Artikel
Risk factor analysis for secondary fusion surgery after surgical decompression in lumbar spinal stenosis
Charakterisierung und Analyse von Risikofaktoren für sekundäre Fusionsoperationen nach Dekompression lumbaler Spinalkanalstenosen
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Autoren
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Eleftherios Archavlis
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Konstantinos Rigas
- Klinikum Frankfurt, Neurochirurgie, Frankfurt, Deutschland
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Sven Rainer Kantelhardt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: The goal of surgery in lumbar spinal stenosis is to improve walking distance and to relieve pain by decompression of nerve roots. There is growing evidence showing a benefit of decompression surgery without fusion even in the subgroup of patients who have degenerative spondylolisthesis. The aim of this study was to evaluate clinical and radiographic parameters that influence reoperation rate and clinical outcome.
Methods: In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with lumbar spinal stenosis with and without low grade spondylolisthesis (groups A and B, respectively) from January 2014 to December 2016. Group A included 103 patients with a mean age of 62±6 years, and group B included 40 patients with a mean age of 65±7 years. Minimum follow-up was 24 months. The standard surgical procedure comprised unilateral laminotomie with bilateral neural canal decompression. We analyzed the following factors that could affect outcome independently: obesity (BMI), stenosis grade (classification after Schizas et al.), facet cysts, facet fluid accumulation, facet joint orientation, olisthesis grade in mm, disc height and presence of foraminal stenosis. We performed a telephone interview.
Results: Secondary fusion surgery at the index level due to spondylolisthesis was required in 15% (6 out of 40 patients) in the olisthesis group and 5% (5 out of 103 patients) in the non olisthesis group (p=0.05, trend to significance). Patients with facet cysts in the olisthesis group had a higher risk for revision surgery (p<0.05). The efficacy of primary decompression surgery based on pain (VAS) and disability (ODI) was similar in the olisthesis and non olisthesis groups (VAS 40 versus 33 and ODI 38 versus 32 respectively.
Conclusion: Among patients who underwent decompression surgery for lumbar spinal stenosis, the presence of low grade degenerative spondylolisthesis did not result in worse clinical outcomes at 2 years but in a trend to higher reoperation rate at the index level. Facet cysts combined with olisthesis had a significant impact on reoperation rate at the index level.
