Artikel
Retrospective matched-pair cohort study on the effect of a multi-segmental fenestration in comparison to hemilaminectomy for spinal canal stenosis at the level of lumbar vertebrae 3–4 and 4–5
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Autoren
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Friedrich Weber
- Rückenzentrum Bergisch Gladbach, Germany
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Julia Fiedler
- München, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: This extensive study with 144 Patients investigates whether a minimally invasive surgery in terms of clinical outcome is equal to at invasive surgery.
Method: This retrospective matched-pair cohort study includes a total of 144 patients who underwent surgery between 2008 and 2012. There are 72 matching pairs that correspond in sex, year of birth, and size of the degenerated segment. The patients‘ impairments were reported before, immediately after, six and twelve months after surgery by means of the Oswestry Disability Questionnaire (ODQ-D) and the EuroQol 5 D. The data was evaluated statistically with SPSS (PASW) version 18.0.
Results: The comparison of both surgical procedures with regard to walking ability under consideration of the walking distance with and without walking aid reveals a significant difference. Patients that underwent hemilaminectomy had clearly better postoperative results. The individual criteria of the ODQ-D and EuroQol 5D revealed no significant differences between fenestration and hemilaminectomy. However, there is always significant postoperative improvement in comparison to the preoperative status. Age, sex, BMI, comorbidities, smoking and alcohol consumption showed no influence on surgery. The reoperation rate is between 13 and 15% for both surgeries, no significant difference between the two methods was revealed.
Conclusions: Fenestration and hemilaminectomy are equivalent therapies for lumbar spinal canal stenosis. With regard to walking, the study revealed better results for hemilaminectomy than for fenestration in this cohort of patients. Pain intensity, personal care, lifting and carrying of objects, sitting, social life and travel, all improved significantly postoperatively as compared to preoperatively. In both groups, health status as the decisive predictor improved considerably after surgery. We could show that both surgical methods result in a significant postoperative improvement for the patients with regard to all individual criteria of the ODQ-D and the EuroQol 5D.
