Decompression fusion surgery and minimally invasive microsurgical decompression in patients with single-segment lumbar spinal stenosis

Konovalov NA, Brinyuk ES, Kaprovoy SV, et al. . Decompression fusion surgery and minimally invasive microsurgical decompression in patients with single-segment lumbar spinal stenosis. Burdenko's Journal of Neurosurgery. 2023;87(3):13‑19. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20238703113

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To compare the results of TLIF + transpedicular interbody fusion and MMD in patients with single-segment lumbar spinal stenosis.

MATERIAL AND METHODS

A retrospective observational cohort study included medical records of 196 patients (100 (51%) men, 96 (49%) women). Age of patients ranged from 18 to 84 years. Mean postoperative follow-up period was 20.1±6.7 months. Patients were divided into 2 groups: group I (control) included 100 patients who underwent TLIF + transpedicular interbody fusion, group II (study) included 96 patients who underwent MMD. We analyzed pain syndrome and working capacity using visual analogue scale (VAS) and Oswestry Disability Index (ODI), respectively.

RESULTS

Analysis of pain syndrome in both groups after 3, 6, 9, 12 and 24 months clearly demonstrated stable relief of pain syndrome (VAS score) in the lower extremities. In group II, VAS score of lower back and leg pain was significantly higher in long-term follow-up period (after 9 months or more) compared to the 1^st group (p<0.05). In long-term follow-up period (after 12 months), there was significant decrease in degree of disability (ODI score) in both groups (p<0.001) without between-group differences. We assessed achievement of treatment goal in 12 and 24 months after surgery in both groups. The result was significantly better in the 2^nd group. At the same time, some respondents failed to achieve the final clinical goal of treatment in both groups (group I — 8 (12.1%), group II — 2 (3%) patients).

CONCLUSION

Analysis of postoperative outcomes in patients with single-segment degenerative lumbar spinal stenosis revealed similar clinical effectiveness of TLIF + transpedicular interbody fusion and MMD regarding decompression quality. However, MMD was associated with less traumatization of paravertebral tissues, blood loss, fewer unwanted phenomena and earlier recovery.

Keywords:

single-segment lumbar stenosis

minimally invasive microsurgical decompression

decompression fusion surgery

clinical results

radiological results

adverse events

Authors:

Konovalov N.A.

Burdenko Neurosurgical Center

ORCID: 0000-0003-0824-1848

Brinyuk E.S.

Burdenko Neurosurgical Center

ORCID: 0000-0002-0346-8018

Kaprovoy S.V.

Burdenko Neurosurgical Center

ORCID: 0000-0001-8813-2793

Nazarenko A.G.

Burdenko Neurosurgical Center

ORCID: 0000-0003-1314-2887

Strunina Yu.V.

Burdenko Neurosurgical Center

ORCID: 0000-0003-1696-4050

Zakirov B.A.

Burdenko Neurosurgical Center

ORCID: 0000-0002-8782-850X

Kudymets M.O.

Burdenko Neurosurgical Center

ORCID: 0000-0003-3791-8619

Stepanov I.A.

Irkutsk State Medical University

ORCID: 0000-0001-9039-9147

Received:

31.01.2022

Accepted:

24.03.2023

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References:

Bagley C, MacAllister M, Dosselman L, Moreno J, Aoun SG, El Ahmadieh TY. Current concepts and recent advances in understanding and managing lumbar spine stenosis. F1000Res. 2019;8:F1000 Faculty Rev-137. https://doi.org/10.12688/f1000research.16082.1
Schroeder GD, Kurd MF, Vaccaro AR. Lumbar Spinal Stenosis: How Is It Classified? Journal of the American Academy of Orthopaedic Surgeons. 2016;24(12):843-852. https://doi.org/10.5435/JAAOS-D-15-00034
Shin SH, Choi WG, Hwang BW, Tsang YS, Chung ER, Lee HC, Lee SJ, Lee SH. Microscopic anterior foraminal decompression combined with anterior lumbar interbody fusion. Spine Journal. 2013;13(10):1190-1199. https://doi.org/10.1016/j.spinee.2013.07.458
Srinivas S, Paquet J, Bailey C, et al. Effect of spinal decompression on back pain in lumbar spinal stenosis: a Canadian Spine Outcomes Research Network (CSORN) study. Spine J. 2019;19(6):1001-1008. https://doi.org/10.1016/j.spinee.2019.01.003
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. 2010;303(13):1259-1265. https://doi.org/10.1001/jama.2010.338
Hara N, Oka H, Yamazaki T, et al. Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis. European Spine Journal. 2010;19(11):1849-1854. https://doi.org/10.1007/s00586-010-1374-1
Mobbs RJ, Li J, Sivabalan P, Raley D, Rao PJ. Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. Journal of Neurosurgery: Spine. 2014;21(2):179-186. https://doi.org/10.3171/2014.4.SPINE13420
Slätis P, Malmivaara A, Heliövaara M, Sainio P, Herno A, Kankare J, Seitsalo S, Tallroth K, Turunen V, Knekt P, Hurri H. Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial [published correction appears in Eur Spine J. 2012;21(1):180]. European Spine Journal. 2011;20(7):1174-1181. https://doi.org/10.1007/s00586-010-1652-y
Takaso M, Nakazawa T, Imura T, Okada T, Fukushima K, Ueno M, Saito W, Shintani R, Sakagami H, Takahashi K, Yamazaki M, Ohtori S, Kotani T. Less invasive and less technically demanding decompressive procedure for lumbar spinal stenosis — appropriate for general orthopaedic surgeons? International Orthopaedics. 2011;35(1):67-73. https://doi.org/10.1007/s00264-010-0986-8
Konovalov NA, Nazarenko AG, Asyutin DS, Zelenkov PV, Onoprienko RA, Korolishin VA, Cherkiev IU, Martynova MA, Zakirov BA, Timonin SY, Kosyr’kova AV, Pimenova LF, Pogosyan AL, Batyrov AA. Modern treatments for degenerative disc diseases of the lumbosacral spine. A literature review. Burdenko’s Journal of Neurosurgery. 2016;80(4):102-108. (In Russ.). https://doi.org/10.17116/neiro2016804102-108
Watanabe K, Yamazaki A, Morita O, Sano A, Katsumi K, Ohashi M. Clinical outcomes of posterior lumbar interbody fusion for lumbar foraminal stenosis: preoperative diagnosis and surgical strategy. Journal of Spinal Disorders and Techniques. 2011;24(3):137-141. https://doi.org/10.1097/BSD.0b013e3181e1cd99
Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234. https://doi.org/10.1136/bmj.h6234
Schroeder GD, Kurd MF, Vaccaro AR. Lumbar Spinal Stenosis: How Is It Classified? Journal of the American Academy of Orthopaedic Surgeons. 2016;24(12):843-852. https://doi.org/10.5435/JAAOS-D-15-00034
Lewandrowski KU, Soriano-Sánchez JA, Zhang X, Ramírez León JF, Soriano Solis S, Rugeles Ortíz JG, Martínez CR, Alonso Cuéllar GO, Liu K, Fu Q, de Lima E Silva MS, de Carvalho PST, Hellinger S, Dowling Á, Prada N, Choi G, Datar G, Yeung A. Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: results of a global survey. Journal of Spine Surgery. 2020;6(suppl 1):260-274. https://doi.org/10.21037/jss.2019.09.31
Weber C, Lønne G, Rao V, Jakola AS, Solheim O, Nerland U, Rossvoll I, Nygaard ØP, Peul WC, Gulati S. Surgical management of lumbar spinal stenosis: a survey among Norwegian spine surgeons. Acta Neurochirurgica. 2017;159(1):191-197. https://doi.org/10.1007/s00701-016-3020-0
von Elm E, Altman DG, Egger M, Stuart JP, Peter CG, Jan PV, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International Journal of Surgery. 2014;12(12):1495-1499. https://doi.org/10.1016/j.ijsu.2014.07.013
Konovalov NA, Nazarenko AG, Asyutin DS, Brinyuk ES, Kaprovoy SV, Zakirov BA. Degenerativnyi stenoz poyasnichnogo otdela pozvonochnika: kharakteristika minimal’no invazivnykh mikrokhirurgicheskikh metodov lecheniya [Degenerative lumbar spine stenosis: minimally invasive microsurgical methods of treatment]. Burdenko’s Journal of Neurosurgery. 2021;85(4):87-95. (In Russ.). https://doi.org/10.17116/neiro20218504187
Schöller K, Steingrüber T, Stein M, Vogt N, Müller T, Pons-Kühnemann J, Uhl E. Microsurgical unilateral laminotomy for decompression of lumbar spinal stenosis: long-term results and predictive factors. Acta Neurochirurgica. 2016;158(6):1103-1113. https://doi.org/10.1007/s00701-016-2804-6
Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review. Journal of Neurosurgery: Spine. 2016;24(3):416-427. https://doi.org/10.3171/2015.2.SPINE14973