Skip to main content

Comparative observational study of surgical outcomes of lumbar foraminal stenosis using minimally invasive microsurgical extraforaminal decompression alone versus posterior lumbar interbody fusion: a prospective cohort study

Abstract

Introduction

There is no comparative study regarding surgical outcomes between microsurgical extraforaminal decompression (MeFD) and posterior lumbar interbody fusion (PLIF) for the treatment of lumbar foraminal stenosis (LFS). Therefore, the purpose of this study was to compare the surgical outcomes of LFS using two different techniques: MeFD alone or PLIF.

Methods

For the purposes of this study, a prospectively collected observational cohort study was conducted. Fifty-five patients diagnosed with LFS who were scheduled to undergo spinal surgery were included in this study. According to the chosen surgical technique, patients were assigned to either the MeFD group (n = 25) or the PLIF group (n = 30). The primary outcome was Oswestry Disability Index (ODI) score at 1 year after surgery.

Results

The baseline patient characteristics and preoperative ODI score, visual analog scale (VAS) scores for back and leg pain, and Short Form-36 score were not significantly different between the two groups. At 12 months postoperative, the mean ODI score in the MeFD and PLIF groups was 25.68 ± 14.49 and 27.20 ± 12.56, respectively, and the 95 % confidence interval (−9.76–6.73) was within the predetermined margin of equivalence. The overall ODI score and VAS scores for back and leg pain did not differ significantly over the follow-up assessment time between the two groups. However, the ODI score and VAS scores for back and leg pain improved significantly over time after surgery in both groups. In the MeFD group, revision surgery was required in three patients (12 %).

Conclusions

This study demonstrated that MeFD alone and PLIF have equivalent outcomes regarding improvement in disability at 1 year after surgery. However, the higher rate of revision surgery in the MeFD group should emphasize the technically optimal amount of decompression.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Papavero L, Kothe R (2013) Microsurgical extraforaminal decompression of lumbar root canal stenosis. Operative Orthopadie und Traumatologie 25(1):16–30. doi:10.1007/s00064-012-0194-3

    CAS  PubMed  Article  Google Scholar 

  2. Yoshimoto M, Takebayashi T, Kawaguchi S, Tsuda H, Ida K, Wada T, Suzuki D, Yamashita T (2011) Minimally invasive technique for decompression of lumbar foraminal stenosis using a spinal microendoscope: technical note. Minim Invasive Neurosurg 54(3):142–146. doi:10.1055/s-0031-1279716

    CAS  PubMed  Article  Google Scholar 

  3. Yamada K, Matsuda H, Nabeta M, Habunaga H, Suzuki A, Nakamura H (2011) Clinical outcomes of microscopic decompression for degenerative lumbar foraminal stenosis: a comparison between patients with and without degenerative lumbar scoliosis. Eur Spine J 20(6):947–953. doi:10.1007/s00586-010-1597-1

    PubMed Central  PubMed  Article  Google Scholar 

  4. Chang HS, Zidan I, Fujisawa N, Matsui T (2011) Microsurgical posterolateral transmuscular approach for lumbar foraminal stenosis. J Spinal Disorders Tech 24(5):302–307

    Article  Google Scholar 

  5. Matsumoto M, Watanabe K, Ishii K, Tsuji T, Takaishi H, Nakamura M, Toyama Y, Chiba K (2010) Posterior decompression surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction. J Neurosurg Spine 12(1):72–81. doi:10.3171/2009.7.SPINE09344

    PubMed  Article  Google Scholar 

  6. Ozeki N, Aota Y, Uesugi M, Kaneko K, Mihara H, Niimura T, Saito T (2008) Clinical results of intrapedicular partial pediculectomy for lumbar foraminal stenosis. J Spinal Disorders Tech 21(5):324–327

    Article  Google Scholar 

  7. Jenis LG, An HS (2000) Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976) 25(3):389–394

    CAS  Article  Google Scholar 

  8. Hallett A, Huntley JS, Gibson JN (2007) Foraminal stenosis and single-level degenerative disc disease: a randomized controlled trial comparing decompression with decompression and instrumented fusion. Spine (Philadelphia, Pa 1976) 32(13):1375–1380

    Article  Google Scholar 

  9. Infusa A, An HS, Glover JM, McGrady L, Lim TH, Riley LH 3rd (1996) The ideal amount of lumbar foraminal distraction for pedicle screw instrumentation. Spine (Phila Pa 1976) 21(19):2218–2223

    CAS  Article  Google Scholar 

  10. Katz JN, Harris MB (2008) Clinical practice. Lumbar spinal stenosis. N Engl J Med 358(8):818–825

    CAS  PubMed  Article  Google Scholar 

  11. Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF, North American Spine S (2008) Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 8(2):305–310. doi:10.1016/j.spinee.2007.10.033

    PubMed  Article  Google Scholar 

  12. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Philadelphia, Pa 1976) 35(21):1919–1924

    Article  Google Scholar 

  13. Bernhardt M, White A, Panjabi M (1992) Biomechanical considerations of spinal stability. The spine. WB Saunders, Philadelphia

    Google Scholar 

  14. Wang JC, Mummaneni PV, Haid RW (2005) Current treatment strategies for the painful lumbar motion segment: posterolateral fusion versus interbody fusion. Spine (Phila Pa 1976) 30(16 Suppl):S33–S43

    Article  Google Scholar 

  15. Enker P, Steffee AD (1994) Interbody fusion and instrumentation. Clin Orthop Relat Res 300:90–101

    PubMed  Google Scholar 

  16. Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine (Philadelphia, Pa 1976) 25(22):2940–2952

    CAS  Article  Google Scholar 

  17. Ware J, Snow K, Kosinski M, Gandek B (1993) SF-36 health survey manual and interpretation guide. New England Medical Center, The Health Institute, Boston

    Google Scholar 

  18. Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33(1):90–94. doi:10.1097/BRS.0b013e31815e3a10

    Article  Google Scholar 

  19. Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, Fossel AH, Liang MH (1997) Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine (Phila Pa 1976) 22(10):1123–1131

    CAS  Article  Google Scholar 

  20. Katz JN (2001) Patient preferences and health disparities. JAMA J Am Med Assoc 286(12):1506–1509

    CAS  Article  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jin S. Yeom.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, HJ., Jeong, JH., Cho, HG. et al. Comparative observational study of surgical outcomes of lumbar foraminal stenosis using minimally invasive microsurgical extraforaminal decompression alone versus posterior lumbar interbody fusion: a prospective cohort study. Eur Spine J 24, 388–395 (2015). https://doi.org/10.1007/s00586-014-3592-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3592-4

Keywords

  • Lumbar foraminal stenosis
  • Microsurgical extraforaminal decompression
  • Posterior lumbar interbody fusion