Surgical Treatment Options for Degenerative Lumbosacral Spinal Stenosis

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Abstract

Degenerative spinal stenosis is the most common type of degenerative and dystrophic spine disease. The clinical picture of stenosis, which may include axial pain syndrome, leg pain, intermittent claudication syndrome, weakness and loss of sensitivity in the legs, and impaired pelvic functions, can significantly worsen patients’ quality of life and reduce their ability to work and lead an active lifestyle.

Degenerative spinal stenosis mostly affects the elderly. Therapeutic and neurological communities have stereotypes about spine surgery being too traumatic and invasive, and, therefore, they believe that their use should be contraindicated to and limited in elderly patients. However, surgeons are increasingly giving preference to minimally invasive interventions with high efficacy and safety together with a low risk of complications.

We aimed at reviewing current treatment methods for degenerative lumbosacral spinal stenosis with an emphasis on surgical treatment methods.

About the authors

Adilya R. Yusupova

Research Center of Neurology

Author for correspondence.
Email: dr.yusupova.adilya@gmail.com
ORCID iD: 0000-0002-1679-2781

postgraduate student, neurosurgeon, 1st Neurosurgery department, Institute of Clinical and Preventive Neurology

Russian Federation, Moscow

Artem O. Gushcha

Research Center of Neurology

Email: dr.yusupova.adilya@gmail.com
ORCID iD: 0000-0003-3451-5750

D. Sci. (Med.), Prof., Head, Department of neurosurgery, 1st Neurosurgery department, Institute of Clinical and Preventive Neurology

Russian Federation, Moscow

Sergey O. Arestov

Research Center of Neurology

Email: dr.yusupova.adilya@gmail.com
ORCID iD: 0000-0003-4809-4117

Cand. Sci. (Med.), senior researcher, Department of neurosurgery, 1st Neurosurgery department, Institute of Clinical and Preventive Neurology

Russian Federation, Moscow

David V. Petrosyan

Research Center of Neurology

Email: dr.yusupova.adilya@gmail.com
ORCID iD: 0000-0001-9588-7721

neurosurgeon, 1st Neurosurgery department, Institute of Clinical and Preventive Neurology, Research Center of Neurology

Russian Federation, Moscow

Roman A. Kartavykh

Research Center of Neurology

Email: dr.yusupova.adilya@gmail.com
ORCID iD: 0000-0003-4543-3451

Cand. Sci. (Med.), neurosurgeon, 1st Neurosurgery department, Institute of Clinical and Preventive Neurology

Russian Federation, Moscow

Armen S. Simonyan

Research Center of Neurology

Email: dr.yusupova.adilya@gmail.com
ORCID iD: 0000-0001-8848-801X

neurosurgeon, 1st Neurosurgery department, Institute of Clinical and Preventive Neurology

Russian Federation, Moscow

Andrey A. Kiselev

Research Center of Neurology

Email: dr.yusupova.adilya@gmail.com
ORCID iD: 0000-0003-1903-9274

neurosurgeon, 1st Neurosurgery department, Institute of Clinical and Preventive Neurology

Russian Federation, Moscow

References

  1. Хирургия дегенеративных поражений позвоночника: национальное руководство / под ред. А.О. Гущи, Н.А. Коновалова, А.А. Гриня. М.; 2019. 480 с. Gushcha A.O., Konovalov N.A., Grin’ A.A. (eds.) Degenerative spine surgery: national guidelines. Moscow; 2019. 480 p.
  2. Антипко Л.Э. Стеноз позвоночного канала. Воронеж; 2001. 272 c. Antipko L.E. Spinal canal stenosis. Voronezh; 2001. 272 p.
  3. Boos N., Aebi M. Spinal disorders, fundamentals of diagnosis and treatment. Berlin Heidelberg; 2008. 1166 p.
  4. Verbiest H. Lumbar spine stenosis. Neurological surgery. Philadelphia; 1980: 2805–2855.
  5. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J. Bone Joint Surg. Br. 1954;36-B(2):230–237. doi: 10.1302/0301-620X.36B2.230
  6. Onel D., Sari H., Donmez C. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients: conservative treatment or surgical intervention? Spine. 1993;18:291–298.
  7. Yong-Hing K., Kirkaldy-Willis W.H. The pathophysiology of degenerative disease of the lumbar spine. Orthop. Clin. North Am. 1983;14(3):491–504.
  8. Jensen R.K., Jensen T.S., Koes B., Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. Eur. Spine J. 2020;29(9):2143–2163. doi: 10.1007/s00586-020-06339-1
  9. Гуща А.О., Герасимова Е.В., Полторако Е.Н. Болевой синдром при дегенеративно-дистрофических изменениях позвоночника. Анналы клинической и экспериментальной неврологии. 2018;12(4):67–75. Gushcha A.O., Gerasimova E.V., Poltorako Y.N. Pain syndrome in degenerative spine conditions. Annals of Clinical and Experimental Neurology. 2018;12(4):67–75. doi: 10.25692/ACEN.2018.4.10
  10. White A., Panjabi M.M. Clinical biomechanics of the spine. Philadelphia, Toronto; 1978;XXII:534
  11. Schizas C., Theumann N., Burn A. et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magne- tic resonance images. Spine (Phila Pa 1976). 2010;35(21):1919–1924. doi: 10.1097/BRS.0b013e3181d359bd
  12. Weber C., Giannadakis C., Rao V. et al. Is there an association between radiological severity of lumbar spinal stenosis and disability, pain, or surgical outcome? A multicenter observational study. Spine (Phila Pa 1976). 2016;41(2):E78–E83. doi: 10.1097/BRS.0000000000001166
  13. Van Tulder M., Becker A., Bekkering T. et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur. Spine J. 2006;15(Suppl. 2):S169–S191. doi: 10.1007/s00586-006-1071-2
  14. Clark D.W., Layton D., Shakir S.A. Do some inhibitors of COX-2 increase the risk of thromboembolic events? Linking pharmacology with pharmacoepidemiology. Drug Saf. 2004;27(7):427–456. doi: 10.2165/00002018-200427070-00002
  15. Chou R., Peterson K., Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J. Pain Symptom Manage. 2004;(2):140–175. doi: 10.1016/j.jpainsymman.2004.05.002
  16. See S., Ginzburg R. Choosing a skeletal muscle relaxant. Am. Fam. Physician. 2008;78(3):365–370.
  17. Serpell M., Neuropathic Pain Study Group. Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial. Pain. 2002;99(3):557–566. doi: 10.1016/S0304-3959(02)00255-5
  18. Gatchel R.J., Rollings K.H. Evidence informed management of chronic low back pain with cognitive behavioral therapy. Spine J. 2008;8(1):40–44. doi: 10.1016/j.spinee.2007.10.007
  19. Zaina F., Tomkins-Lane C., Carragee E., Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database of Systematic Reviews. 2016;1:CD010264. doi: 10.1002/14651858.CD010264.pub2
  20. Ammendolia C., Stuber K.J., Rok E. et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst. Rev. 2013;8;CD010712. doi: 10.1002/14651858.CD010712
  21. Lurie J.D., Tosteson T.D., Tosteson A. et al. Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine. 2015;40(2):63–76. doi: 10.1097/BRS.0000000000000731
  22. Deer T.R., Grider J.S., Pope J.E. et al. The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Pract. 2019;19(3):250–274. doi: 10.1111/papr.12744
  23. Caputy A.J., Spence C.A., Bejjani G.K., Luessenhop A.J. The role of spinal fusion in surgery for lumbar spinal stenosis: a review. Neurosurg. Focus. 1997;3(2):e3. doi: 10.3171/foc.1997.3.2.6
  24. Virk S., Qureshi S. Current concepts in spinal fusion: a special issue. HSS J. 2020;16(2):106–107. doi: 10.1007/s11420-020-09757-5
  25. Försth P., Ólafsson G., Carlsson T. et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N. Engl. J. Med. 2016;374:1413–1423. doi: 10.1056/NEJMoa1513721
  26. Herkowitz H.N., Kurz L.T. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J. Bone Joint Surg. Am. 1991;73(6):802–808.
  27. Bridwell K.H., Sedgewick T.A., O’Brien M.F. et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J. Spinal Disord. 1993;6(6):461–472. doi: 10.1097/00002517-199306060-00001
  28. Vaccaro A.R., Garfin S.R. Degenerative lumbar spondylolisthesis with spinal stenosis, a prospective study comparing decompression with decompression and intertransverse process arthrodesis: a critical analysis. Spine (Phila Pa 1976). 1997;22(4):368–369. doi: 10.1097/00007632-199702150-00002
  29. Martin C.R., Gruszczynski A.T., Braunsfurth H.A. et al. The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976). 2007;32(16):1791–1798. doi: 10.1097/BRS.0b013e3180bc219e
  30. Goel A. Spinal cord injuries — instability is the issue-stabilization is the treatment. J. Craniovertebr. Junction Spine. 2022;13(1):1–3. doi: 10.4103/jcvjs.jcvjs_24_22
  31. Johnsson K.E., Redland-Johnell I., Uden A., Willner S. Preoperative and postoperative instability in lumbar spinal stenosis. Spine (Phila Pa 1976). 1989;14(6): 591–593. doi: 10.1097/00007632-198906000-00008
  32. Fox M.W., Onofrio B.M., Onofrio B.M., Hanssen A.D. Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J. Neurosurg. 1996;85(5):793–802. doi: 10.3171/jns.1996.85.5.0793
  33. Hasegawa K., Kitahara K., Shimoda H. et al. Lumbar degenerative spondylolisthesis is not always unstable: clinicobiomechanical evidence. Spine (Phila Pa 1976). 2014;39(26):2127–2135. doi: 10.1097/BRS.0000000000000621
  34. Kepler C.K., Vaccaro A.R., Hilibrand A.S. et al. National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976). 2014; 39(19):1584–1589. doi: 10.1097/BRS.0000000000000486
  35. Resnick D.K., Watters W.C. III, Mummaneni P.V. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: lumbar fusion for stenosis without spondylolisthesis. J. Neurosurg. Spine. 2014;21(1):62–66. doi: 10.3171/2014.4.SPINE14275
  36. Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol. Res. 1999; 21(1):39–42. doi: 10.1080/01616412.1999.11740889
  37. Foley K.T., Smith M.M. Microendoscopic discectomy. Techniques in Neurosurgery. 1997;3(4):301–307.
  38. Foley K.T., Smith M.M., Rampersaud Y.R. Microendoscopic Discectomy. In: Schmidek H.H. (ed): Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results, ed 4. Philadelphia; 2000;2:2246–2256.
  39. Kim J.E., Choi D.J., Park E.J.J. et al. Biportal endoscopic spinal surgery for lumbar spinal stenosis. Asian Spine J. 2019;13(2):334–342. doi: 10.31616/asj.2018.0210
  40. Carrascosa-Granada A., Velazquez W., Wagner R. et al. Comparative study between uniportal full-endoscopic interlaminar and tubular approach in the treatment of lumbar spinal stenosis: a pilot study. Global Spine J. 2020;10(2S):70S–78S. doi: 10.1177/2192568219878419
  41. Tang S., Mok T.N., He Q. et al. Comparison of clinical and radiological outcomes of full-endoscopic versus microscopic lumbar decompression laminectomy for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis. Ann. Palliat. Med. 2021;10(10):10130–10146. doi: 10.21037/apm-21-198
  42. Kim H.S., Sharma S.B., Raorane H.D. et al. Early results of full-endoscopic decompression of lumbar central canal stenosis by outside-in technique: a clinical and radiographic study. Medicine (Baltimore). 2021;100(39):e27356. doi: 10.1097/MD.0000000000027356
  43. Kim H.S., Paudel B., Jang J.S. et al. Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurgery. 2017;103:201–209. doi: 10.1016/j.wneu.2017.03.130
  44. Kim H.S., Patel R., Paudel B. et al. Early outcomes of endoscopic contralateral foraminal and lateral recess decompression via an interlaminar approach in patients with unilateral radiculopathy from unilateral foraminal stenosis. World Neurosurg. 2017;108:763–773. doi: 10.1016/j.wneu.2017.09.018
  45. Wagner R., Telfeian A.E., Krzok G., Iprenburg M. Fully-endoscopic lumbar laminectomy for central and lateral recess stenosis: technical note. Interdiscip. Neurosurg. 2018;13:6–9. doi: 10.1016/j.inat.2018.01.006
  46. Wagner R., Haefner M. Indications and contraindications of full-endoscopic interlaminar lumbar decompression. World Neurosurg. 2021;145:657–662. doi: 10.1016/j.wneu.2020.08.042
  47. Hasan S., White-Dzuro B., Barber J.K. et al. The endoscopic trans-superior articular process approach: a novel minimally invasive surgical corridor to the lateral recess. Oper. Neurosurg. (Hagerstown). 2020;19:E1–E10. doi: 10.1093/ons/opaa054
  48. Iprenburg M., Wagner R., Godschalx A., Telfeian A.E. Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study. Neurosurg. Focus. 2016;40(2):E7. doi: 10.3171/2015.11.FOCUS15485
  49. Siepe C.J., Sauer D., Mayer H.M. Full endoscopic, bilateral over-the-top decompression for lumbar spinal stenosis. Eur. Spine J. 2018;27(Suppl 4):S563–S565. doi: 10.1007/s00586-018-5656-3
  50. Siepe C.J., Sauer D. Technique of full-endoscopic lumbar discectomy via an interlaminar approach. Eur. Spine J. 2018;27(Suppl 4):S566–S567. doi: 10.1007/s00586-018-5657-2
  51. Wu B., Xiong C., Tan L. et al. Clinical outcomes of MED and iLESSYS® Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: a comparison study. Exp. Ther. Med. 2020;20(252):1–9. doi: 10.3892/etm.2020.9382
  52. Deyo R.A., Mirza S.K., Martin B.I. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259–1265. doi: 10.1001/jama.2010.338
  53. Fenglong S., Qingchen L., Ming Y. et al. Unilateral laminectomy by endoscopy in central lumbar canal spinal stenosis. Technical note and early outcomes. Spine (Phila Pa 1976). 2020;45(14):E871–E877. doi: 10.1097/BRS.0000000000003478

Supplementary files

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2. Fig. 1. Visual grading of stenosis according to С. Schizas [11].

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3. Fig. 2. Surgery treatment algorithm for degenerative stenosis according to T.R. Deer et al. [22]. Blue arrows, option chosen; green arrows, yes; dotted green lines, instability, hypertrophy of the ligamentum flavum, the patient is not a candidate for open surgery with or without stabilization; red arrows, no; dotted red lines, instability, no hypertrophy of the ligamentum flavum, the patient is not a candidate for open surgery with or without stabilization. *In this algorithm, instability is defined as spondylolisthesis of grade 2 or more.

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4. Fig. 3. Access types for interbody fusion. ALIF, anterior lumbar interbody fusion; OLIF, oblique lumbar interbody fusion; XLIF, extralateral lumbar interbody fusion; KLIF, Kambin’s triangle for lumbar interbody fusion; TLIF, transforaminal lumbar interbody fusion, PLIF, posterior lumbar interbody fusion. Source: Morimoto M., Sairyo K. Full-endoscopic trans-Kambin’s triangle lumbar interbody fusion (Fullendo-KLIF). In: Sairyo K. (eds.) Transforaminal full-endoscopic lumbar surgery under the local anesthesia. Singapore Springer; 2021. DOI: 10.1007/978-981-15-7023-0_13

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5. Fig. 4. Kambin’s triangle (1). 2, nerve root forms the anterior border of the working area; 3, proximal plate; 4, intervertebral disc; 5 superior articular process.

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6. Fig. 5. Percutaneous endoscopic methods: intralaminar (1), posterolateral (2) and transforaminal (3).

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7. Fig. 6. System for percutaneous endoscopic surgery for degenerative spinal stenosis. Arrow, one access for decompression at two levels.

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8. Fig. 7. MRI of a patient with central degenerative stenosis at L4–L5 level. А, before surgery; В, after endoscopic decompressoin with Delta Joimax.

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Copyright (c) 2024 Yusupova A.R., Gushcha A.O., Arestov S.O., Petrosyan D.V., Kartavykh R.A., Simonyan A.S., Kiselev A.A.

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