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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

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Abstract

Purpose

To compare patient outcomes and complication rates after different decompression techniques or instrumented fusion (IF) in lumbar spinal stenosis (LSS).

Methods

The multicentre study was based on Spine Tango data. Inclusion criteria were LSS with a posterior decompression and pre- and postoperative COMI assessment between 3 and 24 months. 1,176 cases were assigned to four groups: (1) laminotomy (n = 642), (2) hemilaminectomy (n = 196), (3) laminectomy (n = 230) and (4) laminectomy combined with an IF (n = 108). Clinical outcomes were achievement of minimum relevant change in COMI back and leg pain and COMI score (2.2 points), surgical and general complications, measures taken due to complications, and reintervention on the index level based on patient information. The inverse propensity score weighting method was used for adjustment.

Results

Laminotomy, hemilaminectomy and laminectomy were significantly less beneficial than laminectomy in combination with IF regarding leg pain (ORs with 95 % CI 0.52, 0.34–0.81; 0.25, 0.15–0.41; 0.44, 0.27–0.72, respectively) and COMI score improvement (ORs with 95 % CI 0.51, 0.33–0.81; 0.30, 0.18–0.51; 0.48, 0.29–0.79, respectively). However, the sole decompressions caused significantly fewer surgical (ORs with 95 % CI 0.42, 0.26–0.69; 0.33, 0.17–0.63; 0.39, 0.21–0.71, respectively) and general complications (ORs with 95 % CI 0.11, 0.04–0.29; 0.03, 0.003–0.41; 0.25, 0.09–0.71, respectively) than laminectomy in combination with IF. Accordingly, the likelihood of required measures was also significantly lower after laminotomy (OR 0.28, 95 % CI 0.17–0.46), hemilaminectomy (OR 0.28, 95 % CI 0.15–0.53) and after laminectomy (OR 0.39, 95 % CI 0.22–0.68) in comparison with laminectomy with IF. The likelihood of a reintervention was not significantly different between the treatment groups.

Discussion

As already demonstrated in the literature, decompression in patients with LSS is a very effective treatment. Despite better patient outcomes after laminectomy in combination with IF, caution is advised due to higher rates of surgical and general complications and consequent required measures. Based on the current study, laminotomy or laminectomy, rather than hemilaminectomy, is recommendable for minimum relevant pain relief.

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Acknowledgments

The participants of the Spine Tango Register are acknowledged for their continuous contribution that makes possible such studies reflecting the daily practice of spine surgeons. The data of the following centres were used (in alphabetic order of country, city, hospital and department): Dept. of Spinal Surgery in Royal Adelaide Hospital (Australia); Dept. of Spinal Surgery in St. Andrew’s Hospital in Adelaide (Australia); Dept. of Orthopaedic Surgery in University Hospital of Graz (Austria); Dept. of Orthopaedic Surgery in Edith Cavell Clinic of Brussels (Belgium); Dept. of Orthopaedic Surgery in Saint Pierre Clinic of Ottignies (Belgium); Dept. of Neurosurgery in Köpenick Hospital DRK Kliniken Berlin (Germany); Dept. of Orthopaedic Surgery in University Hospital of Cologne (Germany); Dept. of Neurosurgery in Hospital Cologne-Merheim (Germany); Dept. of Spine Surgery in Hospital Dortmund (Germany); Dept. Of Orthopaedic Surgery in University Hospital of Greifswald (Germany); Group Practice of Orthopaedics and Neurosurgery in Hof (Germany); Dept. of Special Spine Surgery in Leopoldina Hospital of Schweinfurt (Germany); Dept. of Neurosurgery in Sapienza University of Rome (Italy); Dept. of Orthopaedic Surgery in Tan Tock Seng Hospital (Singapore); Dept. of Orthopaedic Surgery in University Hospital of Ljubljana (Slovenia); Dept. of Neurosurgery in Bethesda Hospital of Basel (Switzerland); Dept. of Spine Surgery in Bethesda Hospital of Basel (Switzerland); Dept. of Orthopaedic Surgery in Salem Hospital of Bern (Switzerland); Dept. of Spine Surgery in The Spine Center Thun (Switzerland); Dept. of Orthopaedic Surgery in Hospital Schwyz (Switzerland); Dept. of Orthopaedic Surgery in Zollikerberg Hospital (Switzerland); Dept. of Spine Surgery in University Hospital Balgrist of Zurich (Switzerland); Spine Unit of Nuffield Oxford Centre (UK); Dept. of Neurosurgery in Walton Centre Foundation Trust of Liverpool (UK); Division of Spine Surgery in NYU Hospital of New York (USA).

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Authors and Affiliations

  1. Clinique Saint Pierre, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium

    Everard Munting

  2. Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland

    Christoph Röder, Daniel Dietrich & Emin Aghayev

  3. Department of Orthopaedic Surgery, Medizinisches Zentrum Städte Region Aachen, Mauerfeldchen 25, 52146, Würselen, Germany

    Rolf Sobottke

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  1. Everard Munting
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  5. Emin Aghayev
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Correspondence to Emin Aghayev.

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Munting, E., Röder, C., Sobottke, R. et al. 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 24, 358–368 (2015). https://doi.org/10.1007/s00586-014-3349-0

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