Unilateral Laminotomy with Bilateral Decompression: A Case Series Studying One- and Two-Year Outcomes with Predictors of Minimal Clinical Improvement.

Autor: Knio ZO; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Schallmo MS; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Hsu W; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Corona BT; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Lackey JT; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Marquez-Lara A; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Luo TD; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Medda S; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Wham BC; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., O'Gara TJ; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. Electronic address: togara@wakehealth.edu.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2019 Nov; Vol. 131, pp. e290-e297. Date of Electronic Publication: 2019 Jul 26.
DOI: 10.1016/j.wneu.2019.07.144
Abstrakt: Objective: To assess factors that may predict failure to improve at 12 and 24 months after unilateral laminotomy with bilateral decompression (ULBD) for the management of lumbar spinal stenosis.
Methods: A database of 255 patients who underwent microdecompression surgery by a single orthopedic spine surgeon between 2014 and 2018 was queried. Patients who underwent primary single-level ULBD of the lumbar spine were included. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) results were collected preoperatively and at 12 and 24 months postoperatively. Demographic, radiographic, and operative factors were assessed for associations with failure to improve. Clinically important improvement was defined as reaching or surpassing the previously established minimum clinically important difference for ODI (12.8) and not requiring revision.
Results: A total of 68 patients were included. Compared with preoperative values for back pain, leg pain, and ODI (7.32, 7.53, and 51.22, respectively), there were significant improvements on follow-up at 12 months (2.89, 2.23, and 22.40, respectively; P < 0.001) and 24 months (2.80, 2.11, 20.32, respectively; P < 0.001). Based on the defined criteria, 50 patients showed clinically important improvement after ULBD. Of the 18 patients who failed to improve, 12 required revision. Independent predictors of failure to improve included female sex (adjusted odds ratio, 5.06; 95% confidence interval, 1.49-21.12; P = 0.014) and current smoker status (adjusted odds ratio, 5.39; 95% confidence interval, 1.39-23.97; P = 0.018).
Conclusions: ULBD for the management of lumbar spinal stenosis leads to clinically important improvement that is maintained over a 24-month follow-up period. Female sex and tobacco smoking are associated with poorer outcomes.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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