in porcine model. BMC Musculoskelet Disord 9:84, 2008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Toyone T, , Tanaka T, , Kato D, , Kaneyama R, & Otsuka M: Patients' expectations and satisfaction in lumbar spine surgery. Spine (Phila Pa 1976) 30:26892694, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Truumees E: Spinal stenosis: pathophysiology, clinical and radiologic classification. Instr Course Lect 54:287302, 2005

  • 31

    Tuli SK, , Yerby SA, & Katz JN: Methodological approaches to developing criteria for improvement in lumbar spinal stenosis surgery. Spine (Phila Pa 1976) 31:12761280, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32

    Turner JA, , Ersek M, , Herron L, & Deyo R: Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976) 17:18, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Tuschel A, , Chavanne A, , Eder C, , Meissl M, , Becker P, & Ogon M: Implant survival analysis and failure modes of the X STOP interspinous distraction device. Spine (Phila Pa 1976) [epub ahead of print], 2011

    • Search Google Scholar
    • Export Citation
  • 34

    Weinstein JN, , Lurie JD, , Tosteson TD, , Zhao W, , Blood EA, & Tosteson ANA, et al.: Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Fouryear results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:12951304, 2009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35

    Weinstein JN, , Tosteson TD, , Lurie JD, , Tosteson A, , Blood EA, & Herkowitz H, et al.: Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 35:13291338, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Yamazaki K, , Yoshida S, , Ito T, , Toba T, , Kato S, & Shimamura T: Postoperative outcome of lumbar spinal canal stenosis after fenestration: correlation with changes in intradural and extradural tube on magnetic resonance imaging. J Orthop Surg (Hong Kong) 10:136143, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37

    Yoshimoto M, , Takebayashi T, , Kawaguchi S, , Tsuda H, , Ida K, & Wada T, et al.: Minimally invasive technique for decompression of lumbar foraminal stenosis using a spinal microendoscope: technical note. Minim Invasive Neurosurg 54:142146, 2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Zucherman JF, , Hsu KY, , Hartjen CA, , Mehalic TF, , Implicito DA, & Martin MJ, et al.: A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine (Phila Pa 1976) 30:13511358, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39

    Zucherman JF, , Hsu KY, , Hartjen CA, , Mehalic TF, , Implicito DA, & Martin MJ, et al.: A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results. Eur Spine J 13:2231, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 662 117 10
Full Text Views 145 6 0
PDF Downloads 235 11 0
EPUB Downloads 0 0 0