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Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery

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Abstract

Introduction

The aim of this study was to compare the clinical outcome of spinal process osteotomy with two other midline-retaining methods, bilateral laminotomy and unilateral laminotomy with crossover, among patients undergoing surgery for lumbar spinal stenosis.

Methods

This cohort study was based on data from the Norwegian Registry for Spine Surgery (NORspine). Patients were operated on between 2009 and 2013 at 31 Norwegian hospitals. The patients completed questionnaires at admission for surgery, and after 3 and 12 months. The Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were duration of surgery and hospital stay, Numeric Rating Scale (NRS) for back pain and leg pain, and EQ-5D and EQ-VAS. The patients were classified into one of three treatment groups according to the surgery they had received, and a propensity score was utilized to minimize bias. The three treatment groups were divided into subgroups based on Propensity Scores, and the statistical analyses were performed with and within the Propensity Score stratified subgroups.

Results

103 patients had spinal process osteotomy, 966 patients had bilateral laminotomy, and 462 patients had unilateral laminotomy with crossover. Baseline clinical scores were similar in the three groups. There were no differences in improvement after 3 and 12 months between treatment groups. At 12 months, mean ODI improvement was 15.2 (SD 16.7) after spinous process osteotomy, 16.9 (SD 17.0) after bilateral laminotomy, and 16.7 (SD 16.9) after unilateral laminotomy with crossover. There were no differences in the secondary clinical outcomes or complication rates. Mean duration of surgery was greatest for spinal process osteotomy (p < 0.05). Length of stay was 2.1 days (SD 2.1) in the bilateral laminotomy group, 3.5 (SD 2.4) days for unilateral laminotomy, and 6.9 days (SD 4.1) for spinous process osteotomy group (p < 0.05).

Conclusion

In a propensity scored matched cohort, there were no differences in the clinical outcome 12 months after surgery for lumbar spinal stenosis performed using the three different posterior decompression techniques. Bilateral laminotomy had shortest duration of surgery and shortest length of hospital stay. Surgical technique does not seem to affect clinical outcome after three different midline-retaining posterior decompression techniques.

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References

  1. Gibson JN, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated Cochrane review. Spine (Phila Pa 1976) 30:2312–2320

    Article  Google Scholar 

  2. Jacobs WC, Rubinstein SM, Willems PC, Moojen WA, Pellise F, Oner CF, Peul WC, van Tulder MW (2013) The evidence on surgical interventions for low back disorders, an overview of systematic reviews. Eur Spine J 22:1936–1949. doi:10.1007/s00586-013-2823-4

    Article  PubMed  PubMed Central  Google Scholar 

  3. Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Thome C, Gunzburg R, Peul W (2015) Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Cochrane Database Syst Rev 3:CD010036. doi:10.1002/14651858.CD010036.pub2

    Google Scholar 

  4. Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J, Schmiedek P (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3:129–141

    Article  PubMed  Google Scholar 

  5. Delank KS, Eysel P, Zollner J, Drees P, Nafe B, Rompe JD (2002) Undercutting decompression versus laminectomy. Clinical and radiological results of a prospective controlled trial. Orthopade 31:1048–1056

    Article  CAS  PubMed  Google Scholar 

  6. Fu YS, Zeng BF, Xu JG (2008) Long-term outcomes of two different decompressive techniques for lumbar spinal stenosis. Spine (Phila Pa 1976) 33:514–518

    Article  Google Scholar 

  7. Postacchini F, Cinotti G, Perugia D, Gumina S (1993) The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br 75:386–392

    CAS  PubMed  Google Scholar 

  8. Thomas NW, Rea GL, Pikul BK, Mervis LJ, Irsik R, McGregor JM (1997) Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery 41:567–574

    CAS  PubMed  Google Scholar 

  9. Arai Y, Hirai T, Yoshii T, Sakai K, Kato T, Enomoto M, Matsumoto R, Yamada T, Kawabata S, Shinomiya K, Okawa A (2014) A Prospective comparative study of 2 minimally invasive decompression procedures for lumbar spinal canal stenosis: unilateral laminotomy for bilateral decompression (ULBD) versus muscle-preserving interlaminar decompression (MILD). Spine (Phila Pa 1976) 39:332–340. doi:10.1097/BRS.0000000000000136

    Article  Google Scholar 

  10. Dalgic A, Uckun O, Ergungor MF, Okay O, Daglioglu E, Hatipoglu G, Pasaoglu L, Caglar YS (2010) Comparison of unilateral hemilaminotomy and bilateral hemilaminotomy according to dural sac area in lumbar spinal stenosis. Minim Invasive Neurosurg 53:60–64

    Article  CAS  PubMed  Google Scholar 

  11. Hong SW, Choi KY, Ahn Y, Baek OK, Wang JC, Lee SH, Lee HY (2011) A comparison of unilateral and bilateral laminotomies for decompression of L4–L5 spinal stenosis. Spine (Phila Pa 1976) 36:E172–E178

    Article  Google Scholar 

  12. Yong-Hing K, Kirkaldy-Willis WH (1978) Osteotomy of lumbar spinous process to increase surgical exposure. Clin Orthop Relat Res 134:218–220

    Google Scholar 

  13. Gunzburg R, Keller TS, Szpalski M, Vandeputte K, Spratt KF (2003) A prospective study on CT scan outcomes after conservative decompression surgery for lumbar spinal stenosis. J Spinal Disord Tech 16:261–267

    Article  CAS  PubMed  Google Scholar 

  14. Gunzburg R, Szpalski M (2003) The conservative surgical treatment of lumbar spinal stenosis in the elderly. Eur Spine J 12(Suppl 2):S176–S180

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hermansen E, Moen G, Barstad J, Birketvedt R, Indrekvam K (2013) Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA). Eur Spine J 22:1913–1919. doi:10.1007/s00586-013-2737-1

    Article  PubMed  PubMed Central  Google Scholar 

  16. Takaso M, Nakazawa T, Imura T, Okada T, Fukushima K, Ueno M, Saito W, Shintani R, Sakagami H, Takahashi K, Yamazaki M, Ohtori S, Kotani T (2011) Less invasive and less technically demanding decompressive procedure for lumbar spinal stenosis—appropriate for general orthopaedic surgeons? Int Orthop 35:67–73. doi:10.1007/s00264-010-0986-8

    Article  PubMed  Google Scholar 

  17. Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine (Phila Pa 1976) 25:2940–2952

    Article  CAS  Google Scholar 

  18. Solberg TK, Olsen JA, Ingebrigtsen T, Hofoss D, Nygaard OP (2005) Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery. Eur Spine J 14:1000–1007

    Article  PubMed  Google Scholar 

  19. Nord E (1991) EuroQol: health-related quality of life measurement. Valuations of health states by the general public in Norway. Health Policy 18:25–36

    Article  CAS  PubMed  Google Scholar 

  20. Rabin R, Charro FD (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343

    Article  CAS  PubMed  Google Scholar 

  21. Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55

    Article  Google Scholar 

  22. Carreon LY, Glassman SD, Kantamneni NR, Mugavin MO, Djurasovic M (2010) Clinical outcomes after posterolateral lumbar fusion in workers’ compensation patients: a case–control study. Spine (Phila Pa 1976) 35:1812–1817. doi:10.1097/BRS.0b013e3181c68b75

    Article  Google Scholar 

  23. Munting E, Roder C, Sobottke R, Dietrich D, Aghayev E (2014) Patient outcomes after laminotomy, hemilaminectomy, laminectomy and laminectomy with instrumented fusion for spinal canal stenosis: a propensity score-based study from the Spine Tango registry. Eur Spine J. doi:10.1007/s00586-014-3349-0

    PubMed  Google Scholar 

  24. Nerland US, Jakola AS, Solheim O, Weber C, Rao V, Lonne G, Solberg TK, Salvesen O, Carlsen SM, Nygaard OP, Gulati S (2015) Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ 350:h1603. doi:10.1136/bmj.h1603

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rihn JA, Hilibrand AS, Zhao W, Lurie JD, Vaccaro AR, Albert TJ, Weinstein J (2015) Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population: analysis of the Spine Patient Outcomes Research Trial (SPORT) data. J Bone Joint Surg Am 97:177–185. doi:10.2106/jbjs.n.00313

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gulati S, Nordseth T, Nerland US, Gulati M, Weber C, Giannadakis C, Nygaard OP, Solberg TK, Solheim O, Jakola AS (2015) Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis?—a multicenter observational registry-based study. Acta Neurochir (Wien) 157:1157–1164. doi:10.1007/s00701-015-2437-1

    Article  Google Scholar 

  27. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8:968–974

    Article  PubMed  Google Scholar 

  28. Hagg O, Fritzell P, Oden A, Nordwall A (2002) Simplifying outcome measurement: evaluation of instruments for measuring outcome after fusion surgery for chronic low back pain. Spine (Phila Pa 1976) 27:1213–1222

    Article  Google Scholar 

  29. Parker SL, Adogwa O, Mendenhall SK, Shau DN, Anderson WN, Cheng JS, Devin CJ, McGirt MJ (2012) Determination of minimum clinically important difference (MCID) in pain, disability, and quality of life after revision fusion for symptomatic pseudoarthrosis. Spine J 12:1122–1128. doi:10.1016/j.spinee.2012.10.006

    Article  PubMed  Google Scholar 

  30. Hagg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20

    CAS  PubMed  Google Scholar 

  31. Hagg O, Fritzell P, Ekselius L, Nordwall A (2003) Predictors of outcome in fusion surgery for chronic low back pain. A report from the Swedish Lumbar Spine Study. Eur Spine J 12:22–33

    CAS  PubMed  Google Scholar 

  32. Parker SL, Mendenhall SK, Shau D, Adogwa O, Cheng JS, Anderson WN, Devin CJ, McGirt MJ (2012) Determination of minimum clinically important difference in pain, disability, and quality of life after extension of fusion for adjacent-segment disease. J Neurosurg Spine 16:61–67

    Article  PubMed  Google Scholar 

  33. Nerland US, Jakola AS, Giannadakis C, Solheim O, Weber C, Nygaard OP, Solberg TK, Gulati S (2015) The risk of getting worse: predictors of deterioration after decompressive surgery for lumbar spinal stenosis: a multicenter observational study. World Neurosurg 84:1095–1102. doi:10.1016/j.wneu.2015.05.055

    Article  PubMed  Google Scholar 

  34. Dworkin RH, Turk DC, McDermott MP, Peirce-Sandner S, Burke LB, Cowan P, Farrar JT, Hertz S, Raja SN, Rappaport BA, Rauschkolb C, Sampaio C (2009) Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations. Pain 146:238–244. doi:10.1016/j.pain.2009.08.019

    Article  PubMed  Google Scholar 

  35. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, Haythornthwaite JA, Jensen MP, Kerns RD, Ader DN, Brandenburg N, Burke LB, Cella D, Chandler J, Cowan P, Dimitrova R, Dionne R, Hertz S, Jadad AR, Katz NP, Kehlet H, Kramer LD, Manning DC, McCormick C, McDermott MP, McQuay HJ, Patel S, Porter L, Quessy S, Rappaport BA, Rauschkolb C, Revicki DA, Rothman M, Schmader KE, Stacey BR, Stauffer JW, von Stein T, White RE, Witter J, Zavisic S (2008) Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 9:105–121. doi:10.1016/j.jpain.2007.09.005

    Article  PubMed  Google Scholar 

  36. Solberg T, Johnsen LG, Nygaard OP, Grotle M (2013) Can we define success criteria for lumbar disc surgery?: estimates for a substantial amount of improvement in core outcome measures. Acta Orthop 84:196–201. doi:10.3109/17453674.2013.786634

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ohrn A, Olai A, Rutberg H, Nilsen P, Tropp H (2011) Adverse events in spine surgery in Sweden: a comparison of patient claims data and national quality register (Swespine) data. Acta Orthop 82:727–731. doi:10.3109/17453674.2011.636673

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway

    Erland Hermansen

  2. Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway

    Erland Hermansen, Ivar Magne Austevoll & Kari Indrekvam

  3. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Erland Hermansen, Ivar Magne Austevoll & Kari Indrekvam

  4. Department of Research, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway

    Ulla Kristina Romild

  5. Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway

    Tore Solberg

  6. Norwegian National Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway

    Tore Solberg

  7. Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital, University of Oslo, Oslo, Norway

    Kjersti Storheim

  8. Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway

    Jens Ivar Brox

  9. Department of Orthopedics, Oslo University Hospital, Oslo, Norway

    Christian Hellum

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  1. Erland Hermansen
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Correspondence to Erland Hermansen.

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Hermansen, E., Romild, U.K., Austevoll, I.M. et al. Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery. Eur Spine J 26, 420–427 (2017). https://doi.org/10.1007/s00586-016-4643-9

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  • DOI: https://doi.org/10.1007/s00586-016-4643-9

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