Compare of outcomes of minimally invasive and open surgical techniques in patients with symptomatic lumbar spine stenosis on the background of scoliotic deformity

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Abstract

Objective: to compare the results of minimally invasive and open surgery in the treatment of the patients with combined symptomatic degenerative stenosis and scoliotic deformity of the lumbar spine.

Patients and methods. A retrospective comparative analysis of the long-term results of 54 patients was performed. The patients were devided in two groups: open surgery (group 1, n=39) and minimally invasive surgery (group 2, n=15). Different approaches were used based on the type of deformity (according to Berzhano and Lamartine), localization and extent of lumbar stenosis. The evaluation of volume of decompression, blood loss, time of surgery and postoperative treatment, intraoperative complications, pain and patients condition were measured using clinical scales ODI, ZCQ, SF-12 was performed.

Results. No differences in the type of deformity, the severity of stenosis and clinical manifestations between groups were discovered before treatment. All characteristics of the surgery (except the intraoperative complications) — blood loss, duration of surgery, and hospital stay — were significantly less in the minimally invasive group. Postoperative assessment has shown in group 1 greater regression of axial pain syndrome (p=0.03), in group 2 greater regression of radicular syndrome (p=0.03). Assessment of quality of life based on questionnaires after 2 years has revealed no differences between groups.

Conclusion. Using of minimally-invasive decompression and decompression-stabilizing surgical technologies in patients with combined stenosis and deformity of the lumbar spine allow to eliminate the syndromes of neural compression, provide sufficient correction of segmental relationships and improve the quality of life.

About the authors

S. G. Mlyavykh

FSBEI HE 'Privolzhsky Research Medical University' MOH Russia

Author for correspondence.
Email: serg.mlyavykh@gmail.com
ORCID iD: 0000-0002-6310-4961

Cand. of Sci (Med), Chief of Trauma and Orthopedic

Russian Federation, Nizhny Novgorod

A. E. Bokov

FSBEI HE 'Privolzhsky Research Medical University' MOH Russia

Email: andrei_bokov@mail.ru
ORCID iD: 0000-0002-5203-0717

Cand. of Sci (Med), Head of Department of Oncology and Neurosurgery Department of Trauma and Orthopedic Institute

Russian Federation, Nizhny Novgorod

A. Ya. Aleynik

FSBEI HE 'Privolzhsky Research Medical University' MOH Russia

Email: aaleynik23@gmail.com
ORCID iD: 0000-0002-1761-1022

and. of Sci (Med), Neurosurgeon and Orthopedics of Department of Oncology and Neurosurgery Department of Trauma and Orthopedic

Russian Federation, Nizhny Novgorod

K. S. Yashin

FSBEI HE 'Privolzhsky Research Medical University' MOH Russia

Email: jashinmed@gmail.com
ORCID iD: 0000-0002-5723-7389

Cand. of Sci (Med), Neurosurgeon and Oncologist of Department of Oncology and Neurosurgery Department of Trauma and Orthopedic

Russian Federation, Nizhny Novgorod

References

  1. Weinstein J.N., Lurie J.D., Tosteson T.D. et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007;356(22):2257-70. https://doi.org/10.1056/NEJMoa070302.
  2. Wang G., Cui X., Jiang Z. et al. Evaluation and Surgical Management of Adult Degenerative Scoliosis Associated With Lumbar Stenosis. Medicine. 2016;95(15):e3394. https://doi.org/10.1097/md.0000000000003394.
  3. Silva F.E., Lenke L.G. Adult degenerative scoliosis: evaluation and management. Neurosurgical Focus. 2010;28(3):E1. https:// doi.org/10.3171 /2010.1.focus09271.
  4. Zeng Y., White A.P, Albert T.J., Chen Z. Surgical Strategy in Adult Lumbar Scoliosis. Spine. 2012;37(9):E556-E1. https:// doi.org/10.1097/BRS.0b013e31824af5c6.
  5. Minamide A., Yoshida M., Iwahashi H. et al. Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes. Journal of Orthopaedic Science. 2017;22(3):377-83. https://doi.org/10.1016/j.jos.2016.12.022.
  6. Ploumis A., Transfledt E.E., Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J. 2007;7(4):428-36. https://doi.org/10.1016/j.spinee.2006.07.015.
  7. Lafage V., Schwab F., Patel A. et al. Pelvic Tilt and Truncal Inclination. Spine. 2009;34(17):E599-E606. https://doi.org/10.1097/ BRS.0b013e3181aad219.
  8. Le Huec J.C., Cogniet A., Mazas S., Faundez A. Lumbar scoliosis associated with spinal stenosis in idiopathic and degenerative cases. European Journal of Orthopaedic Surgery & Traumatology. 2016.26(7):705-12.
  9. https://doi.org/I0.1007/s00590-016-1829-0.
  10. Ng K.M.K., Yin C.P.J. Is minimally invasive surgery superior to open surgery for treatment of lumbar spinal stenosis? A systematic review. Journal of Orthopaedic Surgery. 2017;25(2): 230949901771625.
  11. https://doi.org/10.1177/2309499017716254.
  12. Narain A.S., Hijji F.Y., Markowitz J.S. et al. Minimally invasive techniques for lumbar decompressions and fusions. Current Reviews in Musculoskeletal Medicine. 2017;10(4):559-66. https://doi.org/10.1007/sI2178-017-9446-z.
  13. Chang F., Zhang T., Gao G. et al. Comparison of the Minimally Invasive and Conventional Open Surgery Approach in the Treatment of Lumbar Stenosis: A Systematic Review and a Meta-Analysis. Ann Acad Med Singapore. 2017;46(4):124-37.
  14. Kato M., Namikawa T., Matsumura A. et al. Radiographic Risk Factors of Reoperation Following Minimally Invasive Decompression for Lumbar Canal Stenosis Associated With Degenerative Scoliosis and Spondylolisthesis. Global Spine Journal. 2017;7(6):498-505.
  15. https://doi.org/10.1177/2192568217699192.
  16. Kurra S., Lavelle W.F., Silverstein M.P. et al. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. The Spine Journal. 2018;18(6):1014-21.
  17. https://doi.org/10.1016/j.spinee.2017.10.063.
  18. Konno S., Hayashino Y., Fukuhara S. et al. Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2007; 16(11): 1951-7. https://doi.org/10.1007/s00586-007-0402-2.
  19. Berjano P., Lamartina C. Answer to the Letter to the Editor of T.A. Mattei concerning «Far lateral approaches (XLIF) in adult scoliosis». European Spine Journal. 2013;22(5):1186-90. https://doi.org/10.1007/s00586-012-2637-9.
  20. Pratt R.K., Fairbank J.C., Virr A. The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2002;27( 1 ):84-91.
  21. Stucki G., Daltroy L., Liang M.H. et al. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976). 1996;21 (7):796-803.
  22. Stucki G., Liang M.H., Fossel A.H., Katz J.N. Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. J Clin Epidemiol. 1995;48(ll):1369-78.
  23. Бывальцев В.А., Белых E.Г., Сороковиков В.А., Арсентьева Н.Н. Использование шкал и анкет в вертебрологии. Журнал неврологии и психиатрии им. С.С. Корсакова. 2011;111(9—2):51-6. [Byval’tsev V.A., Belykh E.G., Sorokovikov V.A., Arsent’eva N.I. The use of scales and questionnaires in vertebrology. Zh Nevrol Psikhiatr im. S.S. Korsakova. 2011; 111(9-2):51-6. (In Russ.)].
  24. Park K.B., Shin J.-S., Lee J. et al. Minimum Clinically Important Difference and Substantial Clinical Benefit in Pain, Functional, and Quality of Life Scales in Failed Back Surgery Syndrome Patients. Spine. 2017;42(8):E474-E81. https://doi.org/10.1097/brs.0000000000001950.
  25. Austevoll I.M., Gjestad R., Grotle M. et al. Follow-up score, change score or percentage change score for determining clinical important outcome following surgery? An observational study from the Norwegian registry for Spine surgery evaluating patient reported outcome measures in lumbar spinal stenosis and lumbar degenerative spondylolisthesis. BMC Musculoskeletal Disorders. 2019;20(1): 15. https://doi.org/10.1186/sl2891-018-2386-y.
  26. Tribus C.B. Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg. 2003; 11(3): 174-83.
  27. Minamide A., Yoshida M., Yamada H. et al. Clinical outcomes after microendoscopic laminotomy for lumbar spinal stenosis: a 5-year follow-up study. European Spine Journal. 2014;24(2):396- 403.
  28. https://doi.org/10.1007/s00586-014-3599-x.
  29. Haher T.R., O'Brien M., Dryer J.W. et al. The role of the lumbar facet joints in spinal stability. Identification of alternative paths of loading. Spine (Phila Pa 1976). 1994;19(23):2667-70.
  30. Silva F.E., Lenke L.G. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28(3):El. https://doi.org/10.3171/2010.Lfocus09271.
  31. Brodke D.S., Annis P., Lawrence B.D. et al. Reoperation and Revision Rates of 3 Surgical Treatment Methods for Lumbar Stenosis Associated With Degenerative Scoliosis and Spondylolisthesis. Spine. 2013;38(26):2287-94. https://doi.org/10.1097/brs.0000000000000068.
  32. Крутько A.B., Дурни П., Васильев А.И., Булатов A.B. Минимально-инвазивные технологии в хирургическом лечении дегенеративного поясничного сколиоза взрослых. Хирургия позвоночника. 2014;4:49-56. [Krutko A.V., Durny Р., Vasilyev А.I., Bulatov А.V. Minimally Invasive Surgical Treatment for Adult Degenerative Lumbar Scoliosis. Hirurgiâ pozvonocnika. 2014;4:49-56. (In Russ.)].
  33. https://doi.org/10.14531/ss2014.4.49-56.
  34. Houten J.K., Nasser R. Symptomatic progression of degenerative scoliosis after decompression and limited fusion surgery for lumbar spinal stenosis. Journal of Clinical Neuroscience. 2013;20(4):613-15.
  35. https://doi.org/10.1016/j.jocn.2012.06.002.
  36. Гуща A.O., Колесов С.В., Полторако Е.Н. и др. Хирургическое лечение многоуровневого стеноза позвоночного канала в поясничном отделе позвоночника с применением динамической стабилизации в рамках мультицентрового исследования. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2017;4:11-7. [Gushcha А.О., Kolesov S.V., Poltorako E.N. et al. Surgical Treatment of Multilevel Lumbar Vertebral Canal Stenosis Using Dynamic Stabilization. Multicenter Study. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2017;4:11-7. (In Russ.)].
  37. https://doi.org/10.32414/0869-8678-2017-4-11-17.
  38. Афаунов А.А., Басанкин И.В., Кузьменко А.В., Шаповалов В.К. Анализ причин ревизионных операций при хирургическом лечении больных с поясничными стенозами дегенеративной этиологии. Хирургия позвоночника. 2014; 1(2014):86-93. [Anufanov А.А., Basankin I.V, Kuzmenko А.V., Shapovalov В.К. Chirurgia pozvonochnika Analysis of the reasons of repetive surgery in degerative treatment patient. Chirurgia pozvonochnika. 2014; 1 (2014):86-93. (In Russ.)]. https://doi.org/10.14531/ss2014.l.86-93.
  39. Бывальцев В.А., Калинин А.А., Белых Е.Г. и др. Оптимизация результатов лечения пациентов с сегментарной нестабильностью поясничного отдела позвоночника при использовании малоинвазивной методики спондилодеза. Вопросы нейрохирургии им. Н.Н. Бурденко. 2015;79(3):45. [Byvaltsev V.A., Kalinin A.A., Belykh E.G. et al. Optimization of segmental lumbar spine instability treatment using minimally invasive spinal fusion technique. Voprosy neirokhirurgii imeni N.N. Burdenko. 2015;79(3):45. (In Russ.)]. https://doi.org/10.17116/neiro201579345-54.

Supplementary files

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2. Distribution of patients by type of surgical intervention performed: MIS LLIF — indirect decompression + anterior interbody fusion from lateral minimally invasive aproach with percutaneous posterior rigid fixation; Tubular Decompression — tubular (mono/bilateral laminotomy) decompression without spinal fusion; Open Decompression — open decompression without fusion; TLIF — open decompression + transforaminal interbody fusion with rigid fixation; PLF — open decompression + posterior lateral fusion with rigid fixation. Absolute number of patients and fractions (%) are indicated.

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