gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Predictors of reoperation after microdecompression in lumbar spinal stenosis: authors’ experience and a systematic review

Meeting Abstract

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  • Hyung-Ki Park - Soonchunhyang University Seoul Hospital, Seoul, Korea
  • Hee-Jong Hwang - Soonchunhyang University Seoul Hospital, Seoul, Korea
  • June-Young Heo - Soonchunhyang University Seoul Hospital, Seoul, Korea
  • Jae-Chil Chang - Soonchunhyang University Seoul Hospital, Seoul, Korea

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 068

doi: 10.3205/16dgnc443, urn:nbn:de:0183-16dgnc4432

Published: June 8, 2016

© 2016 Park et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Microdecompression has come to be more commonly used in a number of ways for the treatment of lumbar spine stenosis (LSS). But, despite the many advantages, the risk of reoperation higher than the fusion surgery is our main concern for microdecompression. Little is known regarding the risk factors of reoperation after microdecomprssion for LSS. Therefore, the appropriate surgical indications is still unclear. The objectives of this study are to present outcomes of microdecompression for degenerative LSS and investigate factors that result in reoperation and poor outcome at the authors' institution. Additionally, a systematic review of the literature was performed to assess the factors associated with reoperation via PubMed.

Method: Fifty-one patients who underwent microdecompression for LSS were retrospectively studied. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists grade (ASA grade) were used for predicting poor outcome. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, disc height, and Pfirrmann Grading Systems. Next, the systematic review identified studies analyzing risk factors of reoperation after microdecompression for LSS.

Results: Fifty-one patients (20 men, 31 women) aged 43-86 years (69 ± 8) were followed-up for a 19-95 (51 ± 26) months. Patients had comorbidity in 47 patients (92.2%). During follow-up, seven patients (13.7%) died regardless of operation. Eight patients (18.2%) underwent reoperation due to foraminal stenosis, disc herniation, or instability. Disc degeneration of Pfirmann IV grade on L4/5 level was related with reoperation. Preoperative JOA score improved significantly. There were no significant differences in radiological findings preoperatively and postoperatively. Nineteen patients (43.1%) had excellent to good, 11 (25.0%) were fair, 6 (13.6%) were marginal to poor outcomes at latest follow-up. The literature search identified 3 relevant case-series studies. The reoperation rate was 4.2 - 37.5%. There were facet angel, disc height, motion spondylolisthesis, and laminectomy as risk factors of reoperation.

Conclusions: Microdecompression was effective for degenerative LSS in patients accompanying comorbidity. We suggest that disc degeneration of Pfirmann IV grade on L4/5 level is risk factor for reoperation after microdecompression. This study would be helpful in the surgical indications of microdecompression in LSS despite of lack evidence.