Karsten Schöller1, Thomas Steingrüber2, Marco Stein2, Nina Vogt2, Tilman Müller2, Jörn Pons-Kühnemann3, Eberhard Uhl2. 1. Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstr. 33, 35392, Giessen, Germany. karsten.schoeller@neuro.med.uni-giessen.de. 2. Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstr. 33, 35392, Giessen, Germany. 3. Institute for Medical Informatics, Medical Statistics Study Group, Justus-Liebig-University, Giessen, Germany.
Abstract
BACKGROUND: The microsurgical unilateral laminotomy (MUL) technique for bilateral decompression of lumbar spinal stenosis (LSS) is a less destabilizing alternative to laminectomy and leads to good short-term outcomes. However, little is known about the long-term results including predictive factors. METHODS: Medical records of patients who underwent MUL for LSS decompression between 2005 and 2010 were reviewed, and a questionnaire was distributed to complement the long-term outcome data. The study population consisted of 176 patients including 17 patients with stable grade I spondylolisthesis. Complications and reoperations were meticulously analyzed. Clinical outcome was measured using a modified Prolo scale and was further dichotomized in good vs. poor outcome. Predictive factors were obtained from uni- and multivariate analyses. RESULTS: The median age of the cohort was 70.0 years and the follow-up 71.7 months. Complications occurred in 5.1 % of the patients. The overall reoperation rate was 17.0 %, including surgery, which was exclusively performed at other levels in 4.0 %. The reoperation rate for fusion was 4.5 %. Good neurogenic claudication outcome faded from 98.3 % at hospital discharge to 47.2 % at 6 years. Multivariate analysis identified previous lumbar operation as a potential independent predictor of a reoperation; potential independent predictors of poor long-term claudication outcome were older age, female gender, higher body mass index (BMI) and tobacco smoking. CONCLUSIONS: In our experience, the long-term reoperation rate after MUL for LSS is not negligible and higher in previously operated patients. It seems like the good initial clinical results after MUL may fade over time, and several patient-related predictive factors including potentially modifiable obesity and tobacco smoking seem to play an important role.
BACKGROUND: The microsurgical unilateral laminotomy (MUL) technique for bilateral decompression of lumbar spinal stenosis (LSS) is a less destabilizing alternative to laminectomy and leads to good short-term outcomes. However, little is known about the long-term results including predictive factors. METHODS: Medical records of patients who underwent MUL for LSS decompression between 2005 and 2010 were reviewed, and a questionnaire was distributed to complement the long-term outcome data. The study population consisted of 176 patients including 17 patients with stable grade I spondylolisthesis. Complications and reoperations were meticulously analyzed. Clinical outcome was measured using a modified Prolo scale and was further dichotomized in good vs. poor outcome. Predictive factors were obtained from uni- and multivariate analyses. RESULTS: The median age of the cohort was 70.0 years and the follow-up 71.7 months. Complications occurred in 5.1 % of the patients. The overall reoperation rate was 17.0 %, including surgery, which was exclusively performed at other levels in 4.0 %. The reoperation rate for fusion was 4.5 %. Good neurogenic claudication outcome faded from 98.3 % at hospital discharge to 47.2 % at 6 years. Multivariate analysis identified previous lumbar operation as a potential independent predictor of a reoperation; potential independent predictors of poor long-term claudication outcome were older age, female gender, higher body mass index (BMI) and tobacco smoking. CONCLUSIONS: In our experience, the long-term reoperation rate after MUL for LSS is not negligible and higher in previously operated patients. It seems like the good initial clinical results after MUL may fade over time, and several patient-related predictive factors including potentially modifiable obesity and tobacco smoking seem to play an important role.
Authors: Christoph Wipplinger; Eliana Kim; Sara Lener; Rodrigo Navarro-Ramirez; Sertac Kirnaz; R Nick Hernandez; Carolin Melcher; Michelle Paolicelli; Farah Maryam; Franziska Anna Schmidt; Roger Härtl Journal: Global Spine J Date: 2020-05-28
Authors: Bin Lv; Sixin Sun; Haosheng Wang; Li Xiao; Tao Xu; Peng Ji; Jishan Yuan; Hua Ding; Jun Xie; Nan Meng; Lei Zhang; Minjie Hu; Qinyi Jiang; Lei Wang; Xiang Yao Journal: Biomed Res Int Date: 2020-12-09 Impact factor: 3.411