Treatment of restenosis after lumbar decompression surgery: decompression versus decompression and fusion

View More View Less
  • 1 Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo;
  • | 2 University of Tokyo Spine Group (UTSG), Tokyo;
  • | 3 Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo;
  • | 4 Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa;
  • | 5 Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa;
  • | 6 Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Tokyo;
  • | 7 Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo;
  • | 8 Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama; and
  • | 9 Spine Center, NTT Medical Center Tokyo, Tokyo, Japan
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

OBJECTIVE

The aim of this study was to compare perioperative complications and postoperative outcomes between patients with lumbar recurrent stenosis without lumbar instability and radiculopathy who underwent decompression surgery and those who underwent decompression with fusion surgery.

METHODS

For this retrospective study, the authors identified 2606 consecutive patients who underwent posterior surgery for lumbar spinal canal stenosis at eight affiliated hospitals between April 2017 and June 2019. Among these patients, those with a history of prior decompression surgery and central canal restenosis with cauda equina syndrome were included in the study. Those patients with instability or radiculopathy were excluded. The patients were divided between the decompression group and decompression with fusion group. The demographic characteristics, numerical rating scale score for low-back pain, incidence rates of lower-extremity pain and lower-extremity numbness, Oswestry Disability Index score, 3-level EQ-5D score, and patient satisfaction rate were compared between the two groups using the Fisher’s exact probability test for nominal variables and the Student t-test for continuous variables, with p < 0.05 as the level of statistical significance.

RESULTS

Forty-six patients met the inclusion criteria (35 males and 11 females; 19 patients underwent decompression and 27 decompression and fusion; mean ± SD age 72.5 ± 8.8 years; mean ± SD follow-up 18.8 ± 6.0 months). Demographic data and perioperative complication rates were similar. The percentages of patients who achieved the minimal clinically important differences for patient-reported outcomes or satisfaction rate at 1 year were similar.

CONCLUSIONS

Among patients with central canal stenosis who underwent revision, the short-term outcomes of the patients who underwent decompression were comparable to those of the patients who underwent decompression and fusion. Decompression surgery may be effective for patients without instability or radiculopathy.

ABBREVIATIONS

C7-SVA = C7 sagittal vertical axis; CSVL = central sacral vertical line; EQ-5D-3L = 3-level EQ-5D; LL = lumbar lordosis; LSTV = lumbosacral transitional vertebrae; MCID = minimal clinically important difference; NRS = numerical rating scale; ODI = Oswestry Disability Index; PI = pelvic incidence; TLIF = transforaminal lumbar interbody fusion.

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

    Lang Z, Li JS, Yang F, Yu Y, Khan K, Jenis LG, et al. Reoperation of decompression alone or decompression plus fusion surgeries for degenerative lumbar diseases: a systematic review. Eur Spine J. 2019;28(6):13711385.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Aizawa T, Ozawa H, Kusakabe T, Tanaka Y, Sekiguchi A, Hashimoto K, et al. Reoperation rates after fenestration for lumbar spinal canal stenosis: a 20-year period survival function method analysis. Eur Spine J. 2015;24(2):381387.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Hong X, Liu L, Bao J, Shi R, Fan Y, Wu X. Characterization and risk factor analysis for reoperation after microendoscopic diskectomy. Orthopedics. 2015;38(6):e490e496.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Hwang HJ, Park HK, Lee GS, Heo JY, Chang JC. Predictors of reoperation after microdecompression in lumbar spinal stenosis. Korean J Spine. 2016;13(4):183189.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Hirabayashi S, Kumano K, Ogawa Y, Aota Y, Maehiro S. Microdiscectomy and second operation for lumbar disc herniation. Spine (Phila Pa 1976).1993;18(15):22062211.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Dazley JM, Deering RM, Bono CM. Recurrent lumbar spinal stenosis: etiology and surgical management. Semin Spine Surg. 2013;25(4):283294.

  • 7

    Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):218.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Guha D, Heary RF, Shamji MF. Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts. Neurosurg Focus. 2015;39(4):E9.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Campbell RC, Mobbs RJ, Lu VM, Xu J, Rao PJ, Phan K. Posterolateral fusion versus interbody fusion for degenerative spondylolisthesis: systematic review and meta-analysis. Global Spine J. 2017;7(5):482490.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Yamashita T, Okuda S, Aono H, Matsumoto T, Maeno T, Sugiura T, Iwasaki M. Controllable risk factors for neurologic complications in posterior lumbar interbody fusion as revision surgery. World Neurosurg. 2018;116:e1181e1187.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Nagata K, Shinozaki T, Yamada K, Nakajima K, Nakamoto H, Yamakawa K, et al. A sliding scale to predict postoperative complications undergoing posterior spine surgery. J Orthop Sci. 2020;25(4):545550.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Suh SP, Jo YH, Jeong HW, Choi WR, Kang CN. Outcomes of revision surgery following instrumented posterolateral fusion in degenerative lumbar spinal stenosis: a comparative analysis between pseudarthrosis and adjacent segment disease. Asian Spine J. 2017;11(3):463471.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Lin B, Yu H, Chen Z, Huang Z, Zhang W. Comparison of the PEEK cage and an autologous cage made from the lumbar spinous process and laminae in posterior lumbar interbody fusion. BMC Musculoskelet Disord. 2016;17(1):374.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol. 2011;40(8):10331039.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Shinto K, Minamide A, Hashizume H, Oka H, Matsudaira K, Iwahashi H, et al. Prevalence of facet effusion and its relationship with lumbar spondylolisthesis and low back pain: the Wakayama Spine Study. J Pain Res. 2019;12:35213528.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Youn MS, Shin JK, Goh TS, Son SM, Lee JS. Endoscopic posterior decompression under local anesthesia for degenerative lumbar spinal stenosis. J Neurosurg Spine. 2018;29(6):661666.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Noren R, Trafimow J, Andersson GB, Huckman MS. The role of facet joint tropism and facet angle in disc degeneration. Spine (Phila Pa 1976).1991;16(5):530532.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968974.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Ogura Y, Ogura K, Kobayashi Y, Kitagawa T, Yonezawa Y, Takahashi Y, et al. Minimum clinically important difference of major patient-reported outcome measures in patients undergoing decompression surgery for lumbar spinal stenosis. Clin Neurol Neurosurg. 2020;196:105966.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Burgstaller JM, Wertli MM, Ulrich NH, Pichierri G, Brunner F, Farshad M, et al. Evaluating the minimal clinically important difference of EQ-5D-3L in patients with degenerative lumbar spinal stenosis: a Swiss prospective multicenter cohort study. Spine (Phila Pa 1976).2020;45(18):13091316.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):14131423.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Adogwa O, Parker SL, Shau DN, Mendenhall SK, Aaronson O, Cheng JS, et al. Cost per quality-adjusted life year gained of revision neural decompression and instrumented fusion for same-level recurrent lumbar stenosis: defining the value of surgical intervention. J Neurosurg Spine. 2012;16(2):135140.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Mendenhall SK, Parker SL, Adogwa O, Shau DN, Cheng J, Aaronson O, et al. Long-term outcomes after revision neural decompression and fusion for same-level recurrent lumbar stenosis: defining the effectiveness of surgery. J Spinal Disord Tech. 2014;27(7):353357.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Minimally invasive or open transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression of the lumbar spine. Eur Spine J. 2011;20(4):623628.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Nakashima H, Kanemura T, Satake K, Ito K, Ishikawa Y, Ouchida J, et al. Indirect decompression using lateral lumbar interbody fusion for restenosis after an initial decompression surgery. Asian Spine J. 2020;14(3):305311.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Kudo Y, Okano I, Toyone T, Matsuoka A, Maruyama H, Yamamura R, et al. Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression. Neurosurg Focus. 2020;49(3):E11.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Alpantaki K, Kampouroglou A, Koutserimpas C, Effraimidis G, Hadjipavlou A. Diabetes mellitus as a risk factor for intervertebral disc degeneration: a critical review. Eur Spine J. 2019;28(9):21292144.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Arinzon Z, Adunsky A, Fidelman Z, Gepstein R. Outcomes of decompression surgery for lumbar spinal stenosis in elderly diabetic patients. Eur Spine J. 2004;13(1):3237.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1093 1093 251
Full Text Views 235 235 129
PDF Downloads 319 319 192
EPUB Downloads 0 0 0