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Less-invasive decompression procedures can reduce risk of reoperation for lumbar spinal stenosis with diffuse idiopathic skeletal hyperostosis extended to the lumbar segment: analysis of two retrospective cohorts

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Abstract

Purpose

Clinical outcomes after decompression procedures are reportedly worse for lumbar spinal stenosis (LSS) with diffuse idiopathic skeletal hyperostosis (DISH), especially DISH extended to the lumbar segment (L-DISH). However, no studies have compared the effect of less-invasive surgery versus conventional decompression techniques for LSS with DISH. The purpose of this study was to compare the long-term risk of reoperation after decompression surgery focusing on LSS with L-DISH.

Methods

This study compared open procedure cohort (open conventional fenestration) and less-invasive procedure cohort (bilateral decompression via a unilateral approach) with ≥ 5 years of follow-up. After stratified analysis by L-DISH, patients with L-DISH were propensity score-matched by age and sex.

Results

There were 57 patients with L-DISH among 489 patients in the open procedure cohort and 41 patients with L-DISH among 297 patients in the less-invasive procedure cohort. The reoperation rates in L-DISH were higher in the open than less-invasive procedure cohort for overall reoperations (25% and 7%, p = 0.026) and reoperations at index levels (18% and 5%, p = 0.059). Propensity score-matched analysis in L-DISH demonstrated that open procedures were significantly associated with increased overall reoperations (hazard ratio [HR], 6.18; 95% confidence interval [CI], 1.37–27.93) and reoperations at index levels (HR, 4.80; 95% CI, 1.04–22.23); there was no difference in reoperation at other lumbar levels.

Conclusions

Less-invasive procedures had a lower risk of reoperation, especially at index levels for LSS with L-DISH. Preserving midline-lumbar posterior elements could be desirable as a decompression procedure for LSS with L-DISH.

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Acknowledgements

The authors also thank all staff and physiotherapists of the Wajokai Eniwa Hospital for data entry assistance with the preoperative information or postal survey.

Funding

This study has no funding support.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Kentaro Yamada

  2. Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka City, Osaka, Japan

    Hiromitsu Toyoda, Shinji Takahashi, Akinobu Suzuki, Hidetomi Terai & Hiroaki Nakamura

  3. Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa City, Hokkaido, Japan

    Takahiko Hyakumachi & Yuichiro Abe

Authors
  1. Kentaro Yamada
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  2. Hiromitsu Toyoda
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  4. Yuichiro Abe
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  5. Shinji Takahashi
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  6. Akinobu Suzuki
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  7. Hidetomi Terai
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  8. Hiroaki Nakamura
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Contributions

Conception and design were contributed by KY and HT. Acquisition of data was contributed by KY, HT, TH, YA, ST, AS, and HT. Analysis and interpretation of data were contributed by KY and ST. Drafting the article was contributed by KY. HT critically revised the article. HT, TH, ST, and HN reviewed submitted version of manuscript. KY, HT, TH, YA, ST, AS, HT, and HN approved the final version of the manuscript on behalf of all authors. Statistical analysis was contributed by KY and ST. Study supervision was contributed by HN.

Corresponding author

Correspondence to Kentaro Yamada.

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Conflict of interest

All authors have no conflicts of interest.

Ethical approval

This study was approved by the Institutional Review Board of Osaka City University (Approval number: 3170. Approval date: June 30, 2015) and by the Institutional Review Board of the Wajokai Eniwa Hospital (Approval number: 33. Approval date: July 22, 2015).

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Yamada, K., Toyoda, H., Hyakumachi, T. et al. Less-invasive decompression procedures can reduce risk of reoperation for lumbar spinal stenosis with diffuse idiopathic skeletal hyperostosis extended to the lumbar segment: analysis of two retrospective cohorts. Eur Spine J 32, 505–516 (2023). https://doi.org/10.1007/s00586-022-07496-1

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  • DOI: https://doi.org/10.1007/s00586-022-07496-1

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